Relationship Between Cardiovascular Risk Factors and Atherosclerotic Disease Burden Measured by Intravascular Ultrasound

Size: px
Start display at page:

Download "Relationship Between Cardiovascular Risk Factors and Atherosclerotic Disease Burden Measured by Intravascular Ultrasound"

Transcription

1 Journal of the American College of Cardiology Vol. 47, No. 10, by the American College of Cardiology Foundation ISSN /06/$32.00 Published by Elsevier Inc. doi: /j.jacc Relationship Between Cardiovascular Risk Factors and Atherosclerotic Disease Burden Measured by Intravascular Ultrasound Atherosclerosis Stephen J. Nicholls, MBBS, PHD,* E. Murat Tuzcu, MD,* Tim Crowe, BS,* Ilke Sipahi, MD,* Paul Schoenhagen, MD,* Samir Kapadia, MD,* Stanley L. Hazen, MD, PHD,* Chuan-Chuan Wun, PHD, Michele Norton, PHD, Fady Ntanios, PHD, Steven E. Nissen, MD* Cleveland Ohio; and New York, New York OBJECTIVES The goal of this study was to determine the relationship between established cardiovascular risk factors and the extent of coronary atherosclerotic plaque. BACKGROUND Few data exist correlating cardiovascular risk factors with volumetric measurements of coronary atheroma burden in patients with coronary artery disease. METHODS Clinical characteristics, quantitative coronary angiography, and intravascular ultrasound (IVUS) were evaluated in subjects enrolled in a study comparing atorvastatin and pravastatin. Plaque areas were measured at 1-mm intervals to compute atheroma volume. The percent of cross sections with an abnormal intimal thickness ( 0.5 mm) was determined. Data on cardiovascular risk factors were collected. RESULTS In 654 subjects, atheroma volume averaged mm 3 and percent atheroma volume 38.9%. Atherosclerosis was present in 81.2% of 25,897 cross sections. In univariate analysis, there was a strong association between diabetes, male gender, and a history of either prior revascularization or stroke with percent atheroma volume. Hypertension or prior myocardial infarction was also predictive of more severe disease. Low-density lipoprotein and C-reactive protein were not significant predictors of greater disease burden. In multivariate analysis, diabetes, male gender, and a history of a prior interventional procedure remained strong predictors of increased atheroma volume. History of stroke, non-caucasian race, and smoking status remained significant. Although multiple measures of IVUS disease burden were worse in subjects with diabetes, angiographic stenosis severity was not different. CONCLUSIONS Male gender, diabetes, and a history of prior revascularization are strong independent predictors of atherosclerotic burden in coronary disease patients. Many risk factors did not predict angiographic disease severity, suggesting different mechanisms drive stenosis development and atheroma accumulation. (J Am Coll Cardiol 2006;47: ) 2006 by the American College of Cardiology Foundation Necropsy examinations typically demonstrate extensive atherosclerosis in patients who succumb to coronary artery disease (CAD) (1 3). Although the relationship between a number of cardiovascular risk factors and clinical event rates is well established, it remains unclear whether the presence of risk factors correlate with the extent of atherosclerosis. Several groups have employed quantitative coronary angiography (QCA), cross-sectional assessment of a single slice of coronary artery by intravascular ultrasound (IVUS), carotid intimal-medial thickness, myocardial perfusion abnormalities, and coronary calcification to address this question (4 8). Some of these groups have reported relationships From the *Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio; and Pfizer Pharmaceuticals, New York, New York. The REVERSAL study was funded by Pfizer. This work was supported in part by grants P01 HL and HL from the National Institutes of Health. Dr. Nicholls is supported by a Ralph Reader Overseas Research Fellowship from the National Heart Foundation of Australia. Dr. Sipahi has received an educational grant from Pfizer. Drs. Nissen, Tuzcu, and Hazen have each received research support from Pfizer. Drs. Nicholls, Nissen, Tuzcu, and Hazen have received speaking honoraria from Pfizer. Neil Weissman acted as guest editor for this paper. Manuscript received September 19, 2005; revised manuscript received December 7, 2005, accepted December 13, between individual risk factors or clinical risk scores and both the extent and annual progression rate of plaque. However, none of these techniques measure the actual volume of coronary atherosclerotic plaque. Intravascular ultrasound is a relatively new imaging technique that generates high-quality tomographic images of coronary atheromata (9). Using a motorized pullback apparatus, a series of cross-sectional plaque measurements can be obtained and summated to determine atheroma burden. Intravascular ultrasound has been applied to study the effects of lipid-lowering therapy on atherosclerosis progression in patients with CAD and hyperlipidemia (10). Quantitative coronary angiography and IVUS were performed, enabling systematic analysis of the relationship between a wide variety of risk factors and plaque burden. METHODS Study design. The Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) trial was a prospective, double-blind, multicenter, parallel-treatment study comparing the effects of atorvastatin 80 mg and pravastatin

2 1968 Nicholls et al. JACC Vol. 47, No. 10, 2006 Risk Factors and Plaque Burden May 16, 2006: Abbreviations and Acronyms BMI body mass index CAD coronary artery disease CRP C-reactive protein EEM external elastic membrane HDL high-density lipoprotein IVUS intravascular ultrasound LDL low-density lipoprotein PAV percent atheroma volume QCA quantitative coronary angiography TAV total atheroma volume 40 mg. Patients between the ages of 30 and 75 years, with a clinical indication for diagnostic coronary angiography were enrolled. Eligibility required evidence of CAD on screening angiography, defined as the presence of one or more stenoses in a native coronary artery with 20% luminal diameter narrowing by visual estimation. A target vessel containing a segment 30 mm in length with 50% reduction in lumen diameter was selected for IVUS examination. A target vessel was considered suitable only if the artery had never undergone revascularization. At baseline, a physical examination was performed, and lipid levels and high-sensitivity C-reactive protein (CRP) were measured in a core laboratory (Medical Research Laboratory, Highland Heights, Kentucky). Lipid entry criteria required a lowdensity lipoprotein (LDL) cholesterol between 125 and 210 mg/dl after a 4- to 10-week washout period. The presence of the metabolic syndrome was defined by an adaptation of the Adult Treatment Panel (ATPIII) of the National Cholesterol Education Program. Because measures of abdominal girth were not recorded, this component was replaced by a body mass index (BMI) 30 kg/m 2. Quantitative angiography. Coronary angiography of the target vessel was performed using standardized methods. Patients were pre-treated with 100 to 300 g of intracoronary nitroglycerin and selective contrast angiography performed using pre-defined acquisition angles. Measurements were performed using a computer-assisted system (11). Angiographic images were analyzed in a blinded core laboratory (Cleveland Clinic Foundation) where technicians identified the segment imaged during the IVUS procedure and subsequently measured vessel borders to calculate luminal diameters and percent stenosis. Measurements were only made in the segment that was assessed by IVUS. Comparison of the diameter of the contrast-filled angiographic catheter tip with its known dimensions was used to calibrate the system. The percent diameter stenosis and percent area stenosis are reported for the site with the smallest lumen diameter. IVUS acquisition. After diagnostic angiography, the operator performed a motorized IVUS pullback in a single major epicardial vessel as previously described (12). After anticoagulation with heparin, a guidewire was subselectively placed in the vessel, and a 30-MHz, 2.6-F (0.87- mm) IVUS catheter (Ultracross, Boston Scientific Scimed, Inc., Maple Grove, Minnesota) was advanced into the target vessel. The transducer was positioned distal to a side branch and a motorized pullback apparatus employed to progressively withdraw the IVUS transducer at a pullback speed of 0.5 mm/s. During pullback, IVUS images were obtained at 30 frames/s and recorded on Super-VHS videotape (Fig. 1). IVUS core laboratory analysis. Videotapes containing the IVUS pullbacks were analyzed in a core laboratory by personnel blinded to all patient characteristics (Cleveland Clinic Foundation). An operator digitized the videotape Figure 1. Method for selection of cross sections for analysis. Cross sections are obtained for slices selected at 1-mm intervals (top). Three of the 48 cross sections illustrated for this vessel are shown at the bottom (cross sections 10, 26, and 48).

3 JACC Vol. 47, No. 10, 2006 May 16, 2006: Nicholls et al. Risk Factors and Plaque Burden 1969 and selected the origin of a distal side-branch as a fiduciary point from which to begin analysis (Fig. 1). This frame was selected as the image immediately before the takeoff of the distal side branch. Subsequently, every 60th image in the pullback was selected for analysis, representing a series of cross sections spaced exactly 1 mm apart over a length of 30 to 90 mm. The final analyzed cross section is the last image in the sequence before appearance of the left main coronary artery or right coronary ostium (Fig. 1). Direct IVUS measurements. Intravascular ultrasound measurements were performed in accordance with the standards of the American College of Cardiology and European Society of Cardiology (13). A calibration procedure was performed by measuring 1-mm grid marks encoded in the IVUS image by the scanner. For each cross section selected for analysis, the operator performed manual planimetry to trace the leading edges of the luminal and external elastic membrane (EEM) borders (Fig. 2). The minimum and maximum diameters of the vessel and the minimum and maximum intimal thicknesses were directly measured. A cross section was defined as atherosclerotic if maximum intimal thickness exceeded 0.5 mm at any point in the vessel circumference (4 standard deviations greater than the upper limit of normal) (14). Derived IVUS measurements. Atheroma area was calculated as EEM area minus luminal area. The total atheroma volume (TAV) was calculated as the sum of atheroma areas for each 1-mm cross section (13). TAV n (EEM area Lumen area ) As the pullback length was determined by the distance between the proximal and distal side branches, there was considerable heterogeneity in the length of segment that was analyzed. To compensate for this difference between subjects, a normalized TAV was derived for each subject by multiplication of mean atheroma area (total volume for the subject divided by the number of images analyzed) for a subject by the median number of analyzable segments for all subjects (10). Normalized TAV (EEM area Lumen area ) number of slices in pullback median number of slices in study population The percent atheroma volume was computed as the ratio of sum of atheroma areas divided by the sum of EEM areas (15). (EEM area Lumen area ) PAV 100 (EEM area ) This represents the average percent of EEM area occupied by atheroma within the examined vessel. The IVUS percent area stenosis was determined for the site with the smallest lumen diameter as the ratio of atheroma area divided by EEM area. For each vessel, the percentage of cross sections meeting the predefined criteria for atherosclerosis (intimal thickness 0.5 mm) was determined, and this value is reported as percent abnormal cross sections (13). Statistical methods. Analyses were performed using SAS 6.12 software (SAS, Inc., Cary, North Carolina). Demographics and clinical characteristics are summarized for all randomized patients. Categorical variables are described using frequencies, while continuous variables are reported as median and interquartile ranges. Univariate predictors are reported using linear regression analysis of rank-transformed outcome. Multivariate analysis used multiple linear regression analysis of rank-transformed outcome. Two regression model selection approaches were used. The forward regres- Figure 2. Method for analysis of atheroma area. The left panel shows a representative intravascular ultrasound cross section. The right panel illustrates the boundaries planimetered for the external elastic membrane (EEM) and lumen. Atheroma area is calculated.

4 1970 Nicholls et al. JACC Vol. 47, No. 10, 2006 Risk Factors and Plaque Burden May 16, 2006: sion approach initially contained no variables (null model). Only variables with a p value 0.15 on univariate analysis were included. One variable was added at a time into the multivariate model from the most significant to the least significant. Only variables that resulted in a p value 0.5, when comparing the current model with the previous model, were included. In the backward elimination approach, the multivariate model commenced including all variables. One variable was removed at a time, proceeding from the least significant to the most significant. Only variables with p values 0.1 were retained in the model at each step. This process was continued until all remaining variables in the model had p values 0.1. RESULTS Patient demographics. A total of 654 patients were enrolled in the study. Patient characteristics are summarized in Tables 1 and 2 as previously reported (10). The cohort included a relatively young median age (56 years), a history of angina in 89.8%, history of hypertension in 67.1%, and a history of diabetes in 19.6%. The most significant physical examination finding was an increased BMI (median 29.8 kg/m 2 ). The metabolic syndrome, defined using the guidelines of the National Cholesterol Education Program, substituting BMI 30 kg/m 2 for waist circumference, was present in 41.0% of patients. Laboratory parameters included median LDL cholesterol of 147 mg/dl, median high-density lipoprotein (HDL) of 41 mg/dl, and a median CRP of 2.9 mg/dl. Angiographic and IVUS disease burden. Angiographic and IVUS measures of disease burden are summarized in Table 3. The angiogram typically contained a single lesion within the examined vessel, which averaged 39% in diameter stenosis and 62.8% in area stenosis at the most severely narrowed site. By IVUS, TAV averaged mm 3 over a median pullback length of 36 mm, and the percent of EEM area occupied by atheroma for the entire vessel averaged 38.9% (percent atheroma volume). For the entire cohort, Table 1. Patient Characteristics (n 654) Demographics Age 56 (49 63) Male gender 456 (69.7) Caucasian 580 (88.7) History Current smoker 182 (27.8) Past smoker 290 (44.3) Never smoked 182 (27.8) Diabetes 128 (19.6) Hypertension 439 (67.1) Angina 587 (89.8) Prior myocardial infarction 228 (34.9) Metabolic syndrome 268 (41.0) Stroke 22 (3.4) Coronary intervention before qualifying angiography 438 (67.0) Coronary intervention between qualifying 110 (16.8) angiography and randomization Values are n (interquartile range) or n (%). Table 2. Physical Examination and Laboratory Parameters (n 654) Height, cm ( ) Weight, kg 89.1 ( ) BMI, kg/m ( ) Systolic blood pressure, mm Hg ( ) Diastolic blood pressure, mm Hg 80.0 ( ) Total cholesterol, mg/dl ( ) LDL cholesterol, mg/dl ( ) HDL cholesterol, mg/dl 41.0 ( ) Triglycerides, mg/dl ( ) Apo B, mg/dl ( ) CRP*, mg/l 2.90 ( ) Hemoglobin A1C, % (n 148) 7.1 ( ) *Based on log-scale data. Geometric SD are presented correspondingly. Values in parentheses indicate interquartile range. Apo B apolipoprotein B; BMI body mass index; CRP C-reactive protein; HDL high-density lipoprotein; LDL low-density lipoprotein. 81.2% of all cross sections were atherosclerotic, using the pre-defined criteria of a maximum intimal thickness 0.5 mm. Univariate predictors of percent atheroma volume. Table 4 summarizes the univariate predictors of IVUS disease burden. For percent atheroma volume, there was a very strong association between presence of diabetes, male gender, and a history of prior revascularization or stroke and atherosclerotic burden. For percent atheroma volume, a history of a prior myocardial infarction or hypertension and non- Caucasian race were also predictors of more severe disease. Total cholesterol, LDL cholesterol, HDL cholesterol, CRP, and smoking were not predictors of disease severity. Univariate predictors of normalized TAV. Univariate predictors of normalized TAV are summarized in Table 4. There was a very strong association between male gender, non-caucasian race, and a history of prior revascularization and atherosclerotic burden. A history of diabetes or hypertension, systolic and diastolic blood pressure, HDL cholesterol, and age were also predictors of more severe disease. Total cholesterol, LDL cholesterol, CRP, and smoking were not predictors of disease severity. Table 3. Angiographic (QCA) and IVUS Measures of Disease Burden (n 654) Median QCA values (most severe stenosis in target vessel) Percent diameter stenosis, % 39.0 ( ) Percent area stenosis, % 62.8 ( ) Minimum luminal diameter, mm 1.96 ( ) Median IVUS values (most severe stenosis in target vessel) Percent area stenosis, % 56.4 ( ) Minimum luminal diameter, mm 2.26 ( ) Median IVUS values (for entire pullback within target vessel) Normalized total atheroma volume ( ) (median segment length 36 mm), mm 3 Total atheroma volume, mm ( ) Percent atheroma volume, % 38.9 ( ) Mean percent of cross sections abnormal, % 81.2 ( ) Values in parentheses indicate interquartile range. IVUS intravascular ultrasound; QCA quantitative coronary angiography.

5 JACC Vol. 47, No. 10, 2006 May 16, 2006: Nicholls et al. Risk Factors and Plaque Burden 1971 Table 4. Univariate Predictors of IVUS Disease Burden (n 654) Percent Atheroma Volume Total Atheroma Volume Percent Abnormal Cross Sections Parameters Coeff. (95% CI) p Value* Coeff. (95% CI) p Value* Coeff. (95% CI) p Value* Age 1.2 ( 0.2 to 2.5) (0.1 to 2.7) ( 0.6 to 2.0) 0.30 Male gender (n 456) 59.6 (31.7 to 87.5) (63 to 117.6) (38.7 to 92.8) Non-white race (n 74) 40.5 (0.9 to 80.2) (12.9 to 92.1) ( 16.9 to 60.6) 0.27 BMI 1.7 ( 3.8 to 0.4) ( 0.4 to 3.8) ( 2.2 to 1.9) 0.91 Current smoker (n 182) 19.4 ( 9.5 to 48.3) ( 37.2 to 20.9) ( 12.8 to 43.7) 0.29 Systolic BP 0.4 ( 0.3 to 1.1) (0.1 to 1.5) ( 0.3 to 1.1) 0.24 Diastolic BP 0.4 ( 0.8 to 1.7) (0.4 to 2.8) ( 0.5 to 1.9) 0.25 Total cholesterol 0.3 ( 0.7 to 0.1) ( 0.7 to 0.1) ( 0.5 to 0.3) 0.64 LDL cholesterol 0.1 ( 0.6 to 0.3) ( 0.7 to 0.3) ( 0.5 to 0.4) 0.94 HDL cholesterol 1 ( 2.3 to 0.1) ( 3.1 to 0.7) ( 2.5 to 0.2) 0.03 Triglycerides 0.1 ( 0.2 to 0.1) ( 0.1 to 0.2) ( 0.1 to 0.2) 0.73 Apo B 0.3 ( 0.8 to 0.3) ( 0.7 to 0.4) ( 0.5 to 0.6) 0.79 CRP 2.2 ( 13.9 to 9.6) ( 16 to 7.6) ( 14.3 to 8.6) 0.63 Diabetes (n 128) 60.3 (28.2 to 92.3) (4.8 to 69.6) (3.2 to 66.2) 0.03 Hypertension (n 439) 28.8 (1.5 to 56.1) (3.2 to 57.8) ( 7.7 to 45.6) 0.16 Prior MI (n 228) 28.2 (1.8 to 54.6) ( 20.7 to 32.4) ( 19.9 to 31.8) 0.65 Angina (n 587) 11.6 ( 29.9 to 53) ( 67.6 to 15.2) ( 51.4 to 29.3) 0.59 Prior procedure (n 447) 88.3 (61.4 to 115.1) (14.5 to 70.1) (12.4 to 66.5) Prior revascularization (n 438) 87.2 (60.5 to 113.8) (14.8 to 69.8) (11.2 to 64.8) Stroke (n 22) (42.1 to 201) ( 37.2 to 123.2) (13.5 to 168.9) 0.02 Metabolic syndrome (n 268) 1.8 ( 24.2 to 27.7) ( 4.8 to 47) ( 17.1 to 33.4) 0.53 * coefficient ( Coeff.), 95% confidence interval (CI) of Coeff., and p value are based on univariate least-square regression analysis using rank-transformed IVUS parameters as the dependent variable. Apo B apolipoprotein B; BMI body mass index; BP blood pressure; CRP C-reactive protein; HDL high-density lipoprotein; IVUS intravascular ultrasound; LDL low-density lipoprotein; MI myocardial infarction. Univariate predictors of percent abnormal cross sections. Univariate predictors of disease burden were similar, but not identical, to the parameters that were significant for percent atheroma volume (Table 4). Male gender, diabetes, HDL levels, and a history of revascularization or stroke were strong predictors. Total cholesterol, LDL cholesterol, CRP, hypertension, and smoking were not predictors of disease severity. Univariate predictors of angiographic stenosis severity. Results of QCA studies are summarized in Table 5. In general, there were relatively few parameters predictive of angiographic disease severity, and the associations were not as strong as observed for IVUS data. A history of prior revascularization and a history of stroke were moderately predictive of more severe stenoses. Non-Caucasian race was marginally significant, and a history of prior myocardial infarction just failed to meet statistical significance. Multivariate predictors of IVUS disease burden. These findings are summarized in Table 6. Diabetes, male gender, and a history of any prior procedure remained as strong predictors of increased percent atheroma volume. Prior stroke and non-caucasian race were weak independent predictors of more severe disease after multivariate analyses. Current smoking was also a weak independent predictor of more severe disease, despite not being a univariate predictor. For normalized TAV, age, male gender, non-caucasian race, BMI, and a history of diabetes or prior procedures remained as predictors. For percent abnormal cross sections, only diabetes and male gender remained as predictors and having a prior procedure was borderline significant. Multivariate predictors of angiographic stenosis severity. These findings are summarized in Table 7. The strongest predictor was a history of prior procedure. Non-Caucasian race remained significant in the multivariate analysis, but Table 5. Univariate Predictors of Angiographic Percent Area Stenosis (n 654) Parameters Coeff. (95% CI) p Value* Age 1.1 ( 0.3 to 2.5) 0.14 Male gender (n 456) 20.5 ( 9.5 to 50.4) 0.18 Non-white race (n 74) 43.9 (2 to 85.8) 0.04 BMI 1.5 ( 3.7 to 0.7) 0.19 Current smoker (n 182) 13.1 ( 17.6 to 43.7) 0.40 Systolic BP 0.1 ( 0.9 to 0.6) 0.73 Diastolic BP 0.2 ( 1.5 to 1.1) 0.77 Total cholesterol 0.1 ( 0.3 to 0.5) 0.61 LDL cholesterol 0.2 ( 0.3 to 0.7) 0.52 HDL cholesterol 0.8 ( 2.1 to 0.4) 0.20 Triglycerides 0.1 ( 0.1 to 0.2) 0.40 Apo B 0.2 ( 0.3 to 0.8) 0.43 CRP 0.1 ( 12.6 to 12.3) 0.98 Diabetes (n 128) 27.2 ( 7.1 to 61.4) 0.12 Hypertension (n 439) 9.1 ( 19.8 to 38.1) 0.54 Prior MI (n 228) 27.3 ( 0.6 to 55.3) Angina (n 587) 29.5 ( 73.2 to 14.2) 0.19 Prior procedure (n 447) 35.6 (6.2 to 65) 0.02 Prior revascularization (n 438) 38.5 (9.4 to 67.6) 0.01 Stroke (n 22) 65 ( 19.5 to 149.4) 0.13 Metabolic syndrome (n 268) 7.4 ( 34.8 to 20) 0.60 * coefficient ( Coeff.), 95% confidence interval (CI) of Coeff., and p value are based on univariate least-square regression analysis using rank-transformed angiographic parameter as the dependent variable. Abbreviations as in Table 1.

6 1972 Nicholls et al. JACC Vol. 47, No. 10, 2006 Risk Factors and Plaque Burden May 16, 2006: Table 6. Multivariate Predictors of IVUS Disease Burden (n 654) Selection Backward* Selection Stepwise Parameters Coeff. (95% CI) p Value Coeff. (95% CI) p Value Multivariate Predictors of IVUS Percent Plaque Volume Age 1.2 ( 0.1 to 2.5) ( 0.1 to 2.5) 0.07 Male gender 63.6 (36.7 to 90.5) (36.7 to 90.5) Non-white race 43.0 (5.8 to 80.2) (5.8 to 80.2) 0.02 Current smoker 29.3 (1.7 to 56.9) (1.7 to 56.9) 0.04 Diabetes 56.1 (25.3 to 86.9) (25.3 to 86.9) Prior procedure 73.1 (46.9 to 99.3) (46.9 to 99.3) Stroke 89.1 (14.7 to 163.4) (14.7 to 163.4) 0.02 Multivariate Predictors of IVUS Normalized Total Atheroma Volume Age 1.8 (0.5 to 3.1) (0.5 to 3.0) Male gender (79.2 to 133.8) (76.9 to 131.7) Non-white race 65.2 (27.9 to 102.5) (24.9 to 99.7) BMI 3.1 (1.0 to 5.1) (0.9 to 5.0) Diabetes 34.1 (2.8 to 65.4) (2.8 to 65.2) 0.03 Prior procedure 26.6 (0.3 to 52.9) (0.4 to 53.0) 0.04 Diastolic BP 0.9 ( 0.3 to 2.1) 0.12 Multivariate Predictors of IVUS Percent Abnormal Cross Sections Male gender 66.7 (39.5 to 93.9) (42.0 to 96.6) Diabetes 40.6 (9.5 to 71.7) (7.1 to 69.5) 0.02 Prior procedure 27.3 (0.7 to 53.9) (0.6 to 53.8) Stroke 65.5 ( 10 to 141) ( 10.7 to 140) 0.10 Non-white race 29.6 ( 8.2 to 67.4) 0.13 *Variables selected by the backward approach are based on a significance level 0.10; variables selected by the stepwise approach are based on a significance level Abbreviations as in Table 4. the association was moderate. Prior history of angina just failed to meet statistical significance. Diabetes and metabolic syndrome. Tables 8 and 9 summarize the relationships between key measures of disease burden and the presence or absence of diabetes or the metabolic syndrome. All IVUS measures of disease burden were more severe in patients with diabetes, including both measures of atheroma burden and stenosis severity. However, measures of minimum luminal diameter or percent narrowing by angiography were no different in patients with or without diabetes. In comparison with the cohort with diabetes, the relationship between the metabolic syndrome and IVUS disease burden was weaker, with no measure showing a significant relationship. Neither the presence of diabetes nor the metabolic syndrome showed a statistically significant relationship to angiographic measures of disease burden. DISCUSSION Epidemiologic data suggest a complex relationship between cardiovascular risk factors and clinical events in coronary disease patients (16). However, the relationship between cardiovascular risk factors and atherosclerotic disease burden is more difficult to evaluate. Data from necropsy studies only describe the extent of disease in patients who succumb to their disease or suffer from fatal trauma (1 3). Investigators have correlated risk factors with indirect measures of atherosclerotic burden, including carotid intimal-medial thickness, coronary calcification, or measures of stenosis severity, such as angiography (6 8). These approaches have impor- Table 7. Multivariate Predictors of QCA Disease Burden (n 654) Selection Backward* Selection Stepwise Parameters Coeff. (95% CI) p Value Coeff. (95% CI) p Value Multivariate Predictors of QCA Percent Area Stenosis Non-white race 45.2 (3.7 to 86.7) (2.9 to 85.9) 0.04 Angina 42.4 ( 86.2 to 1.4) ( 86.4 to 1.1) 0.06 Prior revascularization 43.0 (13.7 to 72.3) (13.4 to 71.9) Stroke 65.8 ( 21.0 to 152.3) 0.14 *Variables selected by the backward approach are based on a significance level 0.10; variables selected by the stepwise approach are based on a significance level Abbreviations as in Table 4.

7 JACC Vol. 47, No. 10, 2006 May 16, 2006: Nicholls et al. Risk Factors and Plaque Burden 1973 Table 8. Disease Burden in Patients With Diabetes Versus Patients Without Diabetes Diabetes (n 128) Diabetes vs. No Diabetes (IVUS) No Diabetes (n 526) p Value* Percent atheroma volume 42.3 ( ) 38.3 ( ) Percent abnormal cross sections 96.8 ( ) 91.3 ( ) 0.03 Normalized total atheroma volume ( ) ( ) 0.02 (mm 3, median segment length 36 mm) Percent area stenosis 60.8 ( ) 55.1 ( ) 0.01 Diabetes vs. No Diabetes (QCA) Minimum luminal diameter (mm) 1.90 ( ) 1.98 ( ) 0.07 Percent area stenosis 65.9 ( ) 61.9 ( ) 0.12 *p value is based on univariate least-square regression analysis using rank-transformed IVUS or QCA parameters as the dependent variables. Results expressed as median (interquartile range). Abbreviations as in Table 4. tant limitations. The risk factors associated with carotid atherosclerosis are different from those linked to coronary disease (17). Coronary calcification occurs late in atherogenesis, and angiography describes only luminal narrowing, not the true extent of atherosclerosis (18). Intravascular ultrasound provides a high-resolution technique for quantitative assessment of vessel wall anatomy in living patients. Intravascular ultrasound provides a unique opportunity to study the interaction of risk factors with plaque burden. This study is the first large-scale IVUS trial measuring coronary atherosclerosis in hyperlipidemic patients. Diabetes, male gender, and a history of prior revascularization were particularly strong predictors of atheroma burden. Non-Caucasian race and a history of stroke also remained significant in multivariate analysis. In contrast, several risk factors, including hypertension, hyperlipidemia, and CRP, were less important than expected. The absence of a strong association between cholesterol levels and IVUS measures of disease burden requires additional comment. Although HDL levels were predictive in univariate analysis, in terms of their association with TAV and the percentage of abnormal sections, none of the traditionally measured lipid values were independently predictive of disease burden. The apparent lack of association between lipids and atheroma burden is consistent with other available data. The high degree of overlap between cholesterol levels in patients with and without CAD is well established (19). These findings suggest that the interaction between lipid levels and other risk factors, such as inflammation or genetic susceptibility, determines whether abnormalities of lipid metabolism are expressed as atherosclerotic disease. This is in contrast to previous reports of a strong correlation between LDL levels and serial accumulation of atheroma (4). However, that study involved IVUS assessment of only one slice of the left main coronary artery in a small cohort of subjects. Given the multitude of etiologic factors that promote atherogenesis, it is not all that surprising that the degree of correlation between LDL levels and plaque burden is not particularly high. The current findings do not exclude the hypothesis that lipid levels play a role in determining atheroma vulnerability, but suggest that these effects may be independent of their impact on atheroma volume. It was also intriguing that CRP, an emerging biomarker that predicts cardiovascular risk, was not associated with baseline measures of atherosclerotic burden. Reductions in CRP, in response to statin therapy, were recently demonstrated to correlate with both a reduction in clinical events Table 9. Disease Burden in the Metabolic Syndrome Metabolic Syndrome (n 268) No Metabolic Syndrome (n 386) p Value* Metabolic Syndrome vs. No Metabolic Syndrome (IVUS) Percent atheroma volume 38.2 ( ) 39.7 ( ) 0.89 Percent abnormal cross sections 93.0 ( ) 92.1 ( ) 0.53 Normalized total atheroma volume ( ) ( ) 0.11 (mm 3, median segment length 36 mm) Percent area stenosis 55.1 ( ) 57.3 ( ) 0.18 Metabolic Syndrome vs. No Metabolic Syndrome (QCA) Minimum luminal diameter (mm) 2.00 ( ) 1.96 ( ) 0.55 Percent area stenosis 62.3 ( ) 63.1 ( ) 0.60 *p value is based on univariate least-square regression analysis using rank-transformed IVUS or QCA parameters as the dependent variables. Results expressed as median (interquartile range). Abbreviations as in Table 4.

8 1974 Nicholls et al. JACC Vol. 47, No. 10, 2006 Risk Factors and Plaque Burden May 16, 2006: and inhibition of plaque progression (20,21). This finding suggests that CRP may not be mechanistically linked to atheroma development, although reductions in its levels are beneficial. Combining the current and recently reported data suggests that the degree of reduction of both LDL and CRP with statin therapy has a greater influence on change in plaque burden, rather than their absolute levels at baseline. While evidence continues to emerge implicating a pivotal role for inflammatory events in CAD, it would appear that this association is related predominantly to promoting plaque vulnerability. The findings in patients with diabetes and the metabolic syndrome are particularly noteworthy. Every IVUS measure of atherosclerotic burden showed more disease in patients with diabetes. While increased cardiovascular event rates in patients with diabetes has been described, the underlying pathophysiology remains incompletely defined. Many abnormalities in vascular and hematologic function have been described in diabetes resulting in endothelial dysfunction, defective thrombolysis, and enhanced platelet activity (22). The current study directly supports the conclusion that the diabetic state promotes atherosclerotic plaque development and suggests that enhanced atheroma burden may explain a significant proportion of the increased event rates noted in morbidity and mortality trials. Interestingly, there was a non-significant trend for an association between the metabolic syndrome and a greater TAV, but not percent volume, suggesting that the increases in atheroma volume were somewhat accommodated by adaptive coronary remodeling (23). The relationship between cardiovascular risk factors and angiographic measures of disease burden is also intriguing. Only history of prior revascularization was a strong independent predictor of angiographic stenosis severity. Non- Caucasian race remained a less strong predictor in the multivariate analysis. In contrast with the IVUS findings, there was, remarkably, no relationship between diabetes or metabolic syndrome and angiographic stenosis severity. The limited correlation between risk factors and angiographic disease severity as monitored by QCA suggests two possible explanations. Focal angiographic stenoses may be produced by a different pattern of risk factors than global atheroma burden. Alternatively, the dissociation between IVUS and angiographic measures of disease burden more likely reflects the marked discrepancy in what each imaging modality measures (i.e., the size of the doughnut vs. the size of the doughnut hole). For vessels with diffuse narrowing, the normal reference segment may also contain substantial atheroma burden, and, consequently, percent stenosis by angiography will systematically underestimate disease burden (18). A number of potential limitations of this analysis should be noted. While all subjects had angiographic disease, the observations cannot be extrapolated to distinguish the ability of risk factors to predict the presence or absence of CAD. The presence of a lipid range for inclusion in the study introduces a potential bias in the assessment of a relationship between lipid levels and plaque burden. It is uncertain whether a relationship does in fact exist at levels of LDL cholesterol that fall outside of this range. Assessment of plaque burden was made by performing a volumetric measurement of plaque through a segment of coronary artery. While atherosclerosis is a diffuse process, it is possible that within a particular subject the extent of atheroma within the studied segment does not reflect the disease contained in the remainder of that artery or coronary arterial tree in general. The cohort is relatively young, and it is uncertain whether similar relationships between risk factors and plaque burden are seen in an older population. Finally, it should be noted that, due to the absence of abdominal girth measurements, an amended definition was used for metabolic syndrome that may have influenced its incidence and, therefore, its potential relationship with plaque burden. In conclusion, the present data demonstrate greater atheroma burden in patients with diabetes, men, and patients with a history of prior revascularization. In comparison with IVUS, there was a more limited relationship between risk factors and angiographic measures of disease severity. These findings further highlight the complex relationship promoting the translation of traditional and emerging risk factors and the incidence of cardiovascular disease. Reprint requests and correspondence: Dr. Steven E. Nissen, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio nissens@ccf.org. REFERENCES 1. Roberts WC. Diffuse extent of coronary atherosclerosis in fatal coronary artery disease. Am J Cardiol 1990;65:2F 6F. 2. Vlodaver Z, French R, van Tassel RA, Edwards JE. Correlation of the antemortem coronary angiogram and the postmortem specimen. Circulation 1973;47: Arnett EN, Isner JM, Redwood DR, et al. Coronary artery narrowing in coronary heart disease: comparison of cineangiographic and necropsy findings. Ann Intern Med 1979;91: Von Birgelen C, Hartmann M, Mintz GS, Baumgart D, Schmermund A, Erbel R. Relationship between progression and regression of atherosclerotic left main coronary artery disease and serum cholesterol levels as assessed with serial long-term ( or 12 months) follow-up intravascular ultrasound. Circulation 2003;108: Von Birgelen C, Hartmann M, Mintz GS, et al. Relationship between cardiovascular risk as predicted by established risk scores versus plaque progression as measured by serial intravascular ultrasound in left main coronary arteries. Circulation 2004;110: Davis PH, Dawson JD, Riley WA, Lauer RM. Carotid intimal-medial thickness is related to cardiovascular risk factors measured from childhood through middle age: the Muscatine study. Circulation 2001; 104: Newman AB, Naydeck BL, Sutton-Tyrrell K, et al. Relationship between coronary artery calcification and other measures of subclinical cardiovascular disease in older adults. Arterioscler Thromb Vasc Biol 2002;22: Yokoyama I, Ohtake T, Momamura S-I, Nishikawa J, Sasaki Y, Omata M. Reduced coronary flow reserve in hypercholesterolemic patients without overt coronary stenosis. Circulation 1996;94: Nissen SE, Yock P. Intravascular ultrasound: novel diagnostic insights and current clinical applications. Circulation 2001;103:

9 JACC Vol. 47, No. 10, 2006 May 16, 2006: Nicholls et al. Risk Factors and Plaque Burden Nissen SE, Tuzcu EM, Schoenhagen P, et al., REVERSAL Investigators. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA 2004;291: Lincoff M, Califf RM, Moliterno DJ, et al., for the Evaluation of Platelet IIb/IIIa Inhibition in Stenting Investigators. Complimentary clinical benefits of coronary-artery stenting and blockade of platelet glycoprotein IIb/IIIa receptors. N Engl J Med 1999;341: Nissen SE. Application of intravascular ultrasound to characterize coronary artery disease and assess the progression or regression of atherosclerosis. Am J Cardiol 2002;89:24B 31B. 13. Mintz G, Nissen SE, Anderson WD, et al. Standards for the acquisition measurement and reporting of intravascular ultrasound studies. J Am Coll Cardiol 2001;37: Tuzcu EM, Kapadia SR, Tutar E, et al. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation 2001;103: Nissen SE, Tuzcu EM, Libby P, et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary artery disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. JAMA 2004;292: Abbott RD, Wilson PW, Kannel WB, Castelli WP. High density lipoprotein cholesterol, total cholesterol screening, and myocardial infarction. The Framingham study. Arteriosclerosis 1988;8: Kannel WB. Risk factors for atherosclerotic cardiovascular outcomes in different arterial territories. J Cardiovasc Risk 1994;11: Topol EJ, Nissen SE. Our preoccupation with coronary luminology. The dissociation between clinical and angiographic findings in ischemic heart disease. Circulation 1995;92: Kannel WB. Range of serum cholesterol values in the population developing coronary artery disease. Am J Cardiol 1995;76:69C 77C. 20. Ridker PM, Cannon CP, Morrow D, et al. Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22 (PROVE IT-TIMI 22) Investigators. C-reactive protein levels and outcomes after statin therapy. N Engl J Med 2005;352: Nissen SE, Tuzcu EM, Schoenhagen P, et al., Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) Investigators. Statin therapy, LDL cholesterol, C-reactive protein, and coronary artery disease. N Engl J Med 2005;352: Sobel BE. Effects of glycemic control and other determinants of vascular disease in type 2 diabetes. Am J Med 2002;113 Suppl 6A: 12S 22S. 23. Schoenhagen P, Ziada K, Vince G, Nissen SE, Tuzcu EM. Arterial remodeling and coronary artery disease: the concept of dilated versus obstructive coronary atherosclerosis. J Am Coll Cardiol 2001;38:

Spotty Calcification as a Marker of Accelerated Progression of Coronary Atherosclerosis : Insights from Serial Intravascular Ultrasound

Spotty Calcification as a Marker of Accelerated Progression of Coronary Atherosclerosis : Insights from Serial Intravascular Ultrasound Spotty Calcification as a Marker of Accelerated Progression of Coronary Atherosclerosis : Insights from Serial Intravascular Ultrasound Department of Cardiovascular Medicine Heart and Vascular Institute

More information

Effects of Obesity on Lipid-Lowering, Anti-Inflammatory, and Antiatherosclerotic Benefits of Atorvastatin

Effects of Obesity on Lipid-Lowering, Anti-Inflammatory, and Antiatherosclerotic Benefits of Atorvastatin Effects of Obesity on Lipid-Lowering, Anti-Inflammatory, and Antiatherosclerotic Benefits of Atorvastatin or Pravastatin in Patients With Coronary Artery Disease (from the REVERSAL Study) Stephen J. Nicholls,

More information

Relationship Between Atheroma Regression and Change in Lumen Size After Infusion of Apolipoprotein A-I Milano

Relationship Between Atheroma Regression and Change in Lumen Size After Infusion of Apolipoprotein A-I Milano Journal of the American College of Cardiology Vol. 47, No. 5, 2006 2006 by the American College of Cardiology Foundation ISSN 0735-1097/06/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2005.11.040

More information

Title for Paragraph Format Slide

Title for Paragraph Format Slide Title for Paragraph Format Slide Presentation Title: Month Date, Year Atherosclerosis A Spectrum of Disease: February 12, 2015 Richard Cameron Padgett, MD Executive Medical Director, OHVI Pt RB Age 38

More information

Methods. Background and Objectives STRADIVARIUS

Methods. Background and Objectives STRADIVARIUS STRADIVARIUS Effect of on Progression of Atherosclerosis in Patients with Abdominal Obesity and Coronary Artery Disease Steven E. Nissen MD Stephen J. Nicholls MBBS PhD, Kathy Wolski MPH, Josep Rodés-Cabau

More information

Arterial Wall Remodeling in Response to Atheroma Regression with Very Intensive Lipid Lowering

Arterial Wall Remodeling in Response to Atheroma Regression with Very Intensive Lipid Lowering Arterial Wall Remodeling in Response to Atheroma Regression with Very Intensive Lipid Lowering Matthew I. Worthley MB BS, PhD, FRACP, FCSANZ, FACC Senior Lecturer/ Interventional Cardiologist University

More information

Coronary Artery Calcification and Changes in Atheroma Burden in Response to Established Medical Therapies

Coronary Artery Calcification and Changes in Atheroma Burden in Response to Established Medical Therapies Journal of the American College of Cardiology Vol. 49, No. 2, 2007 2007 by the American College of Cardiology Foundation ISSN 0735-1097/07/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2006.10.038

More information

Data Alert. Vascular Biology Working Group. Blunting the atherosclerotic process in patients with coronary artery disease.

Data Alert. Vascular Biology Working Group. Blunting the atherosclerotic process in patients with coronary artery disease. 1994--4 Vascular Biology Working Group www.vbwg.org c/o Medical Education Consultants, LLC 25 Sylvan Road South, Westport, CT 688 Chairman: Carl J. Pepine, MD Eminent Scholar American Heart Association

More information

Effect of Rimonabant on Progression of Atherosclerosis in Patients With Abdominal Obesity and Coronary Artery Disease

Effect of Rimonabant on Progression of Atherosclerosis in Patients With Abdominal Obesity and Coronary Artery Disease ORIGINAL CONTRIBUTION JAMA-EXPRESS Effect of on Progression of Atherosclerosis in Patients With Abdominal Obesity and Coronary Artery Disease The STRADIVARIUS Randomized Controlled Trial Steven E. Nissen,

More information

Imaging Biomarkers: utilisation for the purposes of registration. EMEA-EFPIA Workshop on Biomarkers 15 December 2006

Imaging Biomarkers: utilisation for the purposes of registration. EMEA-EFPIA Workshop on Biomarkers 15 December 2006 Imaging Biomarkers: utilisation for the purposes of registration EMEA-EFPIA Workshop on Biomarkers 15 December 2006 Vascular Imaging Technologies Carotid Ultrasound-IMT IVUS-PAV QCA-% stenosis 2 ICH E

More information

Best Lipid Treatments

Best Lipid Treatments Best Lipid Treatments Pam R. Taub MD, FACC Director of Step Family Cardiac Rehabilitation and Wellness Center Associate Professor of Medicine UC San Diego Health System Overview of Talk Review of pathogenesis

More information

Intravascular Ultrasound

Intravascular Ultrasound May 2008 Beth Israel Deaconess Medical Center Harvard Medical School Intravascular Ultrasound Matthew Altman, HMS III Gillian Lieberman, MD BIDMC Department of Radiology Presentation Overview 1. Patient

More information

Methods Study population: From the Asan Medical Center (Seoul, Korea) clinical and IVUS core laboratory database,

Methods Study population: From the Asan Medical Center (Seoul, Korea) clinical and IVUS core laboratory database, Usefulness of Follow-Up Low-Density Lipoprotein Cholesterol Level as an Independent Predictor of Changes of Coronary Atherosclerotic Plaque Size as Determined by Intravascular Ultrasound Analysis After

More information

Culprit Lesion Remodeling and Long-term (> 5years) Prognosis in Patients with Acute Coronary Syndrome

Culprit Lesion Remodeling and Long-term (> 5years) Prognosis in Patients with Acute Coronary Syndrome Culprit Lesion Remodeling and Long-term (> 5years) Prognosis in Patients with Acute Coronary Syndrome Hiroyuki Okura*, MD; Nobuya Matsushita**,MD Kenji Shimeno**, MD; Hiroyuki Yamaghishi**, MD Iku Toda**,

More information

Atherosclerosis Regression An Overview of Recent Findings & Issues

Atherosclerosis Regression An Overview of Recent Findings & Issues Atherosclerosis Regression An Overview of Recent Findings & Issues 13th Angioplasty Summit 2008 Cheol Whan Lee, MD University of Ulsan, Asan Medical Center, Seoul, Korea CardioVascular Research Foundation

More information

Clinical Trial Synopsis TL-OPI-516, NCT#

Clinical Trial Synopsis TL-OPI-516, NCT# Clinical Trial Synopsis, NCT#00225277 Title of Study: A Double-Blind, Randomized, Comparator-Controlled Study in Subjects With Type 2 Diabetes Mellitus Comparing the Effects of Pioglitazone HCl Versus

More information

Subclinical atherosclerosis in CVD: Risk stratification & management Raul Santos, MD

Subclinical atherosclerosis in CVD: Risk stratification & management Raul Santos, MD Subclinical atherosclerosis in CVD: Risk stratification & management Raul Santos, MD Sao Paulo Medical School Sao Paolo, Brazil Subclinical atherosclerosis in CVD risk: Stratification & management Prof.

More information

The Framingham Coronary Heart Disease Risk Score

The Framingham Coronary Heart Disease Risk Score Plasma Concentration of C-Reactive Protein and the Calculated Framingham Coronary Heart Disease Risk Score Michelle A. Albert, MD, MPH; Robert J. Glynn, PhD; Paul M Ridker, MD, MPH Background Although

More information

Cottrell Memorial Lecture. Has Reversing Atherosclerosis Become the New Gold Standard in the Treatment of Cardiovascular Disease?

Cottrell Memorial Lecture. Has Reversing Atherosclerosis Become the New Gold Standard in the Treatment of Cardiovascular Disease? Cottrell Memorial Lecture Has Reversing Atherosclerosis Become the New Gold Standard in the Treatment of Cardiovascular Disease? Stephen Nicholls MBBS PhD @SAHMRI_Heart Disclosures Research support: AstraZeneca,

More information

The Site of Plaque Rupture in Native Coronary Arteries

The Site of Plaque Rupture in Native Coronary Arteries Journal of the American College of Cardiology Vol. 46, No. 2, 2005 2005 by the American College of Cardiology Foundation ISSN 0735-1097/05/$30.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2005.03.067

More information

Results of the GLAGOV Trial

Results of the GLAGOV Trial Results of the GLAGOV Trial Global Assessment of Plaque Regression with a PCSK9 Antibody as Measured by Intravascular Ultrasound Steven E. Nissen MD Stephen J. Nicholls MBBS PhD Consulting: Many companies

More information

Progression of coronary atherosclerosis may lead to angina

Progression of coronary atherosclerosis may lead to angina Regression of Coronary Atherosclerosis by Simvastatin A Serial Intravascular Ultrasound Study Lisette Okkels Jensen, MD, PhD; Per Thayssen, MD, DMSci; Knud Erik Pedersen, MD, DMSci; Steen Stender, MD,

More information

The PROSPECT Trial. A Natural History Study of Atherosclerosis Using Multimodality Intracoronary Imaging to Prospectively Identify Vulnerable Plaque

The PROSPECT Trial. A Natural History Study of Atherosclerosis Using Multimodality Intracoronary Imaging to Prospectively Identify Vulnerable Plaque The PROSPECT Trial Providing Regional Observations to Study Predictors of Events in the Coronary Tree A Natural History Study of Atherosclerosis Using Multimodality Intracoronary Imaging to Prospectively

More information

JUPITER NEJM Poll. Panel Discussion: Literature that Should Have an Impact on our Practice: The JUPITER Study

JUPITER NEJM Poll. Panel Discussion: Literature that Should Have an Impact on our Practice: The JUPITER Study Panel Discussion: Literature that Should Have an Impact on our Practice: The Study Kaiser COAST 11 th Annual Conference Maui, August 2009 Robert Blumberg, MD, FACC Ralph Brindis, MD, MPH, FACC Primary

More information

Val-MARC: Valsartan-Managing Blood Pressure Aggressively and Evaluating Reductions in hs-crp

Val-MARC: Valsartan-Managing Blood Pressure Aggressively and Evaluating Reductions in hs-crp Página 1 de 5 Return to Medscape coverage of: American Society of Hypertension 21st Annual Scientific Meeting and Exposition Val-MARC: Valsartan-Managing Blood Pressure Aggressively and Evaluating Reductions

More information

Prevalence of Coronary Atherosclerosis in Asymptomatic Healthy Subjects: An Intravascular Ultrasound Study of Donor Hearts

Prevalence of Coronary Atherosclerosis in Asymptomatic Healthy Subjects: An Intravascular Ultrasound Study of Donor Hearts Original Article Journal of Atherosclerosis and Thrombosis Vol. 20, No. 5 465 Prevalence of Coronary Atherosclerosis in Asymptomatic Healthy Subjects: An Intravascular Ultrasound Study of Donor Hearts

More information

Intravascular Ultrasound-Derived Measures of Coronary Atherosclerotic Plaque Burden and Clinical Outcome

Intravascular Ultrasound-Derived Measures of Coronary Atherosclerotic Plaque Burden and Clinical Outcome Journal of the American College of Cardiology Vol. 55, No. 21, 2010 2010 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2010.02.026

More information

대한심장학회춘계학술대회 Satellite Symposium

대한심장학회춘계학술대회 Satellite Symposium 대한심장학회춘계학술대회 Satellite Symposium Coronary Plaque Regression and Compositional Changes by Lipid-Lowering Therapy: IVUS Substudy in Livalo (Pitavastatin) in Acute Myocardial Infarction Study (LAMIS) Livalo

More information

PCSK9 Inhibitors and Modulators

PCSK9 Inhibitors and Modulators PCSK9 Inhibitors and Modulators Pam R. Taub MD, FACC Director of Step Family Cardiac Rehabilitation and Wellness Center Associate Professor of Medicine UC San Diego Health System Disclosures Speaker s

More information

Update on Dyslipidemia and Recent Data on Treating the Statin Intolerant Patient

Update on Dyslipidemia and Recent Data on Treating the Statin Intolerant Patient Update on Dyslipidemia and Recent Data on Treating the Statin Intolerant Patient Steven E. Nissen MD Chairman, Department of Cardiovascular Medicine Cleveland Clinic Disclosure Consulting: Many pharmaceutical

More information

ZEUS Trial ezetimibe Ultrasound Study

ZEUS Trial ezetimibe Ultrasound Study Trial The lower, The better Is it True for Plaque Regression? Statin alone versus Combination of Ezetimibe and Statin Juntendo University, Department of Cardiology, Tokyo, Japan Katsumi Miyauchi, Naohisa

More information

Journal of the American College of Cardiology Vol. 42, No. 6, by the American College of Cardiology Foundation ISSN /03/$30.

Journal of the American College of Cardiology Vol. 42, No. 6, by the American College of Cardiology Foundation ISSN /03/$30. Journal of the American College of Cardiology Vol. 42, No. 6, 2003 2003 by the American College of Cardiology Foundation ISSN 0735-1097/03/$30.00 Published by Elsevier Inc. doi:10.1016/s0735-1097(03)00922-7

More information

Attenuated Plaque at Nonculprit Lesions in Patients Enrolled in Intravascular Ultrasound Atherosclerosis Progression Trials

Attenuated Plaque at Nonculprit Lesions in Patients Enrolled in Intravascular Ultrasound Atherosclerosis Progression Trials JACC: CARDIOVASCULAR INTERVENTIONS VOL. 2, NO. 7, 2009 2009 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/09/$36.00 PUBLISHED BY ELSEVIER INC. DOI: 10.1016/j.jcin.2009.05.007 Attenuated

More information

Evaluation of Intermediate Coronary lesions: Can You Handle the Pressure? Jeffrey A Southard, MD May 4, 2013

Evaluation of Intermediate Coronary lesions: Can You Handle the Pressure? Jeffrey A Southard, MD May 4, 2013 Evaluation of Intermediate Coronary lesions: Can You Handle the Pressure? Jeffrey A Southard, MD May 4, 2013 Disclosures Consultant- St Jude Medical Boston Scientific Speaker- Volcano Corporation Heart

More information

The Effects of Rosuvastatin on Plaque Regression in Patients Who Have a Mild to Moderate Degree of Coronary Stenosis With Vulnerable Plaque

The Effects of Rosuvastatin on Plaque Regression in Patients Who Have a Mild to Moderate Degree of Coronary Stenosis With Vulnerable Plaque ORIGINAL ARTICLE Korean Circ J 28;38:366-373 Print ISSN 1738-552 / On-line ISSN 1738-5555 Copyright c 28 The Korean Society of Cardiology The Effects of Rosuvastatin on Plaque Regression in Patients Who

More information

IVUS Analysis. Myeong-Ki. Hong, MD, PhD. Cardiac Center, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea

IVUS Analysis. Myeong-Ki. Hong, MD, PhD. Cardiac Center, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea IVUS Analysis Myeong-Ki Hong, MD, PhD Cardiac Center, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea Intimal disease (plaque) is dense and will appear white Media is made of

More information

Imaging Atheroma The quest for the Vulnerable Plaque

Imaging Atheroma The quest for the Vulnerable Plaque Imaging Atheroma The quest for the Vulnerable Plaque P.J. de Feijter 1. Department of Cardiology 2. Department of Radiology Coronary Heart Disease Remains the Leading Cause of Death in the U.S, Causing

More information

Autonomic nervous system, inflammation and preclinical carotid atherosclerosis in depressed subjects with coronary risk factors

Autonomic nervous system, inflammation and preclinical carotid atherosclerosis in depressed subjects with coronary risk factors Autonomic nervous system, inflammation and preclinical carotid atherosclerosis in depressed subjects with coronary risk factors Carmine Pizzi 1 ; Lamberto Manzoli 2, Stefano Mancini 3 ; Gigliola Bedetti

More information

CVD risk assessment using risk scores in primary and secondary prevention

CVD risk assessment using risk scores in primary and secondary prevention CVD risk assessment using risk scores in primary and secondary prevention Raul D. Santos MD, PhD Heart Institute-InCor University of Sao Paulo Brazil Disclosure Honoraria for consulting and speaker activities

More information

Cardiovascular Research Foundation and Columbia University Medical Center, New York.

Cardiovascular Research Foundation and Columbia University Medical Center, New York. Virtual Histology Intravascular Ultrasound Analysis of Non-culprit Attenuated Plaques Detected by Grayscale Intravascular Ultrasound in Patients with Acute Coronary Syndromes Xiaofan Wu, Akiko Maehara,

More information

Medical sciences 1 (2017) 1 9

Medical sciences 1 (2017) 1 9 Medical sciences 1 (2017) 1 9 TISSUE CHARACTERISTICS OF CULPRIT CORONARY LESIONS IN ACUTE CORONARY SYNDROME AND TARGET CORONARY LESIONS IN STABLE ANGINA PECTORIS: VIRTUAL HISTOLOGY AND INTRAVASCULAR ULTRASOUND

More information

IVUS Virtual Histology. Listening through Walls D. Geoffrey Vince, PhD The Cleveland Clinic Foundation

IVUS Virtual Histology. Listening through Walls D. Geoffrey Vince, PhD The Cleveland Clinic Foundation IVUS Virtual Histology Listening through Walls D. Geoffrey Vince, PhD Disclosure VH is licenced to Volcano Therapeutics Grant funding from Pfizer, Inc. Grant funding from Boston-Scientific Most Myocardial

More information

Low fractional diastolic pressure in the ascending aorta increased the risk of coronary heart disease

Low fractional diastolic pressure in the ascending aorta increased the risk of coronary heart disease (2002) 16, 837 841 & 2002 Nature Publishing Group All rights reserved 0950-9240/02 $25.00 www.nature.com/jhh ORIGINAL ARTICLE Low fractional diastolic pressure in the ascending aorta increased the risk

More information

ORIGINAL INVESTIGATION. C-Reactive Protein Concentration and Incident Hypertension in Young Adults

ORIGINAL INVESTIGATION. C-Reactive Protein Concentration and Incident Hypertension in Young Adults ORIGINAL INVESTIGATION C-Reactive Protein Concentration and Incident Hypertension in Young Adults The CARDIA Study Susan G. Lakoski, MD, MS; David M. Herrington, MD, MHS; David M. Siscovick, MD, MPH; Stephen

More information

How would you manage Ms. Gold

How would you manage Ms. Gold How would you manage Ms. Gold 32 yo Asian woman with dyslipidemia Current medications: Simvastatin 20mg QD Most recent lipid profile: TC = 246, TG = 100, LDL = 176, HDL = 50 What about Mr. Williams? 56

More information

ORIGINAL CONTRIBUTION. Risk of Developing Coronary Artery Disease Following a Normal Coronary Angiogram in Middle-Aged Adults

ORIGINAL CONTRIBUTION. Risk of Developing Coronary Artery Disease Following a Normal Coronary Angiogram in Middle-Aged Adults ORIGINAL CONTRIBUTION Risk of Developing Coronary Artery Disease Following a Normal Coronary Angiogram in Middle-Aged Adults Maheswara S.G. Rao Golla, MBBS 1 ; Timir Paul, MD 2 ; Siddhartha Rao, MD 1 ;

More information

PCI for Left Anterior Descending Artery Ostial Stenosis

PCI for Left Anterior Descending Artery Ostial Stenosis PCI for Left Anterior Descending Artery Ostial Stenosis Why do you hesitate PCI for LAD ostial stenosis? LAD Ostial Lesion Limitations of PCI High elastic recoil Involvement of the distal left main coronary

More information

Changing lipid-lowering guidelines: whom to treat and how low to go

Changing lipid-lowering guidelines: whom to treat and how low to go European Heart Journal Supplements (2005) 7 (Supplement A), A12 A19 doi:10.1093/eurheartj/sui003 Changing lipid-lowering guidelines: whom to treat and how low to go C.M. Ballantyne Section of Atherosclerosis,

More information

Division of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, Japan

Division of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, Japan Association between continuously elevated C-reactive protein and restenosis after percutaneous coronary intervention using drug-eluting stent in angina patients Division of Cardiovascular Medicine, Jichi

More information

Diabetes and Occult Coronary Artery Disease

Diabetes and Occult Coronary Artery Disease Diabetes and Occult Coronary Artery Disease Mun K. Hong, MD, FACC, FSCAI Director, Cardiac Catheterization Laboratory & Interventional Cardiology St. Luke s-roosevelt Hospital Center New York, New York

More information

Anatomy is Destiny, But Physiology is Here Today

Anatomy is Destiny, But Physiology is Here Today Published on Journal of Invasive Cardiology (http://www.invasivecardiology.com) September, 2010 [1] Anatomy is Destiny, But Physiology is Here Today Thu, 9/9/10-10:54am 0 Comments Section: Commentary Issue

More information

Effect of Intravascular Ultrasound- Guided vs. Angiography-Guided Everolimus-Eluting Stent Implantation: the IVUS-XPL Randomized Clinical Trial

Effect of Intravascular Ultrasound- Guided vs. Angiography-Guided Everolimus-Eluting Stent Implantation: the IVUS-XPL Randomized Clinical Trial Effect of Intravascular Ultrasound- Guided vs. Angiography-Guided Everolimus-Eluting Stent Implantation: the IVUS-XPL Randomized Clinical Trial Myeong-Ki Hong, MD. PhD on behalf of the IVUS-XPL trial investigators

More information

Coronary Artery Thermography

Coronary Artery Thermography Coronary Artery Thermography The 10th Anniversary, Interventional Vascular Therapeutics Angioplasty Summit 2005 TCT Asia Pacific Christodoulos Stefanadis Professor of Cardiology Athens Medical School In

More information

Invasive Coronary Imaging Modalities for Vulnerable Plaque Detection

Invasive Coronary Imaging Modalities for Vulnerable Plaque Detection Invasive Coronary Imaging Modalities for Vulnerable Plaque Detection Gary S. Mintz, MD Cardiovascular Research Foundation New York, NY Greyscale IVUS studies have shown Plaque ruptures do not occur randomly

More information

Journal of the American College of Cardiology Vol. 54, No. 25, by the American College of Cardiology Foundation ISSN /09/$36.

Journal of the American College of Cardiology Vol. 54, No. 25, by the American College of Cardiology Foundation ISSN /09/$36. Journal of the American College of Cardiology Vol. 54, No. 25, 2009 2009 by the American College of Cardiology Foundation ISSN 0735-1097/09/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2009.10.005

More information

Lessons from Recent Atherosclerosis Trials

Lessons from Recent Atherosclerosis Trials Lessons from Recent Atherosclerosis Trials Han, Ki Hoon MD PhD Asan Medical Center Seoul, Korea Change of concept Primary vs. secondary prevention Low risk vs. High risk High Risk CHD and equivalents CHD

More information

John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam

John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Latest Insights from the JUPITER Study John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Inflammation, hscrp, and Vascular Prevention

More information

Plaque Shift vs. Carina Shift Prevalence and Implication

Plaque Shift vs. Carina Shift Prevalence and Implication TCTAP 2013 Fellowship Course Left Main and Bifurcation PCI: Bifurcation PCI Plaque Shift vs. Carina Shift Prevalence and Implication Soo-Jin Kang, MD., PhD. Department of Cardiology, University of Ulsan

More information

INTRODUCTION. ORIGINAL ARTICLE DOI: /kjim

INTRODUCTION. ORIGINAL ARTICLE DOI: /kjim ORIGINAL ARTICLE DOI: 10.3904/kjim.2010.25.4.356 Usual Dose of Simvastatin Does Not Inhibit Plaque Progression and Lumen Loss at the Peri-Stent Reference Segments after Bare-Metal Stent Implantation: A

More information

Effects of Statins on Endothelial Function in Patients with Coronary Artery Disease

Effects of Statins on Endothelial Function in Patients with Coronary Artery Disease Effects of Statins on Endothelial Function in Patients with Coronary Artery Disease Iana I. Simova, MD; Stefan V. Denchev, PhD; Simeon I. Dimitrov, PhD Clinic of Cardiology, University Hospital Alexandrovska,

More information

Coronary artery disease (CAD) risk factors

Coronary artery disease (CAD) risk factors Background Coronary artery disease (CAD) risk factors CAD Risk factors Hypertension Insulin resistance /diabetes Dyslipidemia Smoking /Obesity Male gender/ Old age Atherosclerosis Arterial stiffness precedes

More information

Current Cholesterol Guidelines and Treatment of Residual Risk COPYRIGHT. J. Peter Oettgen, MD

Current Cholesterol Guidelines and Treatment of Residual Risk COPYRIGHT. J. Peter Oettgen, MD Current Cholesterol Guidelines and Treatment of Residual Risk J. Peter Oettgen, MD Associate Professor of Medicine Harvard Medical School Director, Preventive Cardiology Beth Israel Deaconess Medical Center

More information

The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009

The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009 The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009 Learning Objectives 1. Understand the role of statin therapy in the primary and secondary prevention of stroke 2. Explain

More information

Gary S. Mintz,, MD. IVUS Observations in Acute (vs Chronic) Coronary Artery Disease: Structure vs Function

Gary S. Mintz,, MD. IVUS Observations in Acute (vs Chronic) Coronary Artery Disease: Structure vs Function Gary S. Mintz,, MD IVUS Observations in Acute (vs Chronic) Coronary Artery Disease: Structure vs Function Important IVUS Observations: Remodeling Originally used (first by Glagov) ) to explain atherosclerosis

More information

Journal of the American College of Cardiology Vol. 46, No. 5, by the American College of Cardiology Foundation ISSN /05/$30.

Journal of the American College of Cardiology Vol. 46, No. 5, by the American College of Cardiology Foundation ISSN /05/$30. Journal of the American College of Cardiology Vol. 46, No. 5, 2005 2005 by the American College of Cardiology Foundation ISSN 0735-1097/05/$30.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2005.06.009

More information

Cardiovascular Division, Saitama Citizens Medical Center, Shimane, Nishi-ku, Saitama , Japan 2

Cardiovascular Division, Saitama Citizens Medical Center, Shimane, Nishi-ku, Saitama , Japan 2 International Vascular Medicine Volume 2010, Article ID 134692, 5 pages doi:10.1155/2010/134692 Clinical Study Gender Differences of Plaque Characteristics in Elderly Patients with Stable Angina Pectoris:

More information

Preventing Myocardial Infarction in the Young Adult in the First Place: How Do the National Cholesterol Education Panel III Guidelines Perform?

Preventing Myocardial Infarction in the Young Adult in the First Place: How Do the National Cholesterol Education Panel III Guidelines Perform? Journal of the American College of Cardiology Vol. 41, No. 9, 2003 2003 by the American College of Cardiology Foundation ISSN 0735-1097/03/$30.00 Published by Elsevier Inc. doi:10.1016/s0735-1097(03)00187-6

More information

Journal of the American College of Cardiology Vol. 35, No. 5, by the American College of Cardiology ISSN /00/$20.

Journal of the American College of Cardiology Vol. 35, No. 5, by the American College of Cardiology ISSN /00/$20. Journal of the American College of Cardiology Vol. 35, No. 5, 2000 2000 by the American College of Cardiology ISSN 0735-1097/00/$20.00 Published by Elsevier Science Inc. PII S0735-1097(00)00546-5 CLINICAL

More information

A: Epidemiology update. Evidence that LDL-C and CRP identify different high-risk groups

A: Epidemiology update. Evidence that LDL-C and CRP identify different high-risk groups A: Epidemiology update Evidence that LDL-C and CRP identify different high-risk groups Women (n = 27,939; mean age 54.7 years) who were free of symptomatic cardiovascular (CV) disease at baseline were

More information

LDL cholesterol (p = 0.40). However, higher levels of HDL cholesterol (> or =1.5 mmol/l [60 mg/dl]) were associated with less progression of CAC

LDL cholesterol (p = 0.40). However, higher levels of HDL cholesterol (> or =1.5 mmol/l [60 mg/dl]) were associated with less progression of CAC Am J Cardiol (2004);94:729-32 Relation of degree of physical activity to coronary artery calcium score in asymptomatic individuals with multiple metabolic risk factors M. Y. Desai, et al. Ciccarone Preventive

More information

2010 Korean Society of Cardiology Spring Scientific Session Korea Japan Joint Symposium. Seoul National University Hospital Cardiovascular Center

2010 Korean Society of Cardiology Spring Scientific Session Korea Japan Joint Symposium. Seoul National University Hospital Cardiovascular Center 2010 Korean Society of Cardiology Spring Scientific Session Korea Japan Joint Symposium Does Lt Late Cth Catch up Exist Eiti in DES? : Quantitative Coronary Angiography Analysis Kyung Woo Park, MD Cardiovascular

More information

Original paper. Introduction. Material and methods. Aim

Original paper. Introduction. Material and methods. Aim Original paper Relation between coronary plaque calcium deposits as described by computed tomography coronary angiography and acute results of stent deployment as assessed by intravascular ultrasound Jerzy

More information

Review of guidelines for management of dyslipidemia in diabetic patients

Review of guidelines for management of dyslipidemia in diabetic patients 2012 international Conference on Diabetes and metabolism (ICDM) Review of guidelines for management of dyslipidemia in diabetic patients Nan Hee Kim, MD, PhD Department of Internal Medicine, Korea University

More information

RAMA-EGAT Risk Score for Predicting Coronary Artery Disease Evaluated by 64- Slice CT Angiography

RAMA-EGAT Risk Score for Predicting Coronary Artery Disease Evaluated by 64- Slice CT Angiography RAMA-EGAT Risk Score for Predicting Coronary Artery Disease Evaluated by 64- Slice CT Angiography Supalerk Pattanaprichakul, MD 1, Sutipong Jongjirasiri, MD 2, Sukit Yamwong, MD 1, Jiraporn Laothammatas,

More information

Case Presentation. Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer

Case Presentation. Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer Case Presentation Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer Case Presentation 50 YO man NSTEMI treated with PCI 1 month ago Medical History: Obesity: BMI 32,

More information

Comparison of Effects of High (80 mg) Versus Low (20 mg) Dose of Simvastatin

Comparison of Effects of High (80 mg) Versus Low (20 mg) Dose of Simvastatin Comparison of Effects of High (80 mg) Versus Low (20 mg) Dose of Simvastatin on C-Reactive Protein and Lipoproteins in Patients With Angiographic Evidence of Coronary Arterial Narrowing Kent G. Meredith,

More information

Vascular disease. Structural evaluation of vascular disease. Goo-Yeong Cho, MD, PhD Seoul National University Bundang Hospital

Vascular disease. Structural evaluation of vascular disease. Goo-Yeong Cho, MD, PhD Seoul National University Bundang Hospital Vascular disease. Structural evaluation of vascular disease Goo-Yeong Cho, MD, PhD Seoul National University Bundang Hospital resistance vessels : arteries

More information

Clinical research Coronary heart disease

Clinical research Coronary heart disease European Heart Journal (2006) 27, 1664 1670 doi:10.1093/eurheartj/ehi796 Clinical research Coronary heart disease Compensatory enlargement of human coronary arteries during progression of atherosclerosis

More information

Basics of Angiographic Interpretation Analysis of Angiography

Basics of Angiographic Interpretation Analysis of Angiography Basics of Angiographic Interpretation Analysis of Angiography Young-Hak Kim, MD, PhD Cardiac Center, University of Ulsan College of Medicine, Seoul, Korea What made us nervous Supervisors Stent Contrast

More information

Impact of Body Mass Index and Metabolic Syndrome on the Characteristics of Coronary Plaques Using Computed Tomography Angiography

Impact of Body Mass Index and Metabolic Syndrome on the Characteristics of Coronary Plaques Using Computed Tomography Angiography Impact of Body Mass Index and Metabolic Syndrome on the Characteristics of Coronary Plaques Using Computed Tomography Angiography Cardiovascular Division, Faculty of Medicine, University of Tsukuba Akira

More information

Who Cares About the Past?

Who Cares About the Past? Risk Factors, the New Calcium Score, Rheology and Atherosclerosis Progression Arthur Agatston 2/21/15 The Vulnerable Plaque vs. Plaque Burden CT Angiogram Is There a Role for Coronary Artery Calcium Scoring

More information

Impact of Metabolic Syndrome on Tissue Characteristics of Angiographically Mild to Moderate Coronary Lesions

Impact of Metabolic Syndrome on Tissue Characteristics of Angiographically Mild to Moderate Coronary Lesions Journal of the American College of Cardiology Vol. 49, No. 11, 2007 2007 by the American College of Cardiology Foundation ISSN 0735-1097/07/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2006.12.028

More information

DECLARATION OF CONFLICT OF INTEREST. Nothing to disclose

DECLARATION OF CONFLICT OF INTEREST. Nothing to disclose DECLARATION OF CONFLICT OF INTEREST Nothing to disclose Four-Year Clinical Outcomes of the OLIVUS (Impact of OLmesartan on progression of coronary atherosclerosis; evaluation by IntraVascular UltraSound

More information

Simvastatin With or Without Ezetimibe in Familial Hypercholesterolemia

Simvastatin With or Without Ezetimibe in Familial Hypercholesterolemia Simvastatin With or Without Ezetimibe in Familial Hypercholesterolemia The trial ClinicalTrials.gov number: NCT00552097 John J.P. Kastelein, MD, PhD* Department of Vascular Medicine Academic Medical Center

More information

Integrated Use of IVUS and FFR for LM Stenting

Integrated Use of IVUS and FFR for LM Stenting Integrated Use of IVUS and FFR for LM Stenting Gary S. Mintz, MD Cardiovascular Research Foundation Four studies have highlighted the inaccuracy of angiography in the assessment of LMCA disease Fisher

More information

Inflammation, plaque progression and vulnerability: evidence from intravascular ultrasound imaging

Inflammation, plaque progression and vulnerability: evidence from intravascular ultrasound imaging Review Article Inflammation, plaque progression and vulnerability: evidence from intravascular ultrasound imaging Yu Kataoka, Rishi Puri, Stephen J. Nicholls South Australian Health & Medical Research

More information

Current Role of Renal Artery Stenting in Patients with Renal Artery Stenosis

Current Role of Renal Artery Stenting in Patients with Renal Artery Stenosis Current Role of Renal Artery Stenting in Patients with Renal Artery Stenosis Young-Guk Ko, M.D. Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Etiology Fibromuscular

More information

Anne Carol Goldberg, MD, FACP, FAHA, FNLA Washington University, St. Louis, MO USA

Anne Carol Goldberg, MD, FACP, FAHA, FNLA Washington University, St. Louis, MO USA Efficacy and Safety of Bempedoic Acid Added to Maximally Tolerated Statins in Patients with Hypercholesterolemia and High Cardiovascular Risk: The CLEAR Wisdom Trial Anne Carol Goldberg, MD, FACP, FAHA,

More information

CLINICAL STUDY. Yasser Khalil, MD; Bertrand Mukete, MD; Michael J. Durkin, MD; June Coccia, MS, RVT; Martin E. Matsumura, MD

CLINICAL STUDY. Yasser Khalil, MD; Bertrand Mukete, MD; Michael J. Durkin, MD; June Coccia, MS, RVT; Martin E. Matsumura, MD 117 CLINICAL STUDY A Comparison of Assessment of Coronary Calcium vs Carotid Intima Media Thickness for Determination of Vascular Age and Adjustment of the Framingham Risk Score Yasser Khalil, MD; Bertrand

More information

4/7/ The stats on heart disease. + Deaths & Age-Adjusted Death Rates for

4/7/ The stats on heart disease. + Deaths & Age-Adjusted Death Rates for + Update on Lipid Management Stacey Gardiner, MD Assistant Professor Division of Cardiovascular Medicine Medical College of Wisconsin + The stats on heart disease Over the past 10 years for which statistics

More information

Clemens von Birgelen, MD, PhD; Marc Hartmann, MD; Gary S. Mintz, MD; Dietrich Baumgart, MD; Axel Schmermund, MD; Raimund Erbel, MD

Clemens von Birgelen, MD, PhD; Marc Hartmann, MD; Gary S. Mintz, MD; Dietrich Baumgart, MD; Axel Schmermund, MD; Raimund Erbel, MD Relation Between Progression and Regression of Atherosclerotic Left Main Coronary Artery Disease and Serum Cholesterol Levels as Assessed With Serial Long-Term (>12 Months) Follow-Up Intravascular Ultrasound

More information

Impact of coronary atherosclerotic burden on clinical presentation and prognosis of patients with coronary artery disease

Impact of coronary atherosclerotic burden on clinical presentation and prognosis of patients with coronary artery disease Impact of coronary atherosclerotic burden on clinical presentation and prognosis of patients with coronary artery disease Gjin Ndrepepa, Tomohisa Tada, Massimiliano Fusaro, Lamin King, Martin Hadamitzky,

More information

The PROSPECT Trial. A Natural History Study of Atherosclerosis Using Multimodality Intracoronary Imaging to Prospectively Identify Vulnerable Plaque

The PROSPECT Trial. A Natural History Study of Atherosclerosis Using Multimodality Intracoronary Imaging to Prospectively Identify Vulnerable Plaque The PROSPECT Trial Providing Regional Observations to Study Predictors of Events in the Coronary Tree A Natural History Study of Atherosclerosis Using Multimodality Intracoronary Imaging to Prospectively

More information

Intima-Media Thickness

Intima-Media Thickness European Society of Cardiology Stockholm, 30th August 2010 Intima-Media Thickness Integration of arterial assessment into clinical practice Prof Arno Schmidt-Trucksäss, MD Institute of Exercise and Health

More information

Cover Page. The handle holds various files of this Leiden University dissertation

Cover Page. The handle   holds various files of this Leiden University dissertation Cover Page The handle http://hdl.handle.net/1887/43967 holds various files of this Leiden University dissertation Author: Graaf, Michiel A. de Title: Computed tomography coronary angiography : from quantification

More information

The inhibition of CETP: From simply raising HDL-c to promoting cholesterol efflux and lowering of atherogenic lipoproteins Prof Dr J Wouter Jukema

The inhibition of CETP: From simply raising HDL-c to promoting cholesterol efflux and lowering of atherogenic lipoproteins Prof Dr J Wouter Jukema The inhibition of CETP: From simply raising HDL-c to promoting cholesterol efflux and lowering of atherogenic lipoproteins Prof Dr J Wouter Jukema Dept Cardiology, Leiden University Medical Center, Leiden,

More information

FFR and intravascular imaging, which of which?

FFR and intravascular imaging, which of which? FFR and intravascular imaging, which of which? Ayman Khairy MD, PhD, FESC Associate professor of Cardiovascular Medicine Vice Director of Assiut University Hospitals Assiut, Egypt Diagnostic assessment

More information

Women and Heart Disease

Women and Heart Disease Women and Heart Disease The Very Latest in Cardiovascular Medicine and Surgery Gretchen L. Wells, MD, PhD, FACC Thomas Whayne Endowed Professor in Women s Heart Health Gill Heart Institute University of

More information

Identifying patients at risk: novel diagnostic techniques

Identifying patients at risk: novel diagnostic techniques European Heart Journal Supplements (2004) 6 (Supplement C), C15 C20 Identifying patients at risk: novel diagnostic techniques Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, OH, USA

More information