Michael Kim

Role of Coronary Calcium for Risk Stratification and Prognostication

Opinion statementA multitude of studies now support the understanding that an increased coronary artery calcium (CAC) score represents advanced atherosclerosis and high risk for cardiovascular disease (CVD) and, as such, should be treated with conventional therapies for those considered high risk. Data is now available to guide treatment with aspirin, statins, and lifestyle management. The new ACC/AHA 2013 guidelines support intensifying statin therapy when the CAC is ≥75th percentile for age, sex, and ethnicity/race or when the calcium score is ≥300 Agatston units. This allows for aggressive management of those at the highest risk, matching intensity of therapy with intensity of risk. Most importantly, the asymptomatic person rarely needs to undergo evaluation for obstructive disease, even when CAC scores are high, as revascularization with percutaneous coronary interventions does not improve outcomes in asymptomatic persons with preserved left ventricular function. Treatment should be relegated to improvement in lifestyle, diet, exercise, aspirin, statins, and blood pressure control.

The relationship between cardio-ankle vascular index and subclinical atherosclerosis evaluated by cardiac computed tomographic angiography

The cardio‐ankle vascular index (CAVI) is a new noninvasive index to evaluate arterial stiffness. We investigated whether CAVI can predict severity, extent, and burden of coronary artery disease by comparing results with cardiac computed tomographic angiography (CCTA).

IMPACT OF CARDIAC TROPONIN I ON THE PRESENCE OF THE CORONARY ARTERY PLAQUE IN RHEUMATOID ARTHRITIS PATIENTS

Introduction: The presence of accelerated coronary artery disease in rheumatoid arthritis (RA) was previously reported. The goal of this study was to investigate if using high sensitivity cardiac troponin I (hs-cTnI) identifies patients at higher coronary atherosclerosis risk. Method: A total of

Multicenter Aids Cohort Study Quantitative Coronary Plaque Progression Study: rationale and design

Background and aim The association of HIV with coronary atherosclerosis has been established; however, the progression of coronary atherosclerosis over time among participants with HIV is not well known. The Multicenter AIDS Cohort Study Quantitative Coronary Plaque Progression Study is a large prospective multicenter study quantifying progression of coronary plaque assessed by serial coronary computed tomography angiography (CTA). Patients and methods HIV-infected and uninfected men who were enrolled in the Multicenter AIDS Cohort Study Cardiovascular Substudy were eligible to complete a follow-up contrast coronary CTA 3–6 years after baseline. We measured coronary plaque volume and characteristics (calcified and noncalcified plaque including fibrous, fibrous-fatty, and low attenuation) and vulnerable plaque among HIV-infected and uninfected men using semiautomated plaque software to investigate the progression of coronary atherosclerosis over time. Conclusion We describe a novel, large prospective multicenter study investigating incidence, transition of characteristics, and progression in coronary atherosclerosis quantitatively assessed by serial coronary CTAs among HIV-infected and uninfected men.