Panteha Rezaeian

Epicardial fat is associated with duration of antiretroviral therapy and coronary atherosclerosis

Objective:Cytokines released by epicardial fat are implicated in the pathogenesis of atherosclerosis. HIV infection and antiretroviral therapy have been associated with changes in body fat distribution and coronary artery disease. We sought to determine whether HIV infection is associated with greater epicardial fat and whether epicardial fat is associated with subclinical coronary atherosclerosis. Design:We studied 579 HIV-infected and 353 HIV-uninfected men aged 40–70 years with noncontrast computed tomography to measure epicardial adipose tissue (EAT) volume and coronary artery calcium (CAC). Total plaque score (TPS) and plaque subtypes (noncalcified, calcified, and mixed) were measured by coronary computed tomography angiography in 706 men. Methods:We evaluated the association between EAT and HIV serostatus, and the association of EAT with subclinical atherosclerosis, adjusting for age, race, and serostatus and with additional cardiovascular risk factors and tested for modifying effects of HIV serostatus. Results:HIV-infected men had greater EAT than HIV-uninfected men (P = 0.001). EAT was positively associated with duration of antiretroviral therapy (P = 0.02), specifically azidothymidine (P < 0.05). EAT was associated with presence of any coronary artery plaque (P = 0.006) and noncalcified plaque (P = 0.001), adjusting for age, race, serostatus, and cardiovascular risk factors. Among men with CAC, EAT was associated with CAC extent (P = 0.006). HIV serostatus did not modify associations between EAT and either CAC extent or presence of plaque. Conclusion:Greater epicardial fat volume in HIV-infected men and its association with coronary plaque and antiretroviral therapy duration suggest potential mechanisms that might lead to increased risk for cardiovascular disease in HIV.

The relationship between coronary artery calcium score and the long-term mortality among patients with minimal or absent coronary artery risk factors

BACKGROUND Coronary artery calcium (CAC) is strongly predictive of all-cause mortality in intermediate-risk groups, but this relationship is not well defined in very low-risk individuals. We investigated the relationship between CAC scoring and the long-term all-cause mortality among patients with ≤ 1 cardiovascular disease (CVD) risk factor. METHODS We analyzed a retrospective cohort of 5584 asymptomatic patients with no known CVD (mean 56.6 ± 11.6 years, 69%men) and ≤ 1 risk factor who were physician referred for a CAC scan. Mortality was ascertained through linkage with the Social Security Death Index. We calculated the prevalence of CAC stratified by age and risk factors. We also examined the association between CAC and mortality using multivariable Cox Proportional hazards models. RESULTS During a mean follow-up of 10.4 ± 3.1 years, 168 individuals (3.0%) died. Overall, 54.5% of patients had a CAC >0 and 9.8% had CAC ≥ 400. There was a greater risk of mortality with increasing CAC 1-99 (HR 1.9, 95% CI 1.2-3.1), 100-399 (HR 2.1, 95% CI 1.2-3.6) and ≥ 400 (HR 2.8, 95% CI 1.6-4.8) compared to CAC=0 (p<0.0001 for trend). Similar results were observed when the population was stratified by zero or one risk factor. Among patients < 45 years old, there was a 0.7% incidence of mortality compared to 8.1% for individuals ≥ 65 years old. CONCLUSIONS During long-term follow-up, an increasing CAC was significantly associated with a higher risk of all-cause mortality among patients with a very low CVD risk factor profile. CAC scanning may be a potentially useful tool for risk stratification among low CVD risk individuals who are ≥ 45 years old.

Relation of nonalcoholic fatty liver disease to the metabolic syndrome: The Multi-Ethnic Study of Atherosclerosis

BACKGROUND An overlap exists between risk factors for metabolic syndrome (MetS) and nonalcoholic fatty liver disease (NAFLD). OBJECTIVES We studied the association of MetS and its components with NAFLD in a multi-ethnic population. METHODS Cross-sectional study was designed, including 6814 participants from the Multi-Ethnic Study of Atherosclerosis. Liver fat content was measured with cardiac CT scans by using liver-to-spleen ratio of <1.0 and liver attenuation < 40 HU. Participants with heavy alcohol intake (>14 drinks/week for men and >7 drinks/week for women), self-reported history of cirrhosis, and missing information were excluded. A total of 4140 participants met the criteria for inclusion in the study. RESULTS The odds ratios (ORs) for presence of NAFLD were highest for persons with diabetes (OR, 4.16; 95% CI, 3.24-5.33), followed by presence of MetS (OR, 3.97; 95% CI, 3.26-4.83). Among components of MetS central obesity was associated with higher odds for presence (OR, 3.41; 95% CI, 2.77-4.20) and severity (OR, 5.58; 95% CI, 3.86-8.06) of NAFLD . The ORs for moderate-to-severe NAFLD were higher for presence of MetS (OR, 5.92; 95% CI, 4.29-8.19)] by using <40 HU as the cutoff. However, odds of NAFLD increased significantly for combination of MetS components: 9.49 (95% CI, 5.67-15.90) and 24.05 (95% CI, 12.73-45.45) for presence of 3 and 5 MetS components, respectively. CONCLUSION Components of MetS are associated with increased odds for presence and severity of NAFLD and increased risk with increasing number of MetS components in a multi-ethnic population of middle-to-old age persons.

Aged Garlic Extract Reduces Low Attenuation Plaque in Coronary Arteries of Patients with Metabolic Syndrome in a Prospective Randomized Double-Blind Study

BACKGROUND Although several previous studies have demonstrated that aged garlic extract (AGE) inhibits the progression of coronary artery calcification, its effect on noncalcified plaque (NCP) has been unclear. OBJECTIVE This study investigated whether AGE reduces coronary plaque volume measured by cardiac computed tomography angiography (CCTA) in patients with metabolic syndrome (MetS). METHODS Fifty-five patients with MetS (mean ± SD age: 58.7 ± 6.7 y; 71% men) were prospectively assigned to consume 2400 mg AGE/d (27 patients) or placebo (28 patients) orally. Both groups underwent CCTA at baseline and follow-up 354 ± 41 d apart. Coronary plaque volume, including total plaque volume (TPV), dense calcium (DC), NCP, and low-attenuation plaque (LAP), were measured based upon predefined intensity cutoff values. Multivariable linear regression analysis, adjusted for age, gender, number of risk factors, hyperlipidemia medications, history of coronary artery disease, scan interval time, and baseline %TPV, was performed to examine whether AGE affected each plaque change. RESULTS The %LAP change was significantly reduced in the AGE group compared with the placebo group (-1.5% ± 2.3% compared with 0.2% ± 2.0%, P = 0.0049). In contrast, no difference was observed in %TPV change (0.3% ± 3.3% compared with 1.6% ± 3.0%, P = 0.13), %NCP change (0.2% ± 3.3% compared with 1.4% ± 2.9%, P = 0.14), and %DC change (0.2% ± 1.4%, compared with 0.2% ± 1.7%, P = 0.99). Multivariable linear regression analysis found a beneficial effect of AGE on %LAP regression (β: -1.61; 95% CI: -2.79, -0.43; P = 0.008). CONCLUSIONS This study indicates that the %LAP change was significantly greater in the AGE group than in the placebo group. Further studies are needed to evaluate whether AGE has the ability to stabilize vulnerable plaque and decrease adverse cardiovascular events. This trial was registered at clinicaltrials.gov as NCT01534910.

Use of noninvasive imaging in the evaluation of coarctation of aorta.

Abstract Coarctation of the aorta is a congenital heart disease, which is often associated with other cardiac and noncardiac anomalies. Early diagnoses, information about associated anomalies, and defining the severity of the disease are critical for appropriate treatment planning. In this regard, several noninvasive imaging modalities, such as echocardiography, cardiac computed tomography (CT), and cardiac magnetic resonance imaging, have been used. Echocardiography, as an available and safe method, should be used as a primary screening test. It is also useful for intraoperative and hemodynamic studies, but cardiac CT is recommended before any corrective procedure or surgery. Cardiac CT angiography showed an excellent spatial resolution and a good capability for finding associated anomalies. After correction of coarctation of the aorta, serial cardiac magnetic resonance imaging is most commonly performed to avoid repeated radiation exposure.

FRI0234 Cardiac- Specific Troponin-I and Interleukin-6 PREDICT Coronary Atherosclerosis Burden in Rheumatoid Arthritis

Background Rheumatoid arthritis (RA) is associated with accelerated coronary atherogenesis1, myocardial infarction, and mortality. This risk transcends classic cardiac risk factors and may reflect the high inflammatory burden present in this condition. Objectives We explored whether various plasma inflammatory biomarkers, or their combinations, predict coronary plaque presence and burden in patients with RA and no symptoms or prior diagnosis of coronary artery disease. Methods One hundred and fifty RA patients underwent 64-slice computed tomography angiography (CTA); plaque was evaluated using a standardized AHA 15-segment model. Segment involvement score (SIS- n of segments with plaque), stenosis severity score (sum of individual segmental stenoses- SSS) and plaque burden score (sum of segmental plaque burden- PBS) were computed. High sensitivity cardiac Troponin-I (cTnI), tumor necrosis factor alpha (TNFα), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), interleukin-17A and F (IL-17A, IL-17F), were quantified in plasma collected at the time of CTA, using the Erenna immunoassay System (Singulex, Alameda, CA). Linear regression models examined associations of individual biomarkers with all plaque outcomes. The ability of individual or combinations of binarized biomarkers to predict plaque outcomes was explored in logistic regression models adjusted for age and gender (model 1), or additionally for hypertension, diabetes, smoking, dyslipidemia, body mass index, and prednisone use (model 2). Results Higher tertiles of cTnI correlated with plaque prevalence, as well as increasing CAC, SIS, SSS, and PBS (p-values 0.006, 0.005, 0.01, and 0.009 respectively – not shown). IL-6 and cTnI individually and independently predicted various plaque parameters after age and gender adjustments (model 1, table 1). The combination of elevated cTnI with elevated IL-6 predicted plaque burden after adjustments both for age and gender, as well as additional cardiac risk factors (model 2, table 1). Table 1 Outcome Unadjusted Model 11 Model 22 OR (95% CI) OR (95% CI) OR (95% CI) cTnI CAC 2.5 (1.2–5.2) 1.8 (0.8–4.0) 1.8 (0.8–4) SIS 2.4 (1.2–4.8) 1.9 (0.9–4.2) 1.9 (0.9–4.2) SSS 2.5 (1.2–5.1) 2.0 (0.9–4.4) 2.1 (1–4.6) PBS 3.6 (1.7–7.4) 2.9 (1.3–6.5) 3.2 (1.4–7.5) IL–6 CAC 1.6 (0.8–3.2) 2.0 (0.9–4.4) 1.6 (0.7–3.7) SIS 1.8 (0.9–3.5) 2.2 (1.1–4.4) 1.8 (0.9–3.9) SSS 1.6 (0.8–3.1) 1.9 (1.0–3.9) 1.6 (0.8–3.4) PBS 2.1 (1.0–4.2) 2.8 (1.2–6.2) 2 (0.8–4.7) cTnI+IL–6 CAC 2.7 (1.1–7.0) 2.1 (0.7–5.9) 1.9 (0.6–5.5) SIS 3.3 (1.2–9.0) 2.7 (1.0–7.8) 2.3 (0.8–6.9) SSS 3.1 (1.1–8.5) 2.6 (0.9–7.3) 2.3 (0.8–6.9) PBS 5.1 (1.9–13.8) 4.4 (1.5–12.7) 3.9 (1.3–11.6) 1 djusted for age, gender, cTnI, IL-6. 2 Adjusted for age, gender, hypertension, diabetes, dyslipidemia, smoking, body mass index, prednisone use, cTnI, IL-6. Conclusions In RA, biomarkers of cardiac dysfunction (cTnI) and inflammation (IL-6) can predict the presence and burden of coronary plaque as evaluated by CTA. Their associations and prognostic implications for atherosclerosis deserve further evaluation. References Karpouzas GA et al. Ann Rheum Dis. 2013 Jul 25. doi: 10.1136/annrheumdis-2013-203617. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2077