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Current Medical Research and Opinion Jun 2016Objective Evidence from coronary imaging studies suggests an association between increased atherosclerotic plaque burden and cardiovascular disease (CVD) outcomes. A... (Review)
Review
Relationship between changes in coronary atherosclerotic plaque burden measured by intravascular ultrasound and cardiovascular disease outcomes: a systematic literature review.
Objective Evidence from coronary imaging studies suggests an association between increased atherosclerotic plaque burden and cardiovascular disease (CVD) outcomes. A systematic review was performed to evaluate the relationship between coronary atherosclerotic plaque burden changes measured by intravascular ultrasound (IVUS) and CVD outcomes. Research design and methods Rigorous systematic review methodology was used to identify prospective studies of any design assessing the relationship between atherosclerotic plaque volume (percentage or total atheroma volume [PAV or TAV]) changes and CVD outcomes, using multivariable analyses. Main outcome measures CVD outcomes including major adverse cardiac events (MACEs) and major adverse cardiac and cerebrovascular events (MACCEs). Results Literature searches from inception to February 2015 retrieved 6958 records after de-duplication. From these four studies (14 papers) were included. One study reported a significantly lower rate of CVD outcomes associated with a greater reduction in PAV (hazard ratio [HR] 0.26, 95% confidence interval [CI] 0.07-0.83). One study reported that large plaque volume was significantly associated with a greater risk of major adverse cardiac events (MACEs) (HR 1.73, 95% CI: 1.02-2.96). Similarly, a third study reported a significant increase in MACE with an increase in baseline PAV (HR 1.51, 95% CI: 1.06-2.51). Only one potentially inadequately powered Japanese study did not find a statistically significant relationship between PAV changes and MACE. Conclusions The current evidence suggests an independent and statistically significant association between increases in coronary atherosclerotic plaque burden measured by IVUS and greater long-term risk of future CVD outcomes. However, this evidence comes from a limited number of studies which mainly focus on Japanese populations and populations after PCI. Further large prospective studies are required to confirm these findings.
Topics: Cardiovascular Diseases; Humans; Plaque, Atherosclerotic; Proportional Hazards Models; Prospective Studies; Ultrasonography, Interventional
PubMed: 26949994
DOI: 10.1185/03007995.2016.1162775 -
Biomedicines Jan 2023Accumulating evidence considers psoriasis a systemic inflammatory disorder that is associated with comorbidities such as psoriatic arthritis, cardiovascular disease, and... (Review)
Review
Accumulating evidence considers psoriasis a systemic inflammatory disorder that is associated with comorbidities such as psoriatic arthritis, cardiovascular disease, and metabolic syndrome. Although the precise pathogenetic links between psoriasis and atherosclerosis warrants further investigation, it is believed that chronic systemic inflammation along with the T helper (Th)-1 and Th17 polarization are associated with endothelial dysfunction and subsequent acceleration of atherosclerosis. Considering the above, several studies have evaluated if optimal control of the inflammation in psoriasis by inhibiting interleukins targeting the Interleukin (IL)-23/Th17 axis could subsequently reduce the atherosclerotic process during anti-psoriatic treatment by using a variety of surrogate markers of subclinical atherosclerosis. This systematic review summarizes current knowledge on the pathogenetic mechanisms and diagnostic evaluation of atherosclerosis in the context of psoriasis and provides a systematic review of the literature on the impact of treatment with biologics targeting the IL-23/Th17 axis on subclinical atherosclerosis in patients with plaque psoriasis and/or psoriatic arthritis.
PubMed: 36830855
DOI: 10.3390/biomedicines11020318 -
Metabolism: Clinical and Experimental Apr 2017Low circulating levels of adiponectin, an anti-inflammatory and vasculoprotective adipokine, are associated with obesity, type 2 diabetes, and atherosclerotic disease.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Low circulating levels of adiponectin, an anti-inflammatory and vasculoprotective adipokine, are associated with obesity, type 2 diabetes, and atherosclerotic disease. Presence of unstable plaques in the carotid artery is a known etiological factor causing ischemic strokes. Herein, we systematically reviewed the association between circulating adiponectin and progression of carotid atherosclerotic disease, particularly evaluating the occurrence of (1) carotid atherosclerotic plaques, (2) ischemic stroke, and (3) mortality in subjects who suffered a previous ischemic stroke.
METHODS
Medline, Embase, Biosis, Scopus, Web of Science, and Pubmed were searched for published studies and conference abstracts. The effect size and 95% confidence intervals (CIs) of the individual studies were pooled using fixed-effect or random-effect models. The quality of the eligible studies was evaluated using the Newcastle-Ottawa quality assessment scale. Sensitivity, subgroup, and meta-regression analyses were performed to address the impact of various risk factors on the association between adiponectin and ischemic stroke risk.
RESULTS
Twelve studies fulfilled the inclusion criteria for 3 independent meta-analyses. The association of increasing circulating adiponectin levels (5μg/mL-increment) with presence of carotid plaque was not conclusive (n=327; OR: 1.07; 95% CI: 0.85-1.35; 2 studies), whereas high adiponectin levels showed a significant 8% increase in risk of ischemic stroke (n=13,683; 7 studies), with a more sizable association observed among men compared to women. HDL was observed to have a marginal effect on the association between adiponectin and ischemic stroke, while other evaluated parameters were not found to be effect modifiers. A non-significant association of adiponectin with mortality was yielded (n=663; OR: 2.58; 95% CI: 0.69-9.62; 3 studies). Although no publication bias was evident, there was significant between-study heterogeneity in most analyses.
CONCLUSION
It appears that the direction of the relationship between adiponectin and carotid atherosclerotic plaque presence is dependent on the duration, severity, and nature of the underlying disease, while increased adiponectin levels were associated with an increase in risk for ischemic stroke. Lastly, the results from the mortality meta-analysis remain inconclusive. Future properly designed studies are necessary to further elucidate the role of adiponectin on atherosclerotic plaque development, and its related outcomes.
Topics: Adiponectin; Brain Ischemia; Carotid Artery Diseases; Humans; Plaque, Atherosclerotic; Risk Assessment; Stroke
PubMed: 28285652
DOI: 10.1016/j.metabol.2017.01.002 -
The European Respiratory Journal Mar 2022Obstructive sleep apnoea and the related intermittent hypoxia (IH) are widely recognised as risk factors for incident cardiovascular diseases. Numerous studies support... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Obstructive sleep apnoea and the related intermittent hypoxia (IH) are widely recognised as risk factors for incident cardiovascular diseases. Numerous studies support the deleterious vascular impact of IH in rodents but an overall interpretation is challenging owing to heterogeneity in rodent species investigated and the severity and duration of IH exposure. To clarify this major issue, we conducted a systematic review and meta-analysis to quantify the impact of IH on systemic artery structure and function depending on the different IH exposure designs.
METHODS
We searched PubMed, Embase and Web of Science, and included 125 articles in a meta-analysis, among them 112 using wild-type rodents and 13 using apolipoprotein E knockout (ApoE) mice. We used the standardised mean difference (SMD) to compare results between studies.
RESULTS
IH significantly increased mean arterial pressure (+13.90 (95% CI 11.88-15.92) mmHg), and systolic and diastolic blood pressure. Meta-regressions showed that mean arterial pressure change was associated with strain and year of publication. IH altered vasodilation in males but not in females and increased endothelin-1-induced but not phenylephrine-induced vasoconstriction. Intima-media thickness significantly increased upon IH exposure (SMD 1.10 (95% CI 0.58-1.62); absolute values +5.23 (2.81-7.84) µm). This increase was observed in mice but not in rats and was negatively associated with age. Finally, IH increased atherosclerotic plaque size in ApoE mice (SMD 1.08 (95% CI 0.80-1.37)).
CONCLUSIONS
Our meta-analysis established that IH, independently of other confounders, has a strong effect on vascular structure and physiology. Our findings support the interest of identifying and treating sleep apnoea in routine cardiology practice.
Topics: Animals; Blood Pressure; Carotid Intima-Media Thickness; Disease Models, Animal; Female; Humans; Hypoxia; Male; Mice; Rats; Rodentia
PubMed: 34413154
DOI: 10.1183/13993003.00866-2021 -
Journal of Neuroradiology = Journal de... Jul 2017Prior studies have demonstrated that statin use stabilizes and diminishes atherosclerotic lesions. The main objective of this systematic review and meta-analysis was to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND PURPOSE
Prior studies have demonstrated that statin use stabilizes and diminishes atherosclerotic lesions. The main objective of this systematic review and meta-analysis was to study the effects of statin therapy on carotid plaque composition as seen on serial high-resolution carotid plaque MRI. We hypothesized that statin therapy would result in significant improvements in lipid-rich-necrotic-core (LRNC) volumes, wall volumes and lumen volumes.
MATERIALS AND METHODS
Prospective studies using serial high-resolution carotid plaque MRI (1.5 or 3T only) in patients on statin therapy to document changes in carotid plaque composition were included. All studies had a minimum of 10 patients and minimum follow-up duration of 3 months. Outcomes included change in LRNC volume, wall volume, and lumen volume at: (1) 1-6 months; (2) 7-12 months; (3) >12 months following initiation of statin therapy; and (4) at last follow-up. Meta-analysis was performed using the random effects model. Results were reported as weighted mean differences (WMD) and 95% confidence interval (CI).
RESULT
Seven studies including 361 patients were included. There was no significant change in carotid wall volume or lumen volume at any time points. While there was no significant difference in LRNC at 1-6 months and at 7-12 months following initiation of statin therapy; at >12 months, there was significant decrease in LRNC volume (WMD=-9.9mm, 95% CI=-8.9, -2.3).
CONCLUSIONS
Our study suggests statin therapy is associated with significant reductions in LRNC at 1-year of statin therapy on serial carotid MRI. However, no significant reduction in carotid wall volume was seen.
Topics: Carotid Artery Diseases; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Magnetic Resonance Imaging; Plaque, Atherosclerotic
PubMed: 28187866
DOI: 10.1016/j.neurad.2016.12.004 -
Echocardiography (Mount Kisco, N.Y.) Aug 2022Contrast-enhanced ultrasound (CEUS) is a promising imaging modality for the assessment of plaque vulnerability. We aimed to systematically review and meta-analyze the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Contrast-enhanced ultrasound (CEUS) is a promising imaging modality for the assessment of plaque vulnerability. We aimed to systematically review and meta-analyze the ability of CEUS parameters to differentiate between symptomatic and asymptomatic carotid plaques and to assess its reproducibility.
METHODS
PubMed, EMBASE, and Cochrane Library databases were searched for studies that potentially evaluated carotid plaques using CEUS. From the initial 2870 searches, 11 relevant publications comprising a total of 821 carotid plaques were reviewed. Data on CEUS parameters including quantitative and semi-quantitative parameters were extracted and analyzed.
RESULTS
The overall analysis showed significantly higher CEUS parameters in symptomatic carotid plaques compared to asymptomatic carotid plaques (standardised mean difference (SMD) .95, 95% confidence interval (CI) .56-1.27, p < .01). Intra and inter-observer reproducibility of quantitative CEUS parameters were excellent (intra-observer, r = .95, 95% CI .87-1; inter-observer, r = .93, 95% CI .80-.1). Semi-quantitative CEUS parameters showed good intra-observer reliability and moderate inter-observer reliability (intra-observer, r = .77, 95% CI .64-.89; inter-observer, r = .75, 95% CI .61-.89). Heterogeneity among studies compared CEUS parameters in symptomatic and asymptomatic plaques and studies assessed inter-observer reproducibility, and significant biases in studies assessing CEUS reproducibility were present.
CONCLUSION
CEUS is a useful vascular imaging method to differentiate between symptomatic and asymptomatic carotid plaques with moderate to excellent reproducibility. Quantitative CEUS analysis appeared to be more sensitive and reliable in assessing carotid plaques than semi-quantitative parameters. Further longitudinal prospective trials evaluating carotid plaque in asymptomatic population using CEUS to determine plaque characteristics that can become symptomatic are required.
Topics: Carotid Arteries; Carotid Stenosis; Contrast Media; Humans; Plaque, Atherosclerotic; Prospective Studies; Reproducibility of Results; Ultrasonography
PubMed: 35768892
DOI: 10.1111/echo.15407 -
Tomography (Ann Arbor, Mich.) May 2022Coronary optical coherence tomography (OCT) is an intravascular, near-infrared light-based imaging modality capable of reaching axial resolutions of 10-20 µm. This... (Review)
Review
Coronary optical coherence tomography (OCT) is an intravascular, near-infrared light-based imaging modality capable of reaching axial resolutions of 10-20 µm. This resolution allows for accurate determination of high-risk plaque features, such as thin cap fibroatheroma; however, visualization of morphological features alone still provides unreliable positive predictive capability for plaque progression or future major adverse cardiovascular events (MACE). Biomechanical simulation could assist in this prediction, but this requires extracting morphological features from intravascular imaging to construct accurate three-dimensional (3D) simulations of patients' arteries. Extracting these features is a laborious process, often carried out manually by trained experts. To address this challenge, numerous techniques have emerged to automate these processes while simultaneously overcoming difficulties associated with OCT imaging, such as its limited penetration depth. This systematic review summarizes advances in automated segmentation techniques from the past five years (2016-2021) with a focus on their application to the 3D reconstruction of vessels and their subsequent simulation. We discuss four categories based on the feature being processed, namely: coronary lumen; artery layers; plaque characteristics and subtypes; and stents. Areas for future innovation are also discussed as well as their potential for future translation.
Topics: Coronary Artery Disease; Humans; Imaging, Three-Dimensional; Plaque, Atherosclerotic; Tomography, Optical Coherence
PubMed: 35645394
DOI: 10.3390/tomography8030108 -
International Journal of Medical... 2023Smoking is a risk factor of acute coronary syndrome (ACS) that could increase matrix metalloproteinases (MMPs) levels, leading to unstable coronary artery plaque. The... (Meta-Analysis)
Meta-Analysis Review
Smoking is a risk factor of acute coronary syndrome (ACS) that could increase matrix metalloproteinases (MMPs) levels, leading to unstable coronary artery plaque. The current review aimed to identify the relationship between smoking and MMPs in patients with ACS. Literature search was conducted from inception until March 2022 in three online databases. Risk of bias was assessed using the Newcastle-Ottawa Scale. A meta-analysis was performed, and the odds ratio (OR) together with its 95% confidence interval (CI) were determined. A total of 7,843 articles were identified, and only seven studies were included. Four studies investigated the MMP-3 and MMP-9 related genes and found that smokers with certain MMPs genotypes had high risk of ACS. Smoking also increased the MMPs level in patients with ACS compared with non-smokers. Additionally, a meta-analysis of two studies resulted in an increased odd of ACS in smokers with MMP-3 5A allele versus non-smokers with MMP-3 6A6A allele (OR: 15.94, 95% CI: 10.63-23.92; =55%). In conclusion, the current review highlights the role of MMPs in relation to smoking and ACS. The determination of these roles may help in identifying new ACS markers among smokers and the development of drug-targeted treatment.
Topics: Humans; Coronary Artery Disease; Acute Coronary Syndrome; Matrix Metalloproteinase 3; Plaque, Atherosclerotic; Smoking
PubMed: 37057211
DOI: 10.7150/ijms.79889 -
High Coronary Wall Shear Stress Worsens Plaque Vulnerability: A Systematic Review and Meta-Analysis.Angiology Sep 2021The aim of this meta-analysis is to assess the impact of wall shear stress (WSS) severity on arterial plaque vulnerability. (Meta-Analysis)
Meta-Analysis
AIM
The aim of this meta-analysis is to assess the impact of wall shear stress (WSS) severity on arterial plaque vulnerability.
METHODS
We systematically searched electronic databases and selected studies which assessed the relationship between WSS measured by intravascular ultrasound and coronary artery plaque features. In 7 studies, a total of 615 patients with 28 276 arterial segments (median follow-up: 7.71 months) were identified. At follow-up, the pooled analysis showed high WSS to be associated with regression of plaque fibrous area, weighted mean difference (WMD) -0.11 (95% CI: -0.20 to -0.02, = .02) and fibrofatty area, WMD -0.09 (95% CI: -0.17 to -0.01, = .02), reduction in plaque total area, WMD -0.09 (95% CI: -0.14 to -0.04, = .007) and increased necrotic core area, and WMD 0.04 (95% CI: 0.01-0.09, = .03) compared with low WSS. Dense calcium deposits remained unchanged in high and low WSS (0.01 vs 0.02 mm; > .05). High WSS resulted in profound remodeling (40% vs 18%, < .05) and with more constructive remodeling than low WSS (78% vs 40%, < .01).
CONCLUSIONS
High WSS in coronary arteries is associated with worsening plaque vulnerability and more profound arterial wall remodeling compared with low WSS.
Topics: Adult; Aged; Coronary Artery Disease; Coronary Circulation; Coronary Vessels; Female; Hemodynamics; Humans; Male; Middle Aged; Plaque, Atherosclerotic; Prognosis; Risk Assessment; Risk Factors; Rupture, Spontaneous; Stress, Mechanical; Ultrasonography, Interventional; Vascular Remodeling
PubMed: 33535802
DOI: 10.1177/0003319721991722 -
European Journal of Vascular and... Aug 2018The role of positron emission tomography (PET)/computed tomography (CT) in the determination of inflammation in arterial disease is not well defined. This can provide... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The role of positron emission tomography (PET)/computed tomography (CT) in the determination of inflammation in arterial disease is not well defined. This can provide information about arterial wall inflammation in atherosclerotic disease, and may give insight into plaque stability. The aim of this review was to perform a meta-analysis of PET/CT with F-FDG (fluorodeoxyglucose) uptake in symptomatic and asymptomatic carotid artery disease.
METHODS
This was a systematic review, following PRISMA guidelines, which interrogated the MEDLINE database from January 2001 to May 2017. The search combined the terms, "inflammation", "FDG", and "stroke". The search criteria included all types of studies, with a primary outcome of the degree of arterial vascular inflammation determined by F-FDG uptake. Analysis involved an inverse weighted variance estimate of pooled data, using a random effects model.
RESULTS
A total of 14 articles (539 patients) were included in the meta-analysis. Comparing carotid artery F-FDG uptake in symptomatic versus asymptomatic disease yielded a standard mean difference of 0.94 (95% CI 0.58-1.130; p < .0001; I = 65%).
CONCLUSIONS
PET/CT using F-FDG can demonstrate carotid plaque inflammation, and is a marker of symptomatic disease. Further studies are required to understand the clinical implication of PET/CT as a risk prediction tool.
Topics: Aged; Asymptomatic Diseases; Carotid Arteries; Carotid Artery Diseases; Chi-Square Distribution; Female; Fluorodeoxyglucose F18; Humans; Male; Plaque, Atherosclerotic; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Prognosis; Radiopharmaceuticals
PubMed: 29730127
DOI: 10.1016/j.ejvs.2018.03.028