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Stroke Jan 2021Intracranial atherosclerotic disease is a common cause of stroke worldwide. Intracranial vessel wall magnetic resonance imaging may be able to identify imaging... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND PURPOSE
Intracranial atherosclerotic disease is a common cause of stroke worldwide. Intracranial vessel wall magnetic resonance imaging may be able to identify imaging biomarkers of symptomatic plaque. We performed a meta-analysis to evaluate the strength of association of imaging features of symptomatic plaque leading to downstream ischemic events. Effects on the strength of association were also assessed accounting for possible sources of bias and variability related to study design and magnetic resonance parameters.
METHODS
PubMed, Scopus, Web of Science, EMBASE, and Cochrane databases were searched up to October 2019. Two independent reviewers extracted data on study design, vessel wall magnetic resonance imaging techniques, and imaging end points. Per-lesion odds ratios (OR) were calculated and pooled using a bivariate random-effects model. Subgroup analyses, sensitivity analysis, and evaluation of publication bias were also performed.
RESULTS
Twenty-one articles met inclusion criteria (1750 lesions; 1542 subjects). Plaque enhancement (OR, 7.42 [95% CI, 3.35-16.43]), positive remodeling (OR, 5.60 [95% CI, 2.23-14.03]), T1 hyperintensity (OR, 2.05 [95% CI, 1.27-3.32]), and surface irregularity (OR, 4.50 [95% CI, 1.39-8.57]) were significantly associated with downstream ischemic events. T2 signal intensity was not significant (=0.59). Plaque enhancement was significantly associated with downstream ischemic events in all subgroup analyses and showed stronger associations when measured in retrospectively designed studies (=0.02), by a radiologist as a rater (<0.001), and on lower vessel wall magnetic resonance imaging spatial resolution sequences (=0.02).
CONCLUSIONS
Plaque enhancement, positive remodeling, T1 hyperintensity, and surface irregularity emerged as strong imaging biomarkers of symptomatic plaque in patients with ischemic events. Plaque enhancement remained significant accounting for sources of bias and variability in both study design and instrument. Future studies evaluating plaque enhancement as a predictive marker for stroke recurrence with larger sample sizes would be valuable.
Topics: Biomarkers; Blood Vessels; Humans; Intracranial Arteriosclerosis; Magnetic Resonance Imaging; Plaque, Atherosclerotic; Sensitivity and Specificity
PubMed: 33370193
DOI: 10.1161/STROKEAHA.120.031480 -
Frontiers in Cardiovascular Medicine 2022Several clinical trials have indicated that statins stabilize and reverse atherosclerotic plaque. However, different studies have provided inconsistent findings...
OBJECTIVE
Several clinical trials have indicated that statins stabilize and reverse atherosclerotic plaque. However, different studies have provided inconsistent findings regarding mechanisms and influencing factors of plaque regression under statin therapy. Apart from lipid-lowering effect, statins have pleiotropic effects including anti inflammation in humans. In this study, meta-analysis and meta-regression were used to determine the effects of statin medications on coronary plaque volume. Meanwhile, to assess whether statins promote plaque regression effect was related to their anti-inflammatory ability, the impact of CRP/hsCRP reduction during statin therapy on plaque regression was investigated.
METHODS
Up to June 15, 2022, a systematic PubMed, EMBASE, and Cochrane search was performed for randomized controlled trials that assessed treatment effect using total atheroma volume (TAV), percent atheroma volume (PAV), or plaque volume (PV). Only CRP/hsCRP and LDL-C values reported before and after treatment were considered.
RESULTS
12 studies (2,812 patients with heart and/or vascular disease) fulfilled the inclusion criteria and were included in the systematic review. A meta-analysis of 15 statin-treated arms reported a significant reduction in change of TAV/PV [standardized mean difference (SMD): -0.27, 95% confidence intervals (-CI): -0.42, -0.12, < 0.001], compared with the control arms. Another meta-analysis of 7 trials also found that patients in the intervention group had a significant reduction in change of PAV (SMD: -0.16, 95% CI: -0.29, -0.03, = 0.019), compared with those in the control group. Meta-regressionanalysis revealed that the percent change of CRP/hsCRP was significantly associated with SMD in change of TAV/PV after adjusting for percent change of LDL-C, age, gender and study duration. Meta-regression analysis showed that percent change of CRP/hsCRP statistically influenced SMD in change of PAV, when percent change of CRP/hsCRP was included separately. However, the percent change of CRP/hsCRP was not significantly associated with SMD of PAV change after adjusting for all covariates.
CONCLUSION
In conclusion, statin therapy is beneficial for plaque regression. Statins promote plaque regression, which might be associated to their anti-inflammatory ability.
PubMed: 36440015
DOI: 10.3389/fcvm.2022.989527 -
BMC Medicine Sep 2015Virtual histology intravascular ultrasound (VH-IVUS) imaging is an innovative tool for the morphological evaluation of coronary atherosclerosis. Evidence for the effects... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Virtual histology intravascular ultrasound (VH-IVUS) imaging is an innovative tool for the morphological evaluation of coronary atherosclerosis. Evidence for the effects of statin therapy on VH-IVUS parameters have been inconclusive. Consequently, we performed a systematic review and meta-analysis to investigate the impact of statin therapy on plaque volume and its composition using VH-IVUS.
METHODS
The search included PubMed, Cochrane Library, Scopus and Embase (through 30 November 2014) to identify prospective studies investigating the effects of statin therapy on plaque volume and its composition using VH-IVUS.
RESULTS
We identified nine studies with 16 statin treatment arms and 830 participants. There was a significant effect of statin therapy in reducing plaque volume (standardized mean difference (SMD): -0.137, 95 % confidence interval (CI): -0.255, -0.019; P = 0.023), external elastic membrane volume (SMD: -0.097, 95 % CI: -0.183, -0.011; P = 0.027) but not lumen volume (SMD: -0.025, 95 % CI: -0.110, +0.061; P = 0.574). There was a significant reduction in fibrous plaque volume (SMD: -0.129, 95 % CI: -0.255, -0.003; P = 0.045) and an increase of dense calcium volume (SMD: +0.229, 95 % CI: +0.008, +0.450; P = 0.043), while changes in fibro-fatty (SMD: -0.247, 95 % CI: -0.592, +0.098; P = 0.16) and necrotic core (SMD: +0.011, 95 % CI: -0.144, +0.165; P = 0.892) tissue volumes were not statistically significant.
CONCLUSIONS
This meta-analysis indicates a significant effect of statin therapy on plaque and external elastic membrane volumes and fibrous and dense calcium volumes. There was no effect on lumen volume, fibro-fatty and necrotic tissue volumes.
Topics: Cholesterol, LDL; Coronary Artery Disease; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Plaque, Atherosclerotic; Prospective Studies; Treatment Outcome; Ultrasonography
PubMed: 26385210
DOI: 10.1186/s12916-015-0459-4 -
Clinical Imaging Oct 2022A comprehensive understanding of atherosclerotic middle cerebral artery (MCA) plaques aids physicians in diagnosis and treatment of ischemic stroke. High-resolution... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
A comprehensive understanding of atherosclerotic middle cerebral artery (MCA) plaques aids physicians in diagnosis and treatment of ischemic stroke. High-resolution magnetic resonance imaging (MRI) has been used to identify imaging biomarkers of symptomatic MCA plaque. We performed this systematic review and meta-analysis to evaluate which characteristics of MCA plaque are markers of culprit lesions.
MATERIALS AND METHODS
The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for publications up to March 2022. Two independent reviewers extracted data on study design, high-resolution MRI parameters, and imaging end points. Odds ratios (ORs) for the prevalence of stroke with atherosclerotic MCA plaque features were pooled in the meta-analysis by using a random-effects model. Subgroup analysis, sensitivity analysis, and evaluation of publication bias were also conducted.
RESULTS
Seventeen articles were included in this review. Symptomatic MCA plaques were significantly associated with contrast enhancement (OR, 9.4; 95 % CI, 4.3-20.4) and T1 hyperintensity (OR, 6.2; 95 % CI, 2.7-14.3). However, there was no association between symptomatic plaques and T2 hyperintensity (OR, 1.4; 95 % CI, 0.8-2.3). Plaque enhancement was significantly associated with downstream ischemic events in subgroup analyses based on different study designs and MR sequence types.
CONCLUSION
Based on current evidence, contrast enhancement and T1 hyperintensity on high-resolution MRI have high potential as imaging biomarkers of patients with MCA plaques at risk of ischemic events. Future prospective, longitudinal studies of intracranial-plaque high-resolution MRI are required to improve decision-making for the management of intracranial atherosclerotic plaques.
Topics: Atherosclerosis; Humans; Intracranial Arteriosclerosis; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Middle Cerebral Artery; Plaque, Atherosclerotic; Stroke
PubMed: 35952437
DOI: 10.1016/j.clinimag.2022.08.001 -
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 -
JACC. Cardiovascular Imaging Aug 2017The aim of this study was to assess the odds of initiation or continuation of pharmacological and lifestyle preventive therapies in patients with nonzero versus zero... (Meta-Analysis)
Meta-Analysis Review
The Identification of Calcified Coronary Plaque Is Associated With Initiation and Continuation of Pharmacological and Lifestyle Preventive Therapies: A Systematic Review and Meta-Analysis.
OBJECTIVES
The aim of this study was to assess the odds of initiation or continuation of pharmacological and lifestyle preventive therapies in patients with nonzero versus zero coronary artery calcium (CAC) score detected on cardiac computed tomography.
BACKGROUND
Detection of calcified coronary plaque could serve as a motivational tool for physicians and patients to intensify preventive therapies.
METHODS
We searched PubMed, EMBASE (Excerpta Medica database), Web of Science, Cochrane CENTRAL (Cochrane central register of controlled trials), ClinicalTrials.gov, and the International Clinical Trials Registry Platform for studies evaluating the association of CAC scores with downstream pharmacological or lifestyle interventions for prevention of cardiovascular disease. Pooled odds ratios (ORs) of downstream interventions were obtained using the DerSimonian and Laird random effects model.
RESULTS
After a review of 6,256 citations and 54 full-text papers, 6 studies (11,256 participants, mean follow-up time: 1.6 to 6.0 years) were included. Pooled estimates of the odds of aspirin initiation (OR: 2.6; 95% confidence interval [CI]: 1.8 to 3.8), lipid-lowering medication initiation (OR: 2.9; 95% CI: 1.9 to 4.4), blood pressure-lowering medication initiation (OR: 1.9; 95% CI: 1.6 to 2.3), lipid-lowering medication continuation (OR: 2.3; 95% CI: 1.6 to 3.3), increase in exercise (OR: 1.8; 95% CI: 1.4 to 2.4), and dietary change (OR: 1.9; 95% CI: 1.5 to 2.5) were higher in individuals with nonzero CAC versus zero CAC scores, but not for aspirin or blood pressure-lowering medication continuation. When assessed within individual studies, these findings remained significant after adjustment for baseline patient characteristics and cardiovascular risk factors.
CONCLUSIONS
This systematic review and meta-analysis suggests that nonzero CAC score, identifying calcified coronary plaque, significantly increases the likelihood of initiation or continuation of pharmacological and lifestyle therapies for the prevention of cardiovascular disease.
Topics: Adult; Attitude of Health Personnel; Cardiovascular Agents; Chi-Square Distribution; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Female; Health Knowledge, Attitudes, Practice; Humans; Linear Models; Male; Middle Aged; Odds Ratio; Patient Compliance; Plaque, Atherosclerotic; Predictive Value of Tests; Protective Factors; Risk Factors; Risk Reduction Behavior; Time Factors; Treatment Outcome; Vascular Calcification
PubMed: 28797402
DOI: 10.1016/j.jcmg.2017.01.030 -
Frontiers in Pharmacology 2023To systematically evaluate the efficacy and safety of the Chinese medicine detoxification and dredging collaterals in treating carotid atherosclerosis (CAS). A...
To systematically evaluate the efficacy and safety of the Chinese medicine detoxification and dredging collaterals in treating carotid atherosclerosis (CAS). A systematic and comprehensive search of nine relevant domestic and international databases were conducted from their inception until June 2022. The methodological quality of the included trials was evaluated, and the efficacy and safety were comprehensively analyzed. After applying the inclusion and exclusion criteria to the randomized controlled trials (RCTs), the research quality evaluation and data extraction were conducted, followed by a meta-analysis of the selected articles. The Cochrane's Bias risk assessment was utilized to evaluate the quality of the evidence. Of the 2,660 studies initially retrieved, 14 studies were included, involving a total of 1,518 patients. The results of the meta-analysis indicated that the clinical efficacy of the Detoxification and Collateral Dredging method in the treatment of CAS was superior to that of western medicine treatment alone, and the difference was statistically significant [RR = 1.23, 95% CI (1.13, 1.34)] Furthermore, carotid intima-media thickness [Mean Difference (MD) = -0.10, 95% CI (-0.13, -0.08)] and Crouse plaque score [MD = -0.54, 95% CI (-0.75, -0.32)] were significantly lower in the Detoxification and Collateral Dredging group compared to the pure western medicine treatment group. The difference was statistically significant. In addition, serum total cholesterol [MD = -0.70, 95% CI (-0.85, -0.55)] and low-density lipoprotein cholesterol [MD = -0.70, 95% CI (-0.85, -0.55)] were lower in the Detoxification and Collateral Dredging group than in the Western medicine group, with all differences being statistically significant. Serum high-density lipoprotein cholesterol was higher in the Detoxification and Collateral Dredging group compared to the pure western medicine group, and the difference was statistically significant [MD = 0.17, 95% CI (0.11, 0.23)]. The use of Chinese medicine Detoxification and Collateral Dredging approach in the treatment of CAS may offer benefits in improving carotid atherosclerotic plaque and reducing blood lipid levels, with a safety profile superior to that of western medicine treatment alone.
PubMed: 38146459
DOI: 10.3389/fphar.2023.1147964 -
Current Problems in Cardiology Jun 2023Cardiovascular diseases are the leading cause of death worldwide, with atherosclerosis being a prominent risk factor for their development. The current diagnostic... (Review)
Review
Cardiovascular diseases are the leading cause of death worldwide, with atherosclerosis being a prominent risk factor for their development. The current diagnostic criteria for atherosclerosis rely primarily on imaging techniques, including an angiogram. However, current diagnostic procedures fail to provide insights into the plaque's burden and composition. Therefore, nanotechnology is recommended as a novel drug delivery method in treating atherosclerosis and resulting cardiovascular diseases to enhance clinical outcomes. This review discusses the different approaches in which nanotechnology can be applied in the diagnosis and drug delivery of cardiovascular diseases. A systematic review was carried out in line with the PRISMA reporting guidelines, with the literature databases PubMed, Scopus, and Web of Science being screened for relevant literature. Any study that discussed and reported on the application of nanotechnology for either the diagnosis or drug delivery in atherosclerotic patients was included in this review, with each novel design identified in the citations being contrasted to that of the other literature. Moreover, the efficacy of this technology was compared to current diagnostic and drug delivery methods. The search strategy yielded 14 studies relevant to the aims of this review. Nine assessed the therapeutic applications of nanotechnology, 3 solely assessed the diagnostic applications of nanotechnology, and 2 discussed the diagnostic and therapeutic applications. The nanoparticle designs differed significantly between studies; however, all noted a superior therapeutic and diagnostic benefit compared to current approaches to diagnosing and treating atherosclerosis. Multifunctional nanoparticles are a feasible and appropriate novel approach to diagnosing and treating atherosclerosis.
Topics: Humans; Cardiovascular Diseases; Nanotechnology; Drug Delivery Systems; Atherosclerosis; Nanoparticles
PubMed: 36828044
DOI: 10.1016/j.cpcardiol.2023.101671 -
Clinical and Experimental Rheumatology 2018Acute systemic inflammation and chronic systemic vasculitis are associated with endothelial dysfunction and atherosclerotic plaque formation. Studies on cardiovascular... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Acute systemic inflammation and chronic systemic vasculitis are associated with endothelial dysfunction and atherosclerotic plaque formation. Studies on cardiovascular or cerebrovascular events in primary Sjögren's syndrome (pSS) are limited, with conflicting results. This meta-analysis aimed to explore the risk of cardiovascular and cerebrovascular disease in pSS.
METHODS
A comprehensive search of the MEDLINE and EMBASE databases was performed from date of inception through August 2017. The inclusion criterion was observational studies evaluating the association between pSS and cardiovascular disease or cerebrovascular event. Outcomes are diagnosis of ischaemic heart disease, myocardial infarction, ischaemic stroke or haemorrhagic stroke. The pooled odds ratio (OR) of the cerebrovascular event or cardiovascular disease and their 95% confidence interval (CI) were calculated using a random-effect meta-analysis to compare risk between patients with pSS and controls. The between-study heterogeneity of effect-size was quantified using the Q statistic and I2.
RESULTS
Data were extracted from 10 observational studies involving 165,291 subjects. Pooled result demonstrated a significant increase in risk of having cardiovascular disease or cerebrovascular event in pSS patients compared with controls (OR=1.28; 95% CI: 0.11-1.46, p value<0.01, I2=68%). Subgroup analyses showed no difference in risk for cerebrovascular event (OR=1.31; 95% CI: 0.96-1.79, p value=0.09, I2=71%), but an increased risk of cardiovascular disease (OR=1.30; 95% CI: 1.09-1.55, p value=0.003, I2=74%).
CONCLUSIONS
Our study has shown an increased risk of cardiovascular or cerebrovascular disease in patients with pSS. These results support multiple studies' finding of increased arterial stiffness in patients with pSS.
Topics: Adult; Aged; Cardiovascular Diseases; Cerebrovascular Disorders; Chi-Square Distribution; Female; Humans; Male; Middle Aged; Observational Studies as Topic; Odds Ratio; Prognosis; Risk Assessment; Risk Factors; Sjogren's Syndrome
PubMed: 29600936
DOI: No ID Found -
Hormone and Metabolic Research =... Apr 2019High blood pressure is related with increased cerebrovascular accident. High visfatin / NAMPT(nicotinamide phosphoribosyltransferase) plasma levels may promote vascular... (Meta-Analysis)
Meta-Analysis
High blood pressure is related with increased cerebrovascular accident. High visfatin / NAMPT(nicotinamide phosphoribosyltransferase) plasma levels may promote vascular inflammation and atherosclerotic plaque destabilization and have been evaluated as a marker for identifying stages of essential hypertension. However, its role in the pathogenesis of hypertension and cerebrovascular accident (CVA) is still uncertain. In order to review and meta-analyze observational studies investigating visfatin concentration and the risk for hypertension or CVA, a systematic search of PubMed, ovid EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) until December 07, 2016 was performed. After data extraction and quality assessment, a meta-analysis was performed using RevMan 5.3 and STATA 14.0. A total of 1693 adults from 8 studies for hypertension (974 with hypertension) and 1696 adults from 7 CVA studies (957 with CVA) were enrolled in the current meta-analysis. Cochran's Q-statistic and I test were applied to estimate the heterogeneity of the studies. The fixed-effects were used to compute the weighted mean difference in visfatin levels. Plasma visfatin concentration was much higher in hypertension and CVA patients than in healthy individuals. These evidences suggested the association of hypertension and CVA with higher plasma visfatin level.
Topics: Cytokines; Humans; Hypertension; Nicotinamide Phosphoribosyltransferase; Publication Bias; Research Report; Stroke
PubMed: 31022738
DOI: 10.1055/a-0867-1333