In people with no evidence of cardiovascular disease, how effective are interventions aimed at controlling risk factors in reducing all-cause and coronary artery disease mortality?

Coronary artery disease (CAD) - which includes coronary atherosclerotic disease, myocardial infarction (MI), acute coronary syndrome and angina - is the most prevalent form of cardiovascular disease and is the largest subset of this mortality. Coronary artery disease (CAD) is a leading cause of death of women and men worldwide. CADs impact on women traditionally has been underappreciated due to higher rates at younger ages in men. Microvascular coronary disease disproportionately affects women. Women have unique risk factors for CAD, including those related to pregnancy and autoimmune disease.DOI: http://dx.doi.org/10.3329/jom.v15i2.20687 J MEDICINE 2014; 15 : 135-140

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Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association

Circulation ◽

10.1161/cir.0000000000000973 ◽

2021 ◽

Author(s):

Tiffany M. Powell-Wiley ◽

Paul Poirier ◽

Lora E. Burke ◽

Jean-Pierre Després ◽

Penny Gordon-Larsen ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Coronary Artery Disease ◽

Weight Loss ◽

Coronary Artery ◽

Disease Risk ◽

Artery Disease ◽

The Impact

The global obesity epidemic is well established, with increases in obesity prevalence for most countries since the 1980s. Obesity contributes directly to incident cardiovascular risk factors, including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. Obesity also leads to the development of cardiovascular disease and cardiovascular disease mortality independently of other cardiovascular risk factors. More recent data highlight abdominal obesity, as determined by waist circumference, as a cardiovascular disease risk marker that is independent of body mass index. There have also been significant advances in imaging modalities for characterizing body composition, including visceral adiposity. Studies that quantify fat depots, including ectopic fat, support excess visceral adiposity as an independent indicator of poor cardiovascular outcomes. Lifestyle modification and subsequent weight loss improve both metabolic syndrome and associated systemic inflammation and endothelial dysfunction. However, clinical trials of medical weight loss have not demonstrated a reduction in coronary artery disease rates. In contrast, prospective studies comparing patients undergoing bariatric surgery with nonsurgical patients with obesity have shown reduced coronary artery disease risk with surgery. In this statement, we summarize the impact of obesity on the diagnosis, clinical management, and outcomes of atherosclerotic cardiovascular disease, heart failure, and arrhythmias, especially sudden cardiac death and atrial fibrillation. In particular, we examine the influence of obesity on noninvasive and invasive diagnostic procedures for coronary artery disease. Moreover, we review the impact of obesity on cardiac function and outcomes related to heart failure with reduced and preserved ejection fraction. Finally, we describe the effects of lifestyle and surgical weight loss interventions on outcomes related to coronary artery disease, heart failure, and atrial fibrillation.

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Evolving lipoprotein risk factors: lipoprotein(a) and oxidized low-density lipoprotein

Clinical Chemistry ◽

10.1093/clinchem/44.8.1827 ◽

1998 ◽

Vol 44 (8) ◽

pp. 1827-1832 ◽

Cited By ~ 45

Author(s):

Ishwarlal Jialal

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Cerebrovascular Disease ◽

Young Patients ◽

Ldl Oxidation ◽

Indirect Measure ◽

Lipoprotein A ◽

Artery Disease

Abstract Cardiovascular disease is the leading cause of morbidity and mortality in Westernized populations. Evolving lipoprotein risk factors include LDL oxidation and lipoprotein(a) [lp(a)]. Several lines of evidence support a role for oxidatively modified LDL in atherogenesis and its in vivo existence. There are both direct and indirect measures of oxidative stress. The most relevant direct measure of lipid peroxidation is urinary F2 isoprostanes. The most common indirect measure of LDL oxidation is quantifying the lag phase of copper-catalyzed LDL oxidation by assaying conjugated diene formation. Lp(a) is increased in patients with cardiovascular and cerebrovascular disease. However, not all prospective studies have confirmed a positive relationship between Lp(a) and cardiovascular events. Lp(a) appears to present three major problems: standardization of the assay, establishing its role in atherogenesis, and the lack of an effective therapy that can substantially lower Lp(a) concentrations. Thus, at the present time, Lp(a) concentrations should not be recommended for the general population but be reserved for patients with coronary artery disease without established risk factors, young patients with coronary artery disease or cerebrovascular disease, or a family history of premature atherosclerosis and family members of an index patient with increased concentrations of Lp(a). Although both LDL oxidation and Lp(a) are evolving risk factors for cardiovascular disease, more data are needed before they become part of the established lipoprotein repertoire.

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Risk factors for severity of coronary artery disease in patients with cardiovascular disease

Atherosclerosis ◽

10.1016/j.atherosclerosis.2021.06.308 ◽

2021 ◽

Vol 331 ◽

pp. e104-e105

Author(s):

G. Samanidis ◽

A. Gkogkos ◽

S. Bousounis ◽

P. Zoumpourlis ◽

D. Perrea ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Artery Disease

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The Correlation of Dyslipidemia with the Extent of Coronary Artery Disease in the Multiethnic Study of Atherosclerosis

Journal of Lipids ◽

10.1155/2018/5607349 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Moshrik Abd alamir ◽

Michael Goyfman ◽

Adib Chaus ◽

Firas Dabbous ◽

Leslie Tamura ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Statistical Significance ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Low Hdl ◽

Artery Disease ◽

Prevalence Ratios

Background.The extent of coronary artery calcium (CAC) improves cardiovascular disease (CVD) risk prediction. The association between common dyslipidemias (combined hyperlipidemia, simple hypercholesterolemia, metabolic Syndrome (MetS), isolated low high-density lipoprotein cholesterol, and isolated hypertriglyceridemia) compared with normolipidemia and the risk of multivessel CAC is underinvestigated.Objectives.To determine whether there is an association between common dyslipidemias compared with normolipidemia, and the extent of coronary artery involvement among MESA participants who were free of clinical cardiovascular disease at baseline.Methods.In a cross-sectional analysis, 4,917 MESA participants were classified into six groups defined by specific LDL-c, HDL-c, or triglyceride cutoff points. Multivessel CAC was defined as involvement of at least 2 coronary arteries. Multivariate Poisson regression analysis evaluated the association of each group with multivessel CAC after adjusting for CVD risk factors.Results.Unadjusted analysis showed that all groups except hypertriglyceridemia had statistically significant prevalence ratios of having multivessel CAC as compared to the normolipidemia group. The same groups maintained statistical significance prevalence ratios with multivariate analysis adjusting for other risk factors including Agatston CAC score [combined hyperlipidemia 1.41 (1.06–1.87), hypercholesterolemia 1.55 (1.26–1.92), MetS 1.28 (1.09–1.51), and low HDL-c 1.20 (1.02–1.40)].Conclusion.Combined hyperlipidemia, simple hypercholesterolemia, MetS, and low HDL-c were associated with multivessel coronary artery disease independent of CVD risk factors and CAC score. These findings may lay the groundwork for further analysis of the underlying mechanisms in the observed relationship, as well as for the development of clinical strategies for primary prevention.

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Sex, Lies, and Coronary Artery Disease

Journal of Clinical Medicine ◽

10.3390/jcm10143114 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3114

Author(s):

Helena Martínez-Sellés ◽

David Martínez-Sellés ◽

Manuel Martínez-Sellés

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Coronary Artery Disease ◽

Quality Of Care ◽

Coronary Artery ◽

Response To Therapy ◽

Men And Women ◽

Artery Disease ◽

Therapy Quality

Epidemiological and clinical data have shown clear differences in several aspects of cardiovascular disease, particularly in the case of coronary artery disease (CAD), between men and women, including risk factors, response to therapy, quality of care, and natural history.[...]

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Incidence of coronary artery disease before valvular replacement in isolated severe aortic stenosis patients in Western Rajasthan

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20214415 ◽

2021 ◽

Vol 9 (11) ◽

pp. 3347

Author(s):

Ramesh Patel ◽

Sandeep Aggarwal

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Coronary Arteries ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Artery Disease

Background: The aim of the study was to evaluate the incidence of Coronary artery disease (CAD) and predictors of CAD in patients with severe AS in western Rajasthan population.Methods: Data from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Udaipur were entered in a prospective registry beginning in 2015. Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70% and left main coronary arteries having an estimated narrowing of ≥50% on coronary angiography. We excluded patients with multiple valve disease, significant aortic regurgitation, or prior CAD or valve surgery.Results: Mean age of 55 enrolled patients was 52.64±15.5 years. Diabetes mellitus and hypertension were present in 3.64% and 5.45% of patients, respectively. Moderate and severe Left ventricular ejection fraction (LVEF) was found in 16.36% and 10.91% patients, respectively. Only 5.45% patient had severe CAD and thus underwent AVR and coronary artery bypass grafting, and rest 94.55% patients underwent AVR. Mean age of patients who underwent AVR was 51.75±15.36 years and who underwent AVR and CABG was 68±11.14 years with no significant association (p=0.078). Proportion of patients requiring AVR and CABG was significantly higher in moderate (22.22%) and severe LVEF (16.67%) as compared to normal or mild (p=0.034).Conclusions: Coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients above 68 years of age without risk factors for cardiovascular disease. However, larger studies on heterogeneous population are required to prove our findings.

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Conventional risk factors and arterial bed parameters in patients with coronary artery disease younger and older than 50 years

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2020-2541 ◽

2020 ◽

Vol 19 (4) ◽

pp. 2541

Author(s):

A. A. Khromova ◽

L. I. Salyamova ◽

O. G. Kvasova ◽

V. E. Oleinikov

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Healthy People ◽

Stiffness Index ◽

Non Invasive ◽

History Of ◽

Artery Disease ◽

Conventional Risk Factors

Aim. To study conventional risk factors and arterial stiffness parameters to identify non-invasive markers of coronary atherosclerosis in patients with and without history of cardiovascular disease, with premature and physiological vascular aging.Material and methods. The study included 198 patients with coronary artery disease (CAD) and 57 healthy people. The subjects were divided into two cohorts: younger and older than 50 years. Each group included patients with newly diagnosed acute coronary syndrome with/without history of cardiovascular disease (CAD and/or hypertension). Conventional risk factors were analyzed in all subjects. Ultrasound radiofrequency of common carotid arteries (CCA), applanation tonometry, volume sphygmography were performed.Results. Analysis of arterial parameters in individuals <50 years old revealed differences between healthy people and patients with CAD. In the subgroup of patients without a history of cardiovascular disease compared with healthy people, CCA were damaged in 77% (p<0,05), aorta — in 13%, muscular arteries — in 29% (p<0,05); in patients with a history of cardiovascular disease, in 71% (p<0,05), 5% and 34% (p<0,05), respectively. In the older age group of patients with and without history of cardiovascular disease, CCA were damaged in 84% and 94% (p<0,05), aorta — in 92% and 87% (p<0,05), muscular arteries — in 42-44% (p<0,05), respectively. According to the ROC analysis, in patients <50 years old, the area under the curve (AUC) for the intima-media thickness (IMT) was 0,830, the threshold — 622,3 (p=0,000); for the beta stiffness index — 0,850, threshold — 7,01 (p=0,002); for L-/CAVI1 — 0,742, threshold — 7,3 (p=0,000). In patients >50 years of age, AUC for the IMT was 0,948, threshold — 607,5 (p=0,000); for the beta stiffness index — 0,740, threshold — 8,84 (p=0,000); for L-/CAVI1 — 0,861, threshold — 8,4 (p=0,000).Conclusion. Timely identification of atherosclerotic markers using noninvasive techniques can improve the prediction of cardiovascular events. A comprehensive non-invasive examination of the arteries with determination of IMT, beta stiffness index, and L-/CAVI1 will probably identify young people with an unfavorable absolute cardiovascular risk. .

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