The coronary calcium score for risk prediction
|
|
- Abel Kory Hutchinson
- 8 years ago
- Views:
Transcription
1 REVIEW ARTICLE 75 The use of calcium-score risk prediction can eliminate a big problem of the current risk factors The coronary calcium score for risk prediction Raimund Erbel, Amir A Mahabadi, Hagen Kälsch Department of Cardiology, West German Heart and Vascular Centre, University Hospital Essen, University Duisburg-Essen, Germany Summary Sudden cardiac death belongs to the acute coronary syndromes, beside unstable angina and myocardial infarction. Today, 60% 80% of deaths due to myocardial infarction still occur outside the hospital. In order to detect individuals prone to such events, risk scores have been developed, including the Heart Score of the European Society of Cardiology. Drawbacks of all current risk scores are, however, the exclusion of signs of atherosclerosis, the underlying aetiology of plaque rupture and erosion leading to sudden death. Computed tomography is an ideal imaging tool, which is able to detect, to localise and to quantify calcified and noncalcified plaques in coronary vessels. The amount of calcium is related to coronary and cardiovascular risk, as well as all-cause mortality. The use of calcium-score risk prediction can eliminate a big problem of the current risk factors, because the lifetime exposure to risk factors, including genetic and heritable features, has an important influence on atherosclerosis. Individual, meaning personalised, management is provided. Plaque burden indicates the degree of risk, which is what matters most. Key words: coronary artery calcium; screening; risk assessment; risk score; plaque burden An article from the series Atherosclerosis and inflammation Epidemiology of coronary artery calcification Coronary artery calcification (CAC) is present in nearly 100% of men surviving an acute coronary event and more than 80% of women [1]. In young victims of sudden death (<50 years of age), calcified deposits are found in areas of stenosis 50% with plaque ruptures in 70%, plaque erosions in 33% and in stable plaques in 50%. These values slightly increase if the area stenosis is 75% [2, 3]. Most important are the clear linear relationship between the calcified plaque area and the total plaque area per patient, and the relation between plaque area and calcified plaque area by vessel score. The calcified plaque area accurately predicts overall plaque area [3]. The prevalence of coronary artery disease reaches about 7% in West Germany in a population aged between 45 and 75 years. In the general population, however, coronary artery calcification is found in 82% of men and 55% of women. The median calcium score reaches 55 (4 239) in men and 1.5 (0 38.2) in women. A calcium score below 100 was present in 60% of men and 85% of women. A calcium score of was found in 24% and 11% and a calcium score 400 in 17% and 4.5%, respectively [4]. In the United States, the prevalence of coronary calcification was 70.4% in men and 44.6% in women [5]. In other ethnic groups the prevalence of calcification was significantly different, reaching 52.1% in Black men, 46.5% in Hispanic men and 29.2% in Chinese men, as well as 36.5%, 34.9% and 41.9%, respectively, in women. After adjustment for age, education, lipids, Body Mass Index, diabetes, hypertension, hypertriglyceridaemia, gender and scanning centre, the coronary calcification relative to Whites was 77% in Chinese, 74% in Hispanics and 69% in Blacks. At autopsy also, less calcification of coronary artery sclerosis was found in Blacks than in Whites with a difference between Blacks and Whites of 20% 75% [6]. These studies were confirmed by fluoroscopy showing CAC in 24% of African-Americans, 48% in Asian- Americans, and 47% of Caucasians [7]. The prevalence was 62% in Black, 71% in Hispanic,and 84% in White individuals. Using computed tomography (CT), plaques in Blacks are less often calcified than in Whites [8 10]. These ethnic variations in the prevalence of coronary artery calcification are in agreement with genetic variations of the G-protein, which show a similar distribution related to obesity and hypertension [11]. The revalence of atherosclerosis studied in mummies of different areas in the world, also showed such a difference in penetration, reflecting the start of the development of human beings in Africa [12, 13]. Natural history The natural history of atherosclerosis has previously been described in detail [1, 14, 15]. First intracellular than extracellular calcium was a common sign and found not only in advanced atherosclerotic lesions
2 REVIEW ARTICLE 76 Methods for detection of signs of coronary atherosclerosis dependent on the natural history of atherosclerosis including the positive remodelling in the early stages of the disease PET SPECT, ECHO, EKG Noninvasive methods CT MRT Invasive methods Vasomotion OCT IVUS IFS Coronary angiography 0% 20% 45% 50% 70% 90% Remodelling Life time/years Figure 1: Schematic drawing of the development of coronary arteriosclerosis including positive remodelling during plaque burden increase and listing of invasive and noninvasive methods concerning their ability to detect signs of the clinical coronary arteriosclerosis starting with endothelium dysfunction and ending with signs of ischaemia detected in the ECG. Modified from Erbel R, Budoff M [21]. but also in atheroma and fibroatheroma close to the lipid necrotic core [15]. Typically, the first signs of coro nary arteriosclerosis, indicated by plaque formation, are found 2 3 cm from the origin of both the left and right coronary arteries [16, 17]. Aging is indicated by progression of the disease, leading to plaque formation also in the distal part of the left anterior descending and circumflex coronary arteries, which was not observed to the same degree in the right coro nary artery [17]. Also with coronary angiography in patients with multiple lesions and an average of three vessel disease, lesions are found in the proximal left anterior descending coronary artery followed by the right coronary artery [18, 19]. Due to the positive remodelling of the arteriosclerotic process, only plaques compromising more than 45% of the vessel area will, however, lead to lumen narrowing and hence visible angiographic stenosis [20]. Atherosclerotic plaques can nowadays be visualised by use of intracoronary ultrasound well before the inner lumen of a coronary artery is compromised (fig. 1) [21]. Thus, in patients without angiographically visible lesions, coronary artery calcification can be detected and also imaged with CT in approximately 60% of all early coronary arteriosclerotic lesions [22, 23]. The calcium score increases with the number of vessels involved. CT in the early stage of coronary artery disease shows calcification in only one of the major coronary arteries: most often (>50%) the left anterior coronary artery, in 25% the right coronary artery and in 17% the left circumflex. If two calcified lesions are visible, then most often the left and right coronary artery are involved (45%). Other combinations are less frequent. Calcified lesions of the left main artery are detected in only 7%. Importantly, 25% of those with three vessels already show coronary artery calcification of the left main stem [23]. It is interesting to note that with increasing total calcium score more distal segments are involved, but the increase is most pronounced in the proximal segments. That means that the amount of calcification still increases most prominently in the segments initially involved, which are found in the proximal left coronary artery [24].
3 REVIEW ARTICLE 77 Noninvasive quantification of coronary artery calcification With modern technology the quantification of CAC is possible and reproducible. In comparison to other methods, CT is the noninvasive technique to best detect signs of subclinical atherosclerosis (fig. 2). If the density is 130 Hounsfield units, a calcified plaque is present. A plaque is defined if 4 adjusted pixels are found. This density can be related to a density factor between 1 and 4 ( , , , 400) and multiplied with the area of the plaque which leads to the Agatston Score [25]. The usual slice thickness is set at 3 mm and all slices in which plaques can be identified are summed up. Thus, the Agatston Score gives the total amount of calcification, but can also be related to vessels or even vessel segments. Coronary artery calcification during aging Early on, it was already obvious that coronary artery calcification increases continuously during life and this effect differs between patient cohorts and individuals in observational studies. Meanwhile, three observational studies have presented their results: the Heinz Nixdorf Recall (HNR) study, the Multi-Ethnic Study in Atherosclerosis (MESA) and the Rotterdam study demonstrate very comparable results [26 28]. The comparison between MESA and the HNR study in particular demonstrated a comparable percentile distribution of coronary artery calcification for Caucasian men and women, with nearly overlapping curves despite different countries, continents and risk factors. The percentile distribution of CAC is, however, different for different ethnicities [26]. These percentiles of CAC distribution (fig. 3) can be used in order to estimate the individual vascular age risk, and for these two studies have provided an Internet access: A typical example is shown in figure 3, which demonstrates for a man with metabolic syndrome at the age of 50 years, a severe calcification that far exceeds the 90th percentile of CAC distribution. It corresponds to the 90th percentile of a man aged 67 years. That means that the vascular age seems to be >17 years older. In women, calcification is lower and starts later. Whereas some of the male patients already demonstrate a positive calcium score at the age of 45 years or even before, it is found in women >10 years later. Normal CT No CAC Ao RVOT CAC Agatston score year M LM LAD 51 year M CAC Agatston score 115 CAC Agatston score year M 64 year F Figure 2: Signs of subclinical coronary artery sclerosis detected in men and women (m/w) at the age of years with increasing calcium load: 0, 0 49, 115 and 1609 Agatston Score. Visualised is a typical slice at the level of the origin of the left main coronary artery from the aorta, showing the proximal left descending coronary artery distal to the bifurcation. AO = Aorta; LAD = left anterior descending coronary artery; LM = left main coronary artery; RVOT = right ventricular outflow tract.
4 REVIEW ARTICLE 78 Risk factors and coronary artery calcification The percentile distribution of coronary artery calcification can be used in order to study the influence of risk factors on the calcification process. In smokers the calcification process showed a 10-year difference from nonsmokers, in women as well as in men [29]. Similarly, in men and in women with diabetes a shift to the left and upwards could be demonstrated, but the difference was not as high as for the effect of smoking. In addition, an effect of prediabetes could be shown only in women, but not in men [30]. In addition to smoking, diabetes and hypercholesterolaemia, hypertension is a major risk factor. Similar to the effect of diabetes, hypertension leads to a higher calcification grade, which is more pronounced in women than in men. This effect was also found for those with prehypertension [31]. It is interesting to note that even in those without hypertension, a level of high coronary artery calcification can be found. Elevated levels of total cholesterol and low density lipoprotein cholesterol (LDL-C) are associated with excessive calcification of coronary arteries, which is again more pronounced in women than in men [32]. Women with LDL cholesterol below 100 mg/dl show Scores Scores Calcium score distribution Age Calcium score distribution 17 years Age 25th percentile 50th percentile 75th percentile 90th percentile The patient's score at the age of 50 is on the 97th percentile Calculation of Calcium Score based on the data of the Heinz Nixdorf Recall Study A. Schmermund, St. Möhlenkamp, S. Berenbein, H. Pump, S. Moebus, U. Roggenbuck, A. Stang, R. Seibel, D. Grönemeyer, K-H. Jöckel, R. Erbel Atherosclerosis, 2005 Program 2006 M. Rauwolf, R. Erbel Clinic for Cardiology, University Essen-Duisburg, Germany Figure 3: Coronary artery calcification (CAC) score of a male aged 50 years with an Agatston Score of listed in the percentile of CAC distribution (90th [orange], 75th [red], 50th [blue] and 25th [black]). The degree of calcification corresponding to a man at the age of 67 years crosses the 90th percentile (age difference 17 years) based on the CAC calculation algorithm of the HNR study ( was used. (Schmerm und A, et al.[24], Erbel R, et al.[28]).
5 REVIEW ARTICLE 79 CACcategories Relative Risk (versus CAC = 0) Meta-analysis HNR study 1.9 ( ) 1.7 ( ) Meta-analysis HNR study 4.3 ( ) 4.0 ( ) Meta-analysis HNR study 7.2 ( ) 5.4 ( ) >1000 Meta-analysis HNR study 10.8 ( ) 16.1 ( ) Lower Risk Higher Risk Figure 4: Relative risks and 95% confidence intervals of CAC categories 1 99, , and 1000 versus CAC = 0 during a 5-year follow-up in the HNR study, listed in comparison to results of the meta-analysis by Greenland et al. [44]. CAC = coronary artery calcification; HNR = Heinz Nixdorf Recall study nearly no calcification at all ages, whereas women with LDL cholesterol >190 mg/dl demonstrate an excessive calcification process that starts very early. The signs of coronary arteriosclerosis give a nice opportunity to analyse whether or not other parameters of lipoprotein metabolism or ratios may improve the association with CAC. Apolipoprotein B (Apo B) was found to give the closest association with CAC in comparison with all other lipoprotein parameters tested, even when compared with lipoprotein (a). Neither the ratio LDL-C / high density lipoprotein cholesterol (HDL-C), non-apo B/Apo A1 nor non-hdl-c yielded stronger values than Apo B or LDL-C. The association to triglyceride levels was only weak and only positive for the highest quartile compared to the lowest in men and women [32]. For newer risk factors such as psychosocial factors [33, 34] as well as pollution [35, 36] and signs of inflammation [37], a strong association could be demonstrated, meaning that negative psychosocial effects do result in higher calcium values, which could be related to income as well as to education. High traffic levels and pollution were associated with a significant increase of coronary artery calcification in comparison with control groups. The effect of highsensitivity C-reactive protein was not as high as expected. Chronic kidney disease has to be regarded in a different way, as the medial sclerosis (Mönckeberg type atherosclerosis) is much more prominent, so that calcification is extensive or already present in young adults. The increase seems to be related to the estimated glomerular filtration rate [38]. Cardiovascular risk prediction with coronary artery calcification Many risk scores have been proposed in order to support physicians in the assessment of patients' risk for developing acute myocardial infarction or other cardiovascular diseases [39, 40]. An overview comparison has been presented previously [41]. The major limitation of these scores is the absence of corrections for the lifetime exposure to risk factors, genetic as well as heritable risk factors. The use of the different risk scores presents information about risk according to three major categories (low risk, intermediate risk, high risk). This differentiation is again different in the different algorithms proposed, but generally for low-risk individuals a healthy lifestyle is advised, whereas in high-risk individuals intensive therapy and risk factor modification is recommended. In those with intermediate risk, defined as 10% 20% risk of hard events within 10 years (alternative 6% 20%), imaging and nonimaging techniques are proposed for better discrimination. In addition to a stress electrocardiogram in men, biomarkers, ankle-brachial-index and carotid ultrasound as well as computed tomography are recommended [40].
6 REVIEW ARTICLE 80 No coronary artery calcification The event rate increases with the amount of coronary artery calcium, and no calcium provides an excellent longtime prognosis. The observed event rate during the first 5-year follow-up in the HNR study demonstrated an event rate of only 0.18% in men and 0.16% in women [27]. Even the all-cause mortality in the absence of CAC is very low reaching in 19,898 patients a value of 0.52% (0.09%/year) during a followup time of 5.6 years [41]. Thus, in those with no signs of coronary calcification the risk is very low and imaging should be performed after 5 years in order to see if any change has occurred. This may show a conversion in 6.2% at 4 years and 11.6% at 5 years. However, it has to be taken into account that conversion does not mean a clinical event, because it cannot be expected that the CAC value is >100 within a timeframe of 5 years in case of a zero CAC at baseline [42, 43]. Reclassification using coronary artery calcification as a parameter for assessment of cardiovascular events The high value of CAC for risk prediction can be seen in the comparison of the HNR study to meta-analysis provided by Greenland et al. (fig. 4), which demonstrates quite similar distributions and risk ratios, supporting the diagnostic value for the CAC measurements depending on the amount of calcification [21, 44]. A high amount of coronary calcification means a high risk, which is similar for both genders and reaches 8% in those who have a CAC 400, which was found in 16.8% of men and 4.5% of women in a total cohort of 4,157 individuals in the HNR study. On the other hand both, men and women showed a very low event rate if the CAC value was <100, which was found in 59% of men and 85% of women with an event rate <3% within 5 years. 1. In low-risk individuals (51.5%) according to the NECP AT III score (<10% /10-year risk), which also means no diabetes, stroke or aneurysm, the assessment of coronary artery calcification does not demonstrate an increase of risk dependent on the amount of CAC, which is in part owing to the fact that only 3.4% of the total cohort showed a CAC 400 and only 9.3% a value between [28]. 2. The situation is different in high-risk (>20%/10- year risk) individuals (19.7% ) according to the NECP AT III score. Taking into account risk factors as well as those with diabetes, stroke or aortic aneurysms plus low CAC, a CAC <100 was found in 49.8%. The risk was nearly as low (<0.4%/year) as in the group with low (NECP AT III) or intermediate risk (fig. 5). Therapeutic consequences are still not possible to determine, because such a down grading is not possible owing to a lack of prospective studies. This categories of CAC > (27.4%) and CAC 400 (22.9%) demonstrate again the risk Prevalence 51.5% 28.8% 19.7% 20 Event Rate in 5 Years [%] CAC ATP III 87.3% 9.3% 3.4% 62.9% 23.1% 14.1% 49.8% 27.4% 22.9% < < < Low risk <10% 10-year Intermediate risk 10 20% 10-year High risk >20% 10-year Figure 5: Observed 5-year rate of hard events (nonfatal and fatal myocardial infarction) in the Heinz Nixdorf Recall study. Reclassification of the NCEP ATP III categories using the coronary artery classification (CAC) categories (<100, , 400). The additional level of accuracy reached between the categories and the total cohort for men as well as women is listed. The percentages of participants in each category are given in the upper line as well as the prevalence. (Erbel et al. [28]).
7 REVIEW ARTICLE 81 Risk marker/mactor: NRI Intermediate risk definition (event rate /10 yrs) p-value Reference Multiple biomarker score 26.0% 6 20% p = (Zethelius, NEJM 2008) (Troponin I, NT-proBNP, cystatin C, CRP) Multiple biomarker dcore 4.7% 6 20% p = NS (Melander, JAMA 2009) (MR-proADM, NT-proBNP) HDL-cholesterol (Framingham) 12.1% 6 20% p <0.001 (Pencina, Stat Med 2008) HDL-cholesterol (SCORE-Data) 2.2%? p = (Cooney, EJCPR 2009) Heart-Rate (SCORE-Data) 1.1% 2 5% % p = NS (Cooney, EHJ 2010) hscrp (women) 5.7% 5 20% p < (Cook, Ann Int Med 2006) hscrp (men) 8.4% 5 20% p <0.001 (Ridker, Circulation 2008) hscrp (men and women) 11.8% 6 20% p <0.009 (Wilson, Circulation Qual Outc 2008) hscrp (men and women) 10.5% 10 20% p = (Möhlenkamp, JACC 2011) HbA1c (men) 3.4% p = 0.06 (Simmons, Arch Int Med 2008) 5 10% % HbA1c (women) 2.2% p = 0.27 (Simmons, Arch Int Med 2008) CAC (MESA) 25.0% 6 20% p <0.001 (Polonski et al. JAMA 2010) CAC (model based on FRS-variables 19.6% 6 20% p = with and without CAC, all subjects) 22.4% 10 20% p = (Erbel, JACC 2010) CAC (comparison with hscrp) 23.8% 10 20% p = (Möhlenkamp, JACC 2011) CAC (persons without statin indication) 25.1% 6 20% p = 0.01 (Möhlenkamp, Atherosclerosis 2011) CAC (Rotterdam Heart Study, elderly) 14.0% 10 20% p <0.01 (Elias-Smale et al., JACC 2011) cimt (common carotid artery) 0.0% p = NS (Polak et al., NEJM 2011) (common carotid artery) 1.4% p = NS (Lorenz et al., Eur Heart J 2010) (internal carotid artery) 7.6% p <0.001 (Polak et al., NEJM 2011) Figure 6: Reclassification improvement by use of different valuables in order to extend the risk stratification. Modified from Erbel et al. [28] and Cooney et al. [30]. The different publications are related to biomarkers, HDL-cholesterol, heart rate and signs of diabetes as well as signs of inflammation. In addition the results of the HNR study are listed related to CAC and hs-crp. hs-crp = high sensitivity C-reactive protein; HbA1 c = glycated hemoglobin; MR-pro ADM = mid-regional pro-adrenomedullin; NRI = net reclassification improvement; NT-proBNP = N-terminal pro-b-type natriuretic peptide; HDL-cholesterol = high density lipoprotein cholesterol } gradient preceeded by the amount of CAC plaque burden. 3. In those individuals with intermediate risk (28.8%), assessment of the amount of coronary artery calcification was very helpful to separate those with low and high risk (62.9% vs 14.1%) (fig. 5). In 23.1% (6.6% of the total group) the degree of CAC was between and showed an intermediate risk 2.8% in 5 years (0.55%/year). In the category with CAC <100 the risk was 2.7% in 5 years (0.27% /year), in CAC % in 5 years (1.7% /year). The negative predictive accuracy reached a level of 98% with a positive predictive accuracy for events of 12.7% in those with CAC >1000 [21]. Recently many attempts have been presented with imaging and nonimaging parameters in order to improve the classical risk assessment by use of scores like the Framingham and Heart Score. For coronary artery calcification, the reclassification rate reached a high level and was superior to other parameters (fig. 6) [30]. Compared with other parameters like high-sensitivity C-reactive protein, HDL-cholesterol and combinations of biomarkers, the reclassification improvement with CAC yielded superior results, reaching 30%. In direct comparison with ankle-brachial index, high-sensitivity C-reactive protein and family history, as well as brachial flow-mediated dilatation on carotid intima-media thickness, CAC provided superior discrimination and risk reclassification [46]. CAC is highly predictive not only for coronary but also for cardiovascular events and all-cause mortality [32, 38]. The higher the CAC the higher the risk for strokes [46]. Meanwhile, it could be demonstrated that CAC is superior to carotid ultrasound assessment of intima-media thickness. Ankle-brachial index was also provided, but is found <0.9 in <5% of the HNR cohort [48]. Practical hints In order to use calcium scoring in daily life, the Agatston score should be used for quantifying coronary artery calcification detected with CT. The total amount of coronary artery calcification presents a very good tool to assess the individual risk, which increases beyond 100 but particularly beyond 400 or even Of course, the age of the patient has to be
8 REVIEW ARTICLE 82 Correspondence: Raimund Erbel, MD FAHA, FESC, FACC, FASE Professor of Medicine/ Cardiology European Cardiologist Department of Cardiology West-German Heart Center University Duisburg-Essen Hufelandstr 55 D Essen Germany erbel[at]uk-essen.de taken into account, as during ageing coronary calcification increases. However, the total plaque burden determines the risk, which is dependent on risk factors including age and gender. Using the percentiles of CAC distribution, the increase of the plaque burden over time can be estimated, which is mainly genetically determined and seems to be inevitable. In addition the ethnicity of the patient has to be taken into account, as the prevalence is lowest in Blacks, higher in Hispanic and Chinese but highest in Caucasian. For the European population the Internet-based calculation algorithms of the HNR study can be used ( in order to estimate the degree of calcification in comparison with the general population, thus improving the individual risk assessment. Funding / potential competing interests No financial support and no other potential conflict of interest relevant to this article was reported. References The full list of references is included in the online version of the article at
9 REFERENCES Online appendix References 1 Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S, et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation 1995;92: Erbel R, Möhlenkamp S, Lehmann N, Schmermund A, Moebus S, et al.; Heinz Nixdorf Recall Study Investigative Group. Sex related cardiovascular risk stratification based on quantification of atherosclerosis and inflammation. Athero sclerosis 2008;197: Schmermund A, Schwartz RS, Adamzik M, Sangiorgi G, Pfeifer EA, et al. Coronary atherosclerosis in unheralded sudden coronary death under age 50: histo-pathologic comparison with healthy subjects dying out of hospital. Atherosclerosis 2001;155: Erbel R, Eisele L, Moebus S, Dragano N, Möhlenkamp S, et al. The Heinz Nixdorf Recall study. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012;55: Bild DE, Detrano R, Peterson D, Guerci A, Liu K, Shahar E, et al. Ethnic differences in coronary calcification: the Multi- Ethnic Study of Atherosclerosis (MESA). Circulation 2005;111: Eggen DA, Strong JP, McGill H. Relationship to Clinically Significant Coronary Lesions and Race, Sex, and Topographic Distribution. Coronary Calcification 1965;32: Tang W, Detrano RC, Brezden OS, Georgiou D, French WJ, et al. Racial differences in coronary calcium prevalence among high-risk adults. Am J Cardiol 1995;75: Budoff MJ, Yang TP, Shavelle RM, Lamont DH, Brundage BH. Ethnic differences in coronary atherosclerosis. J Am Coll Cardiol 2002;39: Newman AB, Naydeck BL, Whittle J, Sutton-Tyrrell K, Edmundowicz D, Kuller LH. Racial differences in coronary artery calcification in older adults. Arterioscler Thromb Vasc Biol 2002;22: Lee TC, O'Malley PG, Feuerstein I, Taylor AJ. The prevalence and severity of coronary artery calcification on coronary artery computed tomography in black and white subjects. J Am Coll Cardiol 2003;41: Siffert W, Forster P, Jöckel KH, Mvere DA, Brinkmann B, et al. Worldwide ethnic distribution of the G protein beta3 subunit 825T allele and its association with obesity in Caucasian, Chinese, and Black African individuals. J Am Soc Nephrol 1999;10: Thompson RC, Allam AH, Lombardi GP, Wann LS, Sutherland ML, et al. Atherosclerosis across 4000 years of human history: the Horus study of four ancient populations. Lancet 2013;381: Erbel R, Delaney JA, Lehmann N, McClelland RL, Möhlenkamp S, Kronmal RA, et al; Multi-Ethnic Study of Atherosclerosis; Investigator Group of the Heinz Nixdorf Recall Study. Signs of subclinical coronary atherosclerosis in relation to risk factor distribution in the Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study (HNR). Eur Heart J 2008;29: Stary HC, Blankenhorn DH, Chandler AB, Glagov S, Insull W Jr, et al. A definition of the intima of human arteries and of its atherosclerosis-prone regions. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation 1992;85; Stary HC. The development of calcium deposits in atherosclerotic lesions and their persistence after lipid regression. Am J Cardiol 2001;88:16E-19E. 16 Montenegro MR, Eggen DA. Topography of atherosclerosis in the coronary arteries. Lab Invest 1968;18: Strong JP. Atherosclerotic lesions. Natural history, risk factors, and topography. Arch Pathol lab Med 1992;116: Halon 'DA, Sapoznikov D, Lewis BS, Gotsman MS. Localization of Lesions in the Coronary circulation. Am J Cardiol 193;52: Gotsman M, Rosenheck S, Nassar H, Welber S, Sapoznikov D, et al. Angiographic findings in the coronary arteries after thrombolysis in acute myocardial infarction. Am J Cardiol 1992;70: Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 1987;316: Erbel R, Budoff M. Improvement of cardiovascular risk prediction using coronary imaging: subclinical atherosclerosis: the memory of lifetime risk factor exposure. Eur Heart J 2012;33: Schmermund A, Rensing BJ, Sheedy PF, Bell MR, Rumberger JA. Intravenous electron-beam computed tomographic coronary angiography for segmental analysis of coronary artery stenoses. J Am Coll Cardiol 1998;31: Baumgart D, Schmermund A, Görge G, Haude M, Ge J, et al. Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for detection of coronary atherosclerosis. J Am Coll Cardiol 1997;30: Schmermund A, Möhlenkamp S, Baumgart D, Kriener P, Pump H, et al. Usefulness of topography of coronary calcium by electron-beam computed tomography in predicting the natural history of coronary atherosclerosis. Am J Cardiol 2000;86: Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15: McClelland RL, Chung H, Detrano R, Post W, Kronmal RA. Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 2006;113: Vliegenthart R, Oudkerk M, Hofman A, Oei HH, van Dijck W, et al. Coronary calcification improves cardiovascular risk prediction in the elderly. Circulation 2005;112: Erbel R, Möhlenkamp S, Moebus S, Schmermund A, Lehmann N, et al; Heinz Nixdorf Recall Study Investigative Group. Coronary risk Stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol 2010;56: Jöckel KH, Lehmann N, Jaeger BR, Moebus S, Möhlenkamp S, et al. Smoking cessation and subclinical atherosclerosis-- results from the Heinz Nixdorf Recall Study. Atherosclerosis 2009;203: Cooney MT, Dudina AL, Graham IM. Value and limitations of existing scores for the assessment of cardiovascular risk: a review for clinicians. J Am Coll Cardiol 2009;54: Moebus S, Stang A, Möhlenkamp S, Dragano N, Schmermund A, Slomiany U, et al; Heinz Nixdorf Recall Study Group. Association of impaired fasting glucose and coronary artery calcification as a marker of subclinical atherosclerosis in a population-based cohort--results of the Heinz Nixdorf Recall Study. Diabetologia 2009;52: Erbel R, Lehmann N, Möhlenkamp S, Churzidse S, Bauer M, et al; Heinz Nixdorf Recall Study Investigators. Subclinical coronary atherosclerosis predicts cardiovascular risk in different stages of hypertension: result of the Heinz Nixdorf Recall Study. Hypertension 2012;59: Erbel R, Lehmann N, Churzidse S, Möhlenkamp S, Moebus S, et al; Heinz Nixdorf Recall Study Investigators. Genderspecific association of coronary artery calcium and CARDIOVASCULAR MEDICINE KARDIOVASKULÄRE MEDIZIN MÉDECINE CARDIOVASCULAIRE
10 REFERENCES Online appendix lipoprotein parameters: the Heinz Nixdorf Recall Study. Atherosclerosis 2013;229: Dragano N, Verde PE, Moebus S, Stang A, Schmermund A, et al; Heinz Nixdorf Recall Study. Subclinical coronary atherosclerosis is more pronounced in men and women with lower socio-economic status: associations in a population-based study. Coronary atherosclerosis and social status. Eur J Cardiovasc Prev Rehabil 2007;14: Dragano N, Hoffmann B, Stang A, Moebus S, Verde PE, et al; Heinz Nixdorf Recall Study Investigative Group. Subclinical coronary atherosclerosis and neighbourhood deprivation in an urban region. Eur J Epidemiol 2009;24: Hoffmann B, Moebus S, Stang A, Beck EM, Dragano N, et al; Heinz Nixdorf RECALL Study Investigative Group. Residence close to high traffic and prevalence of coronary heart disease. Eur Heart J 2006;27: Hoffmann B, Moebus S, Möhlenkamp S, Stang A, Lehmann N, et al; Heinz Nixdorf Recall Study Investigative Group. Residential exposure to traffic is associated with coronary atherosclerosis. Circulation 2007;116: Möhlenkamp S, Lehmann N, Moebus S, Schmermund A, Dragano N, et al; Heinz Nixdorf Recall Study Investigators. Quantification of coronary atherosclerosis and inflammation to predict coronary events and all-cause mortality. J Am Coll Cardiol 2011;57: Budoff MJ, Rader DJ, Reilly MP, Mohler ER 3rd, Lash J, et al; CRIC Study Investigators. Relationship of estimated GFR and coronary artery calcification in the CRIC (Chronic Renal Insufficiency Cohort) Study. Am J Kidney Dis 2011;58: D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008;117: Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, et al; European Association for Cardiovascular Prevention & Rehabilitation (EACPR); ESC Committee for Practice Guidelines (CPG). European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012;33: Blaha M, Budoff MJ, Shaw LJ, Khosa F, Rumberger JA, et al. Absence of coronary artery calcification and all-cause mortality. JACC Cardiovasc Imaging 2009;2: Min JK, Lin FY, Gidseg DS, Weinsaft JW, Berman DS, et al. Determinants of coronary calcium conversion among patients with a normal coronary calcium scan: what is the warranty period for remaining normal? J Am Coll Cardiol 2010;55: Hecht HS. A zero coronary artery calcium score: priceless. J Am Coll Cardiol 2010;55: Greenland P, Bonow RO, Brundage BH, Budoff MJ, Eisenberg MJ, et al; American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography); Society of Atherosclerosis Imaging and Prevention; Society of Cardiovascular Computed Tomography. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography). Circulation 2007;115: Yeboah J, McClelland RL, Polonsky TS, Burke GL, Sibley CT, et al. Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. JAMA 2012;308: Hermann DM, Gronewold J, Lehmann N, Moebus S, Jöckel KH, et al, Heinz Nixdorf Recall Study Investigative Group. Coronary artery calcification is an independent stroke predictor in the general population. Stroke 2013;44: Gronewold J, Bauer M, Lehmann N, Mahabadi AA, Kälsch H, et al. Coronary artery calcification, intima-media thickness and ankle-brachial index are complementary stroke predictors in the general population. Stroke 2014 (epub ahead of print). CARDIOVASCULAR MEDICINE KARDIOVASKULÄRE MEDIZIN MÉDECINE CARDIOVASCULAIRE
Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults. Learn and Live SM. ACCF/AHA Pocket Guideline
Learn and Live SM ACCF/AHA Pocket Guideline Based on the 2010 ACCF/AHA Guideline Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults November 2010 Guideline for Assessment of Cardiovascular
More informationEvidence-Based ACC/AHA Guidelines for Cardiovascular Risk Assessment
Evidence-Based ACC/AHA Guidelines for Cardiovascular Risk Assessment Nathan D. Wong, PhD, FACC, FAHA Professor and Director Heart Disease Prevention Program Division of Cardiology, University of CA, Irvine
More informationCorporate Medical Policy
Corporate Medical Policy Computed Tomography to Detect Coronary Artery Calcification File Name: computed_tomography_to_detect_coronary_artery_calcification Origination: 3/1994 Last CAP Review 11/2014 Next
More informationWill The Coronary Calcium Score Affect the Decision To Treat With Statins?
Will The Coronary Calcium Score Affect the Decision To Treat With Statins? Amresh Raina M.D. Division of Cardiology University of Pennsylvania Disclosures No financial relationships relevant to this presentation
More informationDISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD
STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with
More informationMetabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007
Metabolic Syndrome Overview: Easy Living, Bitter Harvest Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Evolution of Metabolic Syndrome 1923: Kylin describes clustering
More informationMANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES
MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING
More informationAtherosclerosis of the aorta. Artur Evangelista
Atherosclerosis of the aorta Artur Evangelista Atherosclerosis of the aorta Diagnosis Classification Prevalence Risk factors Marker of generalized atherosclerosis Risk of embolism Therapy Diagnosis Atherosclerosis
More informationMain Effect of Screening for Coronary Artery Disease Using CT
Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,
More informationMultiple comorbidities: additive and predictive of cardiovascular risk. Peter M. Nilsson Lund University University Hospital Malmö, Sweden
Multiple comorbidities: additive and predictive of cardiovascular risk Peter M. Nilsson Lund University University Hospital Malmö, Sweden Clinical outcomes: major complications of CVD Heart Attack/ACS
More informationQ1: Global risk assessment using PROCAM, SCORE, FRAMINGHAM or REYNOLDS ecc is sufficient YES NO NEED MORE DATA DISCUSS within Taskforce Your Comments
Site ID: Q1: Global risk assessment using PROCAM, SCORE, FRAMINGHAM or REYLDS ecc is sufficient Q2: The value of an emerging test is best assessed using C - statistics Q3: Atherosclerosis imaging may be
More informationEfficient Evaluation of Chest Pain
Efficient Evaluation of Chest Pain Vikranth Gongidi, DO FACC FACOI Indian River Medical Center Vero Beach, FL No Disclosures Outline Background Chest pain pathway Indications for stress test Stress test
More information2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk Lynne T Braun, PhD, CNP, FAHA, FAAN Professor of Nursing, Nurse Practitioner Rush University Medical Center 2
More informationYour healthcare provider has ordered a Boston Heart Cardiac Risk Assessment
Your healthcare provider has ordered a Boston Heart Cardiac Risk Assessment What does that mean for you? Your healthcare provider has determined that you may be at risk for cardiovascular disease (CVD).
More informationDesign and principal results
International Task Force for Prevention Of Coronary Heart Disease Coronary heart disease and stroke: Risk factors and global risk Slide Kit 1 (Prospective Cardiovascular Münster Heart Study) Design and
More informationStatins and Risk for Diabetes Mellitus. Background
Statins and Risk for Diabetes Mellitus Kevin C. Maki, PhD, FNLA Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL 1 Background In 2012 the US Food and Drug Administration
More informationListen to your heart: Good Cardiovascular Health for Life
Listen to your heart: Good Cardiovascular Health for Life Luis R. Castellanos MD, MPH Assistant Clinical Professor of Medicine University of California San Diego School of Medicine Sulpizio Family Cardiovascular
More informationAssessing risk of myocardial infarction and stroke: new data from the Prospective Cardiovascular Münster (PROCAM) study
European Journal of Clinical Investigation (2007) 37, 925 932 DOI: 10.1111/j.1365-2362.2007.01888.x Blackwell Publishing Ltd Review Assessing risk of myocardial infarction and stroke: new data from the
More informationPredictive value of clinical risk assessment tools and guidelines for 10-year coronary heart disease risk in practice-based primary care
Kardiovaskuläre Medizin 2005;8:180 186 Michel J. Romanens a, David C. Berger b, Edouard J. Battegay c a b c RODIAG Diagnostic Centers, Olten, Switzerland Student, University Hospital, Basel, Switzerland
More informationHYPERCHOLESTEROLAEMIA STATIN AND BEYOND
HYPERCHOLESTEROLAEMIA STATIN AND BEYOND Andrea Luk Division of Endocrinology Department of Medicine & Therapeutics The Chinese University of Hong Kong HA Convention 4 May 2016 Statins reduce CVD and all-cause
More informationRISK STRATIFICATION for Acute Coronary Syndrome in the Emergency Department
RISK STRATIFICATION for Acute Coronary Syndrome in the Emergency Department Sohil Pothiawala FAMS (EM), MRCSEd (A&E), M.Med (EM), MBBS Consultant Dept. of Emergency Medicine Singapore General Hospital
More informationROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE
ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE I- BACKGROUND: Coronary artery disease and stoke are the major killers in the United States.
More informationPrognostic impact of uric acid in patients with stable coronary artery disease
Prognostic impact of uric acid in patients with stable coronary artery disease Gjin Ndrepepa, Siegmund Braun, Martin Hadamitzky, Massimiliano Fusaro, Hans-Ullrich Haase, Kathrin A. Birkmeier, Albert Schomig,
More informationCardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg
Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg 2 nd Annual Duke Renal Transplant Symposium March 1, 2014 Durham, NC Joseph G. Rogers, M.D. Associate
More informationCardiac Rehabilitation: An Under-utilized Resource Making Patients Live Longer, Feel Better
Cardiac Rehabilitation: An Under-utilized Resource Making Patients Live Longer, Feel Better Marian Taylor, M.D. Medical University of South Carolina Director, Cardiac Rehabilitation I have no disclosures.
More informationTHE RISK DISTRIBUTION CURVE AND ITS DERIVATIVES. Ralph Stern Cardiovascular Medicine University of Michigan Ann Arbor, Michigan. stern@umich.
THE RISK DISTRIBUTION CURVE AND ITS DERIVATIVES Ralph Stern Cardiovascular Medicine University of Michigan Ann Arbor, Michigan stern@umich.edu ABSTRACT Risk stratification is most directly and informatively
More informationThe Canadian Association of Cardiac
Reinventing Cardiac Rehabilitation Outside of acute care institutions, cardiovascular disease is a chronic, inflammatory process; the reduction or elimination of recurrent acute coronary syndromes is a
More informationImaging for Improving Therapy
JACC: CARDIOVASCULAR IMAGING VOL. 6, NO. 5, 2013 2013 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-878X/$36.00 PUBLISHED BY ELSEVIER INC. http://dx.doi.org/10.1016/j.jcmg.2013.04.002 EDITORIAL
More informationHigh sensitivity C-reactive protein (CRP), 1,2 carotid
A Negative Carotid Plaque Area Test Is Superior to Other Noninvasive Atherosclerosis Studies for Reducing the Likelihood of Having Underlying Significant Coronary Artery Disease Robert D. Brook, Robert
More informationCoronary Calcium Scoring and Risk Assessment
Norbert Wilke, MD, F.A.C.C., F.E.S.C. Associate Professor of Radiology Associate Professor of Medicine Courtesy to Franz von Ziegler, MD Univ. of Munich, Germany Coronary Calcium Scoring and Risk Assessment
More informationCOMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION
European Medicines Agency Pre-Authorisation Evaluation of Medicines for Human Use London, 25 September 2008 Doc. Ref. EMEA/CHMP/EWP/311890/2007 COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE
More informationCardiac Rehabilitation The Best Medicine for Your CAD Patients. James A. Stone
James A. Stone BPHE, BA, MSc, MD, PhD, FRCPC, FAACVPR, FACC Clinical Professor of Medicine, University of Calgary Total Cardiology, Calgary Acknowledgements and Disclosures Acknowledgements Jacques Genest
More informationCOMMITTEE FOR HUMAN MEDICINAL PRODUCTS (CHMP) DRAFT GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION
European Medicines Agency London, 19 July 2007 Doc. Ref. EMEA/CHMP/EWP/311890/2007 COMMITTEE FOR HUMAN MEDICINAL PRODUCTS (CHMP) DRAFT GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR
More informationLDL PARTICLE SIZE: DOES IT MATTER? Samia Mora, M.D., M.H.S., Brigham and Women s Hospital, Harvard Medical School, Boston, Massachusetts.
LDL PARTICLE SIZE: DOES IT MATTER? Samia Mora, M.D., M.H.S., Brigham and Women s Hospital, Harvard Medical School, Boston, Massachusetts Introduction While both small and large LDL particles may be atherogenic,
More informationRole of Body Weight Reduction in Obesity-Associated Co-Morbidities
Obesity Role of Body Weight Reduction in JMAJ 48(1): 47 1, 2 Hideaki BUJO Professor, Department of Genome Research and Clinical Application (M6) Graduate School of Medicine, Chiba University Abstract:
More informationCoronary Heart Disease (CHD) Brief
Coronary Heart Disease (CHD) Brief What is Coronary Heart Disease? Coronary Heart Disease (CHD), also called coronary artery disease 1, is the most common heart condition in the United States. It occurs
More informationNew Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine
New Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine Disclosures & Relevant Relationships I have nothing to disclose No financial conflicts Editor,
More informationHôpitaux Universitaires de Genève Lipides, métabolisme des hydrates de carbonne et maladies cardio-vasculaires
Hôpitaux Universitaires de Genève Lipides, métabolisme des hydrates de carbonne et maladies cardio-vasculaires Prof. J. Philippe Effect of estrogens on glucose metabolism : Fasting Glucose, HbA1c and C-Peptide
More informationCoronary Artery Calcium Screening: Does it Perform Better than Other Cardiovascular Risk Stratification Tools?
Int. J. Mol. Sci. 2015, 16, 6606-6620; doi:10.3390/ijms16036606 Review OPEN ACCESS International Journal of Molecular Sciences ISSN 1422-0067 www.mdpi.com/journal/ijms Coronary Artery Calcium Screening:
More informationImproving cardiometabolic health in Major Mental Illness
Improving cardiometabolic health in Major Mental Illness Dr. Adrian Heald Consultant in Endocrinology and Diabetes Leighton Hospital, Crewe and Macclesfield Research Fellow, Manchester University Metabolic
More information6/5/2014. Objectives. Acute Coronary Syndromes. Epidemiology. Epidemiology. Epidemiology and Health Care Impact Pathophysiology
Objectives Acute Coronary Syndromes Epidemiology and Health Care Impact Pathophysiology Unstable Angina NSTEMI STEMI Clinical Clues Pre-hospital Spokane County EMS Epidemiology About 600,000 people die
More informationMarilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL
Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL www.goldcopd.com GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR DIAGNOSIS, MANAGEMENT
More informationA Multi-locus Genetic Risk Score for Abdominal Aortic Aneurysm
A Multi-locus Genetic Risk Score for Abdominal Aortic Aneurysm Zi Ye, 1 MD, Erin Austin, 1,2 PhD, Daniel J Schaid, 2 PhD, Iftikhar J. Kullo, 1 MD Affiliations: 1 Division of Cardiovascular Diseases and
More informationBarriers to Healthcare Services for People with Mental Disorders. Cardiovascular disorders and diabetes in people with severe mental illness
Barriers to Healthcare Services for People with Mental Disorders Cardiovascular disorders and diabetes in people with severe mental illness Dr. med. J. Cordes LVR- Klinikum Düsseldorf Kliniken der Heinrich-Heine-Universität
More informationFor the NXT Investigators
Diagnostic performance of non-invasive fractional flow reserve derived from coronary CT angiography in suspected coronary artery disease: The NXT trial Bjarne L. Nørgaard, Jonathon Leipsic, Sara Gaur,
More informationImaging of Thoracic Endovascular Stent-Grafts
Imaging of Thoracic Endovascular Stent-Grafts Tariq Hameed, M.D. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana Disclosures: No relevant financial
More informationThe WHI 12 Years Later: What Have We Learned about Postmenopausal HRT?
AACE 23 rd Annual Scientific and Clinical Congress (2014) Syllabus Materials: The WHI 12 Years Later: What Have We Learned about Postmenopausal HRT? JoAnn E. Manson, MD, DrPH, FACP, FACE Chief, Division
More informationAbsolute cardiovascular disease risk assessment
Quick reference guide for health professionals Absolute cardiovascular disease risk assessment This quick reference guide is a summary of the key steps involved in assessing absolute cardiovascular risk
More informationFFR CT : Clinical studies
FFR CT : Clinical studies Bjarne Nørgaard Department Cardiology B Aarhus University Hospital Skejby, Denmark Disclosures: Research grants: Edwards and Siemens Coronary CTA: High diagnostic sensitivity
More informationPREVENTIVE CARDIOLOGY CURRICULUM. Overview
PREVENTIVE CARDIOLOGY CURRICULUM Overview The primary goal of the Preventive Cardiology curriculum for the University of Wisconsin Cardiovascular Medicine Fellowship is to provide the knowledge and skills
More informationHow To Prevent A Cardiovascular Event
The Challenges and Benefits of Cardiovascular Risk Assessment in Clinical Practice Steven A Grover MD, MPA From the McGill Cardiovascular Health Improvement Program and the Divisions of General Internal
More informationNoninvasive testing can provide useful information for
CONTINUING EDUCATION Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Noninvasive Risk Stratification and a Conceptual Framework for the Selection of Noninvasive
More informationBMC Med 7/19/2007; Simvastatin linked to reduced incidence of dementia, Parkinson s disease.
March 3, 2012 BD Response to FDA statement regarding Statins The Food and Drug Administration announced on Tuesday (February 28, 2012) the changes to the safety information on the labels of statins regarding
More informationEducation. Panel. Triglycerides & HDL-C
Triglycerides & HDL-C Thomas Dayspring, MD, ACP Clinical Assistant Professor of Medicine University of Medicine and Dentistry of New Jersey Attending in Medicine: St Joseph s s Hospital, Paterson, NJ Certified
More informationSerum testosterone and short-term mortality in men with acute myocardial infarction
ORIGINAL ARTICLE Cardiology Journal 2010, Vol. 17, No. 3, pp. 249 253 Copyright 2010 Via Medica ISSN 1897 5593 Serum testosterone and short-term mortality in men with acute myocardial infarction Constantin
More informationPsoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis
Psoriasis Co-morbidities: Changing Clinical Practice Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology Psoriatic Arthritis Psoriatic Arthritis! 11-31% of patients with psoriasis have psoriatic
More informationFewer people with coronary heart disease are being diagnosed as compared to the expected figures.
JSNA Coronary heart disease 1) Key points 2) Introduction 3) National picture 4) Local picture of CHD prevalence 5) Mortality from coronary heart disease in Suffolk County 6) Trends in mortality rates
More informationPredictive Value of the Framingham Risk Score in Identifying High Cardiovascular Risk
4 Internacional Journal of Cardiovascular Sciences. 2015;28(1):4-8 ORIGINAL MANUSCRIPT Predictive Value of the Framingham Risk Score in Identifying High Cardiovascular Risk Priscila Valente Fernandes 1,
More informationCilostazol versus Clopidogrel after Coronary Stenting
Cilostazol versus Clopidogrel after Coronary Stenting Seong-Wook Park, MD, PhD, FACC Division of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul, Korea AMC, 2004 Background
More informationC-Reactive Protein and Diabetes: proving a negative, for a change?
C-Reactive Protein and Diabetes: proving a negative, for a change? Eric Brunner PhD FFPH Reader in Epidemiology and Public Health MRC Centre for Causal Analyses in Translational Epidemiology 2 March 2009
More informationCardiovascular Disease in Diabetes
Cardiovascular Disease in Diabetes Where Do We Stand in 2012? David M. Kendall, MD Distinguished Medical Fellow Lilly Diabetes Associate Professor of Medicine University of MInnesota Disclosure - Duality
More informationCardiac Rehabilitation An Underutilized Class I Treatment for Cardiovascular Disease
Cardiac Rehabilitation An Underutilized Class I Treatment for Cardiovascular Disease What is Cardiac Rehabilitation? Cardiac rehabilitation is a comprehensive exercise, education, and behavior modification
More informationAll patients presenting to the Emergency Department with symptoms suggestive of
APPENDIX: Online Data Supplements Clinical Trial Inclusion and Exclusion Criteria All patients presenting to the Emergency Department with symptoms suggestive of acute coronary syndrome (ACS) were screened
More informationNon-invasive functional testing in 2014
Non-invasive functional testing in 2014 Bjarne Nørgaard Department Cardiology B Aarhus University Hospital Skejby, Disclosures: Research grants: Edwards and Siemens Non-invasive functional testing in 2014
More informationAtrial Fibrillation 2014 How to Treat How to Anticoagulate. Allan Anderson, MD, FACC, FAHA Division of Cardiology
Atrial Fibrillation 2014 How to Treat How to Anticoagulate Allan Anderson, MD, FACC, FAHA Division of Cardiology Projection for Prevalence of Atrial Fibrillation: 5.6 Million by 2050 Projected number of
More informationCoronary Artery Disease leading cause of morbidity & mortality in industrialised nations.
INTRODUCTION Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations. Although decrease in cardiovascular mortality still major cause of morbidity & burden of disease.
More informationAmy Z. Fan, MD, PhD, University of Southern California, Los Angeles, CA, USA
IS INTIMAL-MEDIAL THICKNESS A PROPER SURROGATE MARKER FOR SMOKING- ASSOCIATED ATHEROSCLEROSIS? Amy Z. Fan, MD, PhD, University of Southern California, Los Angeles, CA, USA Although cigarette smoking is
More informationManagement of Lipids in 2015: Just Give them a Statin?
Management of Lipids in 2015: Just Give them a Statin? James H. Stein, M.D. Division of Cardiovascular Medicine University of Wisconsin School of Medicine and Public Health Stone NJ, et al. Circulation
More informationScreening for for Cardiovascular Disease and Risk Factors
Screening for for Cardiovascular Disease and Risk Factors MOH Clinical Practice Guidelines 1/2011 1/2011 College College of Family of Family Physicians, Physicians, Academy Academy of Medicine, of Medicine,
More informationIs it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics. Yen Tibayan, M.D. Division of Cardiovascular Medicine
Is it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics Yen Tibayan, M.D. Division of Cardiovascular Medicine Case Presentation 69 y.o. woman calls 911 with the complaint of
More informationPHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES.
PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES. Hossam Bahy, MD (1992 2012), 19 tools have been identified 11 stroke scores 1
More informationIndividual Study Table Referring to Part of Dossier: Volume: Page:
2.0 Synopsis AbbVie Inc. Name of Study Drug: Trilipix (ABT-335) Name of Active Ingredient: choline salt of fenofibric acid Individual Study Table Referring to Part of Dossier: Volume: Page: (For National
More informationThe Fatal Pulmonary Artery Involvement in Behçet s Disease
The Fatal Pulmonary Artery Involvement in Behçet s Disease Dr. Vedat Hamuryudan Div. Rheumatology, Dept. Internal Medicine Cerrahpasa Medical Faculty, University of Istanbul 33 years old man Sept 2011:
More informationHow To Treat Dyslipidemia
An International Atherosclerosis Society Position Paper: Global Recommendations for the Management of Dyslipidemia Introduction Executive Summary The International Atherosclerosis Society (IAS) here updates
More informationIs Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient?
Is Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient? --- NIRS-IVUS TVC Imaging Adds Additional Information for the Heart Team Dr. Luis Tami Memorial Regional Hospital
More informationHow can registries contribute to guidelines? Nicolas DANCHIN, HEGP, Paris
How can registries contribute to guidelines? Nicolas DANCHIN, HEGP, Paris Pros and cons of registers Prospective randomised trials constitute the cornerstone of "evidence-based" medicine, and they therefore
More informationTreatment of High Blood Cholesterol in Adults (Adult Treatment Panel II).
Complete Summary GUIDELINE TITLE (1)Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment
More informationECG may be indicated for patients with cardiovascular risk factors
eappendix A. Summary for Preoperative ECG American College of Cardiology/ American Heart Association, 2007 A1 2002 A2 European Society of Cardiology and European Society of Anaesthesiology, 2009 A3 Improvement,
More informationMYOCARDIAL PERFUSION COMPUTED TOMOGRAPHY PhD course in Medical Imaging. Anne Günther Department of Radiology OUS Rikshospitalet
MYOCARDIAL PERFUSION COMPUTED TOMOGRAPHY PhD course in Medical Imaging Anne Günther Department of Radiology OUS Rikshospitalet CORONARY CT ANGIOGRAPHY (CTA) Accurate method in the assessment of possible
More informationNon-Invasive Risk Predictors in (Children with) Pulmonary Hypertension
Ideal risk prognosticator Easy to acquire Non-Invasive Risk Predictors in (Children with) Pulmonary Hypertension Safe -- Non-invasive Robust Gerhard-Paul Diller Astrid Lammers Division of Adult Congenital
More informationINSTEAD at 5-year follow-up shifts the expectations for endovascular treatment
INSTEAD at 5-year follow-up shifts the expectations for endovascular treatment Christoph A. Nienaber, MD, FACC University Heart Center Rostock Department of Medicine I - Cardiology christoph.nienaber@med.uni-rostock.de
More informationVascular Effects of Caffeine
Vascular Effects of Caffeine John P. Higgins MD, MBA, MPHIL, FACC, FACP, FAHA, FACSM, FASNC, FSGC Director of Exercise Physiology Memorial Hermann Sports Medicine Institute Chief of Cardiology, Lyndon
More informationDiabetes and Heart Disease
Diabetes and Heart Disease Diabetes and Heart Disease According to the American Heart Association, diabetes is one of the six major risk factors of cardiovascular disease. Affecting more than 7% of the
More informationAlbumin and All-Cause Mortality Risk in Insurance Applicants
Copyright E 2010 Journal of Insurance Medicine J Insur Med 2010;42:11 17 MORTALITY Albumin and All-Cause Mortality Risk in Insurance Applicants Michael Fulks, MD; Robert L. Stout, PhD; Vera F. Dolan, MSPH
More informationTestosterone and Heart Disease
Testosterone and Heart Disease By Pamela W. Smith, M.D., MPH, MS Introduction Two recent trials suggest that testosterone replacement therapy may increase the risk of heart disease and/or stroke. 1, 2
More informationRheumatoid Factor is a Strong Risk Factor for Coronary Artery Disease in Men with Metabolic Syndrome
Original Article RF is a Risk Factor for CAD in MS Men Acta Cardiol Sin 2010;26:89 93 Coronary Heart Disease Rheumatoid Factor is a Strong Risk Factor for Coronary Artery Disease in Men with Metabolic
More informationRisk Factors for Fire Fighter Cardiovascular Disease
Risk Factors for Fire Fighter Cardiovascular Disease EXECUTIVE SUMMARY Prepared by: Jefferey L. Burgess, MD, MS, MPH Mel and Enid Zuckerman College of Public Health The University of Arizona The Fire Protection
More informationNIHI Big Data in Healthcare Research Case Study
NIHI Big Data in Healthcare Research Case Study Professor Rob Doughty Heart Foundation Chair of Heart Health National Institute for Health Innovation and the Dept of Medicine, University of Auckland &
More informationObjectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History
Preoperative Cardiac Risk Stratification for Noncardiac Surgery Kimberly Boddicker, MD FACC Essentia Health Heart and Vascular Center 27 th Heart and Vascular Conference May 13, 2011 Objectives Summarize
More informationProtocol. Cardiac Rehabilitation in the Outpatient Setting
Protocol Cardiac Rehabilitation in the Outpatient Setting (80308) Medical Benefit Effective Date: 07/01/14 Next Review Date: 09/15 Preauthorization No Review Dates: 07/07, 07/08, 05/09, 05/10, 05/11, 05/12,
More informationOVERVIEW OF THE ADULT TREATMENT PANEL (ATP) III GUIDELINES *
OVERVIEW OF THE ADULT TREATMENT PANEL (ATP) III GUIDELINES * Roger S. Blumenthal, MD INTRODUCTION Although medical evidence suggests that the mortality rates for cardiovascular disease can be significantly
More informationURN: Family name: Given name(s): Address:
State of Queensland (Queensland Health) 2015 Licensed under: http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Contact: Clinical_Pathways_Program@health.qld.gov.au Facility:... Clinical pathways
More informationStroke Risk Scores. CHA 2 DS 2 -VASc. CHA 2 DS 2 -VASc Scoring Table 2
Bleeding/Clotting Risk Evaluation Tools for Atrial Fibrillation Patients Before prescribing anticoagulants, providers should weigh the risk of thrombosis against the risk of bleeding. The tools below can
More informationAbdominal Aortic Aneurysm (AAA) General Information. Patient information Leaflet
Abdominal Aortic Aneurysm (AAA) General Information Patient information Leaflet 1 st July 2016 WHAT IS THE AORTA? The aorta is the largest artery (blood vessel) in the body. It carries blood from the heart
More informationMortality Assessment Technology: A New Tool for Life Insurance Underwriting
Mortality Assessment Technology: A New Tool for Life Insurance Underwriting Guizhou Hu, MD, PhD BioSignia, Inc, Durham, North Carolina Abstract The ability to more accurately predict chronic disease morbidity
More informationNierfunctiemeting en follow-up van chronisch nierlijden
Nierfunctiemeting en follow-up van chronisch nierlijden 12 Jan 2016 Patrick Peeters, M.D. Dept Nephrology Ghent University Hospital Plan of presentation 1/ Renal function determination: Measured GFR Estimated
More informationESC/EASD Pocket Guidelines Diabetes, pre-diabetes and cardiovascular disease
Diabetes, prediabetes and cardiovascular disease Classes of recommendations Levels of evidence Recommended treatment targets for patients with diabetes and CAD Definition, classification and screening
More informationPlatelet Function Testing vs Genotyping : Focus on Pharmacogenomics of Clopidogrel. Kiyuk Chang, M.D., Ph.D.
Platelet Function Testing vs Genotyping : Focus on Pharmacogenomics of Clopidogrel Kiyuk Chang, M.D., Ph.D. Cardiovascular Center & Cardiology Division Seoul St. Mary s Hospital The Catholic University
More informationInternational Task Force for Prevention Of Coronary Heart Disease. Clinical management of risk factors. coronary heart disease (CHD) and stroke
International Task Force for Prevention Of Coronary Heart Disease Clinical management of risk factors of coronary heart disease and stroke Economic analyses of primary prevention of coronary heart disease
More informationR.P. Zecchin*, J. Baihn, Y.Y. Chai, J. Hungerford, G. Lindsay, M. Owen, J. Thelander, D.L. Ross, C. Chow, A.R. Denniss. Westmead Hospital, Sydney,
R.P. Zecchin*, J. Baihn, Y.Y. Chai, J. Hungerford, G. Lindsay, M. Owen, J. Thelander, D.L. Ross, C. Chow, A.R. Denniss. Westmead Hospital, Sydney, Australia Cardiac rehabilitation is an effective and safe
More information