Amish Patel

Coronary Artery Disease in Patients with HIV Infection

HIV-infected patients are known to be at risk for premature coronary artery disease. This emerging paradigm is a rising concern for clinicians. Due to advances in the treatment of HIV, this once fatal infection has been transformed into a chronic illness. Traditional risk factors paired with the long-term use of antiretroviral therapy (ART) and chronic inflammation leads to premature atherosclerosis, particularly progression of atherosclerotic plaque. This population of patients requires early recognition of subclinical atherosclerosis, as well aggressive primary and secondary prevention strategies among the multi-disciplinary team of physicians caring for them. We sought to present a comprehensive review of the available literature related to HIV and atherosclerosis and cardiovascular risk.

Screening for heart disease: C-reactive protein versus coronary artery calcium.

The Framingham model has become the standard to assess future risk of coronary artery disease. Several nontraditional risk factors have been suggested to improve risk stratification to provide a new algorithm for predicting coronary heart disease (CHD). Two factors with the most available data include C-reactive protein (CRP) and coronary artery calcification (CAC). CRP, a well-established biomarker of inflammation, has shown very inconsistent data to predict CHD, and no study to date shows improvement in the C-statistic; in addition, reclassification is modest (<10% of patients are reclassified to higher or lower risk categories). CAC seems to hold a greater promise in the prediction of CHD and demonstrates a stronger relationship to future cardiac events, with all studies demonstrating improvement in the C-statistic when added to the Framingham risk score. Measurement of CAC consistently provides reclassification of patients more accurately to the Framingham risk model. Only four studies have evaluated both CAC and CRP in the same cohort for future cardiovascular events, but all of these showed significant prediction for coronary artery disease using CAC and no significant prediction ability for CRP. Current review of the literature available suggests CAC to be more relevant in evaluating CHD in a clinical setting. Given the higher cost of CAC scanning compared with CRP, cost–effectiveness studies are still needed.

Effects of eicosapentaenoic acid and docosahexaenoic acid on lipoproteins in hypertriglyceridemia.

Purpose of reviewThe treatment of hypertriglyceridemia (HTG) with &ohgr;-3 fatty acid preparations adds a novel therapy to reduce cardiovascular disease. This review examines the effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid on lipoproteins and the cardioprotective effects in HTG. Recent findingsThe evidence that &ohgr;-3 fatty acid therapy at prescription strength is effective and safe at lowering triglyceride levels is growing. Although EPA/docosahexaenoic acid formulations did lower triglyceride levels, an increase in low-density lipoproteins was observed and outcome data were mixed. More recent trials have shown that decreased levels of low-density lipoprotein can be achieved with EPA preparations. Although the cardiovascular outcomes data are not fully available, meta-analysis of available data reports protection against vascular disease. SummaryThe addition of &ohgr;-3 fatty acid treatment should be considered in patients with severe HTG as well as high-risk patients for atherosclerotic disease. Emerging data are supportive, but long-term outcome studies are still underway.

A meandering mesenteric artery

An 83-year-old woman with a history of peripheral vascular disease presented for evaluation of lower left extremity discomfort. A peripheral multidetector CT angiography showed a dilated inferior mesenteric artery acting as an important source of retrograde collateral perfusion secondary to a celiac axis stenosis.

Internal mammary artery-to-pulmonary vasculature fistula: Systematic review of case reports

The formation of a fistula between the internal mammary artery and the pulmonary vasculature (IMA-to-PV) is a rare anomaly. The etiology can be congenital; however, most recent cases have been associated with coronary artery bypass grafting, trauma, inflammatory conditions, chronic infections, or neoplasia. The knowledge base on the formation of these fistulas is derived primarily from case reports. To our knowledge, no systematic reviews or guidelines are available that provide information on how to manage these cases, and the treatment of an IMA-to-PV fistula is controversial. To our knowledge, this report is the first to review 80 cases of IMA-to-PV fistulas reported in the literature. We describe the etiologies, clinical presentation, and management of these fistulas.

LONG TERM MORTALITY RATES IN UNITED STATES VETERANS WITH CORONARY RISK FACTORS, WITH OR WITHOUT SIGNIFICANT CORONARY ARTERY DISEASE

Coronary artery disease (CAD) is a major cause of death in United States. Mortality rate in US Veterans with coronary risk factors, with or without CAD are not well known. We did a retrospective study to compare the all-cause mortality rate in patients with obstructive CAD, nonobstructive CAD and

ACCURACY OF NON-ENHANCED CARDIAC COMPUTED TOMOGRAPHY TO DETECT MYOCARDIAL INFARCTS.

Background: Cardiac Computed Tomography (CT) is a promising technique for imaging coronary arteries and myocardium. Studies have shown contrast-enhanced CT angiography to be comparable to Myocardial Perfusion Imaging (MPI) in detecting irreversible perfusion defects (myocardial infarction [MI]). Our study evaluates whether non-enhanced computed tomography (coronary artery calcium [CAC] scanning) can detect irreversible perfusion defect (MI) as compared to MPI as a reference.