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Frontiers in Bioscience (Elite Edition) Jan 2020We investigated coronary heart disease (CHD) and cardiovascular disease (CVD) event rates in a diverse population with a coronary artery calcium score (CACS) of 0 and... (Meta-Analysis)
Meta-Analysis
We investigated coronary heart disease (CHD) and cardiovascular disease (CVD) event rates in a diverse population with a coronary artery calcium score (CACS) of 0 and the role of CACS in the detection of subclinical noncalcified atherosclerotic plaque. A total of 15,884 participants in five studies were included in this meta-analysis. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated. The results showed that CHD incidence significantly increased with increased CACS (HR=0.05, 95% CI 0.03-0.06, Z=5.82, P=0.002). The CHD rate was low and further increased with CACS of 101-300. With CACS >300, the CHD rate was highest. Similarly, CVD rate was low with CACS of 0, increased with CACS of 1-100 (HR=0.03, 95% CI 0.01-0.06, Z=1.66, P=0.096), and further increased with CACS of 101-300. With CACS >300, the CVD rate was highest. Clinical evidence indicated that the higher the CACS, the higher the CHD and CVD rates, while the CVD rate does not always decreased compared with CHD rate with the same CACS, especially with CACS of 0.
Topics: Coronary Artery Disease; Humans; Predictive Value of Tests; Severity of Illness Index; Vascular Calcification
PubMed: 31585873
DOI: 10.2741/E861 -
Imaging endpoints of intracranial atherosclerosis using vessel wall MR imaging: a systematic review.Neuroradiology Jun 2021The vessel wall MR imaging (VWI) literature was systematically reviewed to assess the criteria and measurement methods of VWI-related imaging endpoints for symptomatic...
PURPOSE
The vessel wall MR imaging (VWI) literature was systematically reviewed to assess the criteria and measurement methods of VWI-related imaging endpoints for symptomatic intracranial plaque in patients with ischemic events.
METHODS
PubMed, Scopus, Web of Science, EMBASE, and Cochrane databases were searched up to October 2019. Two independent reviewers extracted data from 47 studies. A modified Guideline for Reporting Reliability and Agreement Studies was used to assess completeness of reporting.
RESULTS
The specific VWI-pulse sequence used to identify plaque was reported in 51% of studies. A VWI-based criterion to define plaque was reported in 38% of studies. A definition for culprit plaque was reported in 40% of studies. Frequently scored qualitative imaging endpoints were plaque quadrant (21%) and enhancement (21%). Frequently measured quantitative imaging endpoints were stenosis (19%), lumen area (15%), and remodeling index (14%). Reproducibility for all endpoints ranged from good to excellent (range: ICC = 0.451 to ICC = 0.983). However, rater specialty and years of experience varied among studies.
CONCLUSIONS
Investigators are using different criteria to identify and measure VWI-imaging endpoints for culprit intracranial plaque. Early awareness of these differences to address methods of acquisition and measurement will help focus research resources and efforts in technique optimization and measurement reproducibility. Consensual definitions to detect plaque will be important to develop automatic lesion detection tools particularly in the era of radiomics.
Topics: Humans; Intracranial Arteriosclerosis; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Plaque, Atherosclerotic; Reproducibility of Results
PubMed: 33029735
DOI: 10.1007/s00234-020-02575-w -
Journal of Vascular Surgery Jun 2021Restenosis after carotid endarterectomy (CEA) limits its long-term efficacy for stroke prevention. Thus, it is of utmost importance to identify the factors that...
OBJECTIVE
Restenosis after carotid endarterectomy (CEA) limits its long-term efficacy for stroke prevention. Thus, it is of utmost importance to identify the factors that predispose a patient to restenosis after CEA. This systemic review aims to survey the current literature regarding restenosis after CEA and discuss the predictive value of carotid plaque features.
METHODS
A systemic review of studies on the predictive value of carotid plaque features for restenosis after CEA was conducted according to the PRISMA guidelines. PubMed/MEDLINE and Embase databases were searched up to March 20, 2020. Two authors independently extracted the data and assessed the risk of bias with the Quality in Prognosis Studies tool. Given the heterogeneity in the measurement of prognostic factors, types of CEA, and clinical outcomes, a qualitative synthesis was performed.
RESULTS
Twenty-one articles with a sample size that ranged from 11 to 1203 were included in this systematic review. Based on the presence of calcification in original carotid plaques, two progression patterns of restenosis were hypothesized: patients with calcified plaques may experience a temporary increase in the intima-media thickness (IMT) followed by a decrease in IMT after CEA, whereas patients with noncalcified plaques may experience a gradual increase in IMT after CEA. Accordingly, patients with a high calcium score may have a high restenosis rate within 6 months after CEA and a low restenosis rate thereafter. Thus, the late restenosis rate in patients with uniformly echogenic plaques was lower than that in patients with uniformly echolucent plaques. Pathologically, a lipid-rich, inflammatory carotid plaque is associated with a decreased risk of restenosis within 1 year after CEA, mainly owing to the relatively mild reactive intimal hyperplasia at the surgical site and active inflammation in the remaining media and adventitia. Molecular predictors for restenosis included a Mannose-binding lectin 2 genotype, preoperative C-reactive protein, serum homocysteine, apolipoprotein J, vitamin C, and telomere length of carotid plaques.
CONCLUSIONS
This review demonstrated that carotid plaque features, including imaging features, cellular composition, and molecular features, are correlated with the risk of restenosis after CEA. A comprehensive evaluation of plaque characteristics may help to stratify the risk of restenosis after CEA.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Carotid Stenosis; Endarterectomy, Carotid; Female; Humans; Male; Middle Aged; Neointima; Plaque, Atherosclerotic; Recurrence; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Vascular Calcification
PubMed: 33253876
DOI: 10.1016/j.jvs.2020.10.084 -
Stroke Jan 2020Background and Purpose- An ipsilateral mild carotid stenosis, defined as plaque with <50% luminal narrowing, is identified in nearly 40% of patients with embolic stroke... (Meta-Analysis)
Meta-Analysis
Background and Purpose- An ipsilateral mild carotid stenosis, defined as plaque with <50% luminal narrowing, is identified in nearly 40% of patients with embolic stroke of undetermined source and could represent an unrecognized source of atheroembolism. We aimed to summarize data about the frequency of mild carotid stenosis with high-risk features in embolic stroke of undetermined source. Methods- We searched Pubmed and Ovid-Embase for studies reporting carotid plaque imaging features in embolic stroke of undetermined source. The prevalence of ipsilateral and contralateral mild carotid stenosis with high-risk features was pooled using random-effect meta-analysis. Results- Eight studies enrolling 323 participants were included. The prevalence of mild carotid stenosis with high-risk features in the ipsilateral carotid was 32.5% (95% CI, 25.3-40.2) compared with 4.6% (95% CI, 0.1-13.1) in the contralateral carotid. The odds ratio of finding a plaque with high-risk features in the ipsilateral versus the contralateral carotid was 5.5 (95% CI, 2.5-12.0). Conclusions- Plaques with high-risk features are 5 times more prevalent in the ipsilateral compared with the contralateral carotid in embolic stroke of undetermined source, suggesting a relationship to stroke risk.
Topics: Aged; Carotid Stenosis; Female; Humans; Intracranial Embolism; Male; Plaque, Atherosclerotic; Risk Factors; Ultrasonography
PubMed: 31752616
DOI: 10.1161/STROKEAHA.119.027272 -
PloS One 2017Diets rich in flavonoids have been reported to have beneficial effects in the primary prevention of cardiovascular events. There are limited data, however, on the... (Meta-Analysis)
Meta-Analysis Review
Diets rich in flavonoids have been reported to have beneficial effects in the primary prevention of cardiovascular events. There are limited data, however, on the cardiovascular benefits of purified flavonoids. The aim of this systematic review and meta-analysis was to examine the reported effects of isolated flavonoids on aortic atherosclerosis in a mouse model. Medline, Pubmed, Science direct and Web of Science were searched to identify studies which examined the effect of isolated flavonoids on aortic atherosclerosis in apolipoprotein E deficient mice. A meta-analysis was performed to determine the overall effect of the flavonoids, and sub-analyses were performed to compare the effects of the flavonols and flavan-3-ols. Eleven studies, which examined a total of 208 mice receiving a flavonoid and 126 control mice, were included. Overall the flavonoids significantly reduced aortic atherosclerosis (SMD 1.10, 95% CI 0.69, 1.51). Of the 18 flavonoid interventions examined 12 were flavonols and 3 were flavan-3-ols. Sub-analyses suggested that the flavonols (SMD 1.31, 95% CI 0.66, 1.91) but not the flavan-3-ols (SMD 0.33, 95% CI -0.19, 0.85) significantly decreased atherosclerosis area. Of the eleven studies, only one examined histological markers of atherosclerosis plaque stability. Most studies did not report blinding of outcome assessors or reproducibility of the primary outcome, and did not justify the sample size used and flavonoid dose administered. Based on the included studies, the flavonols appear to be the most effective flavonoids for reducing aortic atherosclerotic lesion area in apolipoprotein E deficient mice.
Topics: Animals; Apolipoproteins E; Coronary Artery Disease; Flavonols; Humans; Mice
PubMed: 28742839
DOI: 10.1371/journal.pone.0181832 -
Frontiers in Cardiovascular Medicine 2021Statin therapy is an essential component of cardiovascular preventive care. In recent years, various vessel wall MRI (VW-MRI) techniques have been used to monitor...
Assessment of Therapeutic Response to Statin Therapy in Patients With Intracranial or Extracranial Carotid Atherosclerosis by Vessel Wall MRI: A Systematic Review and Updated Meta-Analysis.
Statin therapy is an essential component of cardiovascular preventive care. In recent years, various vessel wall MRI (VW-MRI) techniques have been used to monitor atherosclerosis progression or regression in patients with extracranial or intracranial large-artery atherosclerosis. We aimed to perform a systematic review and meta-analysis on the effects of statin therapy on plaque evolution as assessed by VW-MRI. Prospective studies investigating carotid and intracranial atherosclerotic plaques in patients on statin therapy monitored by serial VW-MRI were systematically identified in the literature. The plaque burden and lipid-rich necrotic core (LRNC) volume of carotid plaque and the imaging features of intracranial plaques were extracted and summarized. For studies investigating carotid artery wall volume and LRNC volume, combined estimates were derived by meta-analysis. The study identified 21 studies of carotid plaque and two studies of intracranial plaque. While 16 studies investigating carotid plaques that included 780 patients by High-resolution VW-MRI were included in the meta-analysis. There was no significant change in carotid wall volume from baseline to 12 months. A significant change in LRNC volume was observed at > 12 months compared with baseline (Effect = -10.69, 95% CI = -19.11, -2.28, < 1), while no significant change in LRNC volume at 3-6 months or 7-12 months after statin therapy initiation in 6 studies. Increases in fibrous tissue and calcium and reduction in neovascularization density of the plaque were seen in 2/3 studies (including 48/59 patients), 1/3 studies (including 17/54 patients), and 2/2 studies (including 71 patients) after statin therapy, respectively. Two studies with 257 patients in intracranial atherosclerosis showed that statins could effectively decrease wall volume and plaque enhancement volume. Collective data indicated that statins could potentially stabilize carotid plaques by significantly reducing LRNC with 1 year of therapy as shown on serial carotid VW-MRI. There was no significant decrease in wall volume, which nonetheless indicated that plaque composition changes might be more sensitive to response monitoring than wall volume. It is likely that more sensitive, clinically relevant, and preferably quantitative indicators of therapeutic effects on intracranial vessel plaque morphology will be developed in the future.
PubMed: 34778404
DOI: 10.3389/fcvm.2021.742935 -
American Journal of Physiology. Heart... Apr 2021Atherosclerosis is a dynamic process starting with endothelial dysfunction and inflammation and eventually leading to life-threatening arterial plaques. Exercise...
Atherosclerosis is a dynamic process starting with endothelial dysfunction and inflammation and eventually leading to life-threatening arterial plaques. Exercise generally improves endothelial function in a dose-dependent manner by altering hemodynamics, specifically by increased arterial pressure, pulsatility, and shear stress. However, athletes who regularly participate in high-intensity training can develop arterial plaques, suggesting alternative mechanisms through which excessive exercise promotes vascular disease. Understanding the mechanisms that drive atherosclerosis in sedentary versus exercise states may lead to novel rehabilitative methods aimed at improving exercise compliance and physical activity. Preclinical tools, including in vitro cell assays, in vivo animal models, and in silico computational methods, broaden our capabilities to study the mechanisms through which exercise impacts atherogenesis, from molecular maladaptation to vascular remodeling. Here, we describe how preclinical research tools have and can be used to study exercise effects on atherosclerosis. We then propose how advanced bioengineering techniques can be used to address gaps in our current understanding of vascular pathophysiology, including integrating in vitro, in vivo, and in silico studies across multiple tissue systems and size scales. Improving our understanding of the antiatherogenic exercise effects will enable engaging, targeted, and individualized exercise recommendations to promote cardiovascular health rather than treating cardiovascular disease that results from a sedentary lifestyle.
Topics: Animals; Arteries; Atherosclerosis; Bioengineering; Cells, Cultured; Computer Simulation; Disease Models, Animal; Endothelium, Vascular; Exercise Therapy; Hemodynamics; Humans; Microfluidic Analytical Techniques; Models, Cardiovascular; Plaque, Atherosclerotic; Sedentary Behavior
PubMed: 33385323
DOI: 10.1152/ajpheart.00719.2020 -
Journal of Interventional Cardiology Dec 2015We conducted a systematic review and meta-analysis to evaluate the effect of statin therapy on coronary fibrous cap thickness (FCT) as assessed by optical coherence... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
We conducted a systematic review and meta-analysis to evaluate the effect of statin therapy on coronary fibrous cap thickness (FCT) as assessed by optical coherence tomography (OCT) and the relationship between FCT and traditional coronary risk factors.
BACKGROUND
Increasing evidence has shown that statin therapy results in a marked increase in coronary FCT. However, the relationship between this increase in FCT and the lipid profile has not been clearly elucidated.
METHODS
A literature search of PubMed, Embase, the Cochrane Library, and Web of Science up to March 17, 2015 was performed. Studies providing data on FCT using OCT at baseline and follow-up in patients receiving statin therapy were included. Weighted mean difference (WMD) with a random-effects model was used.
RESULTS
Six OCT studies were included. The FCT in coronary plaques was significantly increased after statin therapy (WMD: 58.79 μm, 95% CI 33.82-83.76 μm, P < 0.001). When compared with the placebo group, the increase in FCT was also greater in the statin group (WMD: 72.28 μm, 95% CI 44.97-99.58 μm, P < 0.001). Meta regression analysis demonstrated no significant correlations between the increase in FTC and the changes in total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol levels during follow-up. Similarly, there were no significant correlations between the increase in FCT and age, male gender, hypertension, diabetes, and smoking.
CONCLUSIONS
Statin therapy induced a significant increase in coronary FCT evaluated by OCT. This increase in FCT was independent of traditional coronary risk factors including the lipid profile.
Topics: Aged; Cholesterol, LDL; Coronary Artery Disease; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Plaque, Atherosclerotic; Tomography, Optical Coherence
PubMed: 26487187
DOI: 10.1111/joic.12245 -
Atherosclerosis Aug 2019Intracranial atherosclerotic plaque is associated with ischemic strokes without substantial stenosis, and needs better characterization. We aim to investigate the...
BACKGROUND AND AIMS
Intracranial atherosclerotic plaque is associated with ischemic strokes without substantial stenosis, and needs better characterization. We aim to investigate the clinical significance of intracranial plaque without substantial stenosis by high resolution vessel wall MRI (vwMRI) through a systematic review of existing studies.
METHODS
Studies investigating intracranial arterial atherosclerotic plaques without substantial stenosis in acute ischemic stroke patients using vwMRI were systematically identified by searching the PubMed and Medline database and article reference lists. Study characteristics were recorded, the methodological quality of eligible studies was assessed, relevant clinical data were extracted, and collective data was analyzed.
RESULTS
Twenty-one studies were identified as eligible. 463 patients were included without stenosis of the intracranial arteries, and 651 patients were included with stenosis <50%. The prevalence of intracranial plaque revealed by vwMRI among acute/subacute ischemic stroke patients with non-stenotic Magnetic Resonance Angiography (MRA) was 50.6% (95% confidence interval (CI), 46.1%-55.1%). The prevalence of <50% MRA stenotic culprit plaque among acute/subacute ischemic stroke patients with a clinical diagnosis of intracranial atherosclerosis was 51.2% (95% CI, 38.4%-64.0%). Plaques features, including wall enhancement, positive remodeling, intraplaque hemorrhage, plaque location and eccentricity, were associated with acute stroke, progressive motor deficits and unfavorable overall functional outcomes.
CONCLUSIONS
Intracranial high-risk plaque with zero or mild degree of stenosis is more prevalent than previously acknowledged, and is associated with ischemic stroke and unfavorable outcome. VwMRI can identify the high-risk plaque features, which may act as a promising tool to better risk stratify these patients.
Topics: Brain Ischemia; Cerebral Arteries; Humans; Imaging, Three-Dimensional; Intracranial Arteriosclerosis; Magnetic Resonance Angiography; Plaque, Atherosclerotic
PubMed: 31254918
DOI: 10.1016/j.atherosclerosis.2019.06.907 -
Frontiers in Cardiovascular Medicine 2021Inflammation plays a key role in atherosclerotic plaque destabilization and adverse cardiac remodeling. Recent evidence has shown a promising role of colchicine in...
Inflammation plays a key role in atherosclerotic plaque destabilization and adverse cardiac remodeling. Recent evidence has shown a promising role of colchicine in patients with coronary artery disease. We evaluated the efficacy and safety of colchicine in post-acute myocardial infarction (MI) patients. We searched five electronic databases from inception to January 18, 2021, for randomized controlled trials (RCTs) evaluating colchicine in post-acute MI patients. Primary outcomes were cardiovascular mortality and recurrent MI. Secondary outcomes were all-cause mortality, stroke, urgent coronary revascularization, levels of follow-up high-sensitivity C-reactive protein (hs-CRP), and drug-related adverse events. All meta-analyses used inverse-variance random-effects models. Six RCTs involving 6,005 patients were included. Colchicine did not significantly reduce cardiovascular mortality [risk ratio (RR), 0.91; 95% confidence interval (95% CI), 0.52-1.61; = 0.64], recurrent MI (RR, 0.87; 95% CI, 0.62-1.22; = 0.28), all-cause mortality (RR, 1.06; 95% CI, 0.61-1.85; = 0.78), stroke (RR, 0.28; 95% CI, 0.07-1.09; = 0.05), urgent coronary revascularization (RR, 0.46; 95% CI, 0.02-8.89; = 0.19), or decreased levels of follow-up hs-CRP (mean difference, -1.95 mg/L; 95% CI, -12.88 to 8.98; = 0.61) compared to the control group. There was no increase in any adverse events (RR, 0.97; 95% CI, 0.89-1.07; = 0.34) or gastrointestinal adverse events (RR, 2.49; 95% CI, 0.48-12.99; = 0.20). Subgroup analyses by colchicine dose (0.5 vs. 1 mg/day), time of follow-up (<1 vs. ≥1 year), and treatment duration (≤30 vs. >30 days) showed no changes in the overall findings. In post-acute MI patients, colchicine does not reduce cardiovascular or all-cause mortality, recurrent MI, or other cardiovascular outcomes. Also, colchicine did not increase drug-related adverse events.
PubMed: 34169101
DOI: 10.3389/fcvm.2021.676771