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Concept: Lipoprotein(a)

230

The accuracy of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Risk Equation for atherosclerotic cardiovascular disease (ASCVD) events in contemporary and ethnically diverse populations is not well understood.

Concepts: Myocardial infarction, Atherosclerosis, Demography, Blood vessel, Cardiovascular disease, Low-density lipoprotein, Cardiovascular diseases, Lipoprotein(a)

27

B-mode ultrasound measurement of the carotid intima-media thickness (CIMT) is a widely used marker for atherosclerosis and is associated with future cardiovascular events. This article provides a review and meta-analysis of the published evidence on the association of CIMT with future cardiovascular events and its additional value to traditional cardiovascular risk prediction models.

Concepts: Atherosclerosis, Blood vessel, Cardiovascular disease, Systematic review, Low-density lipoprotein, Intima-media thickness, Cardiovascular diseases, Lipoprotein(a)

2

In the Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk (FOURIER) trial,1 treatment with evolocumab resulted in a 15% relative (1.5% absolute) risk reduction of major cardiovascular events in patients with atherosclerotic cardiovascular disease (ASCVD) at a median follow-up of 2.2 years. This trial included patients with LDL-C≥70mg/dL or non-HDL-C ≥100mg/dL on at least moderate-intensity statins. It is not known what proportion of ASCVD patients would qualify for evolocumab based on FOURIER entry criteria and how eligibility would change if maximal doses of evidence-based lipid lowering therapies were required. We assessed the number and proportion of U.S. Veterans with ASCVD who would qualify for evolocumab based on FOURIER trial entry criteria and how these figures would change if high-intensity statins, ezetimibe or the combination of both agents was used.

Concepts: Myocardial infarction, Atherosclerosis, Blood vessel, Cardiovascular disease, Low-density lipoprotein, Statin, Cardiovascular diseases, Lipoprotein(a)

2

The extent to which the relative contributions of traditional cardiovascular risk factors to incident cardiovascular disease (CVD) may have changed over time remains unclear.

Concepts: Epidemiology, Myocardial infarction, Atherosclerosis, Blood vessel, Cardiovascular disease, Low-density lipoprotein, Cardiovascular diseases, Lipoprotein(a)

2

Levels of atherogenic lipoproteins achieved with statin therapy are highly variable, but the consequence of this variability for cardiovascular disease risk is not well-documented.

Concepts: Myocardial infarction, Atherosclerosis, Blood vessel, Cardiovascular disease, Low-density lipoprotein, Statin, Cardiovascular diseases, Lipoprotein(a)

1

The atherosclerosis cardiovascular disease (ASCVD) Pooled Cohort risk equations have shown different calibration across US populations with varied levels of social deprivation.

Concepts: Myocardial infarction, Atherosclerosis, Demography, Blood vessel, Cardiovascular disease, Low-density lipoprotein, Sociology, Lipoprotein(a)

1

Perceived discrimination is positively related to cardiovascular disease (CVD) risk factors; its relationship with incident CVD is unknown. Using data from the Multi-Ethnic Study of Atherosclerosis, a population-based multiethnic cohort study of 6,508 adults aged 45-84 years who were initially free of clinical CVD, we examined lifetime discrimination (experiences of unfair treatment in 6 life domains) and everyday discrimination (frequency of day-to-day occurrences of perceived unfair treatment) in relation to incident CVD. During a median 10.1 years of follow-up (2000-2011), 604 incident events occurred. Persons reporting lifetime discrimination in ≥2 domains (versus none) had increased CVD risk, after adjustment for race/ethnicity and sociodemographic factors, behaviors, and traditional CVD risk factors (hazard ratio (HR) = 1.36, 95% confidence interval (CI): 1.09, 1.70) and after control for chronic stress and depressive symptoms (HR = 1.28, 95% CI: 1.01, 1.60). Reported discrimination in 1 domain was unrelated to CVD (HR = 1.05, 95% CI: 0.86, 1.30). There were no differences by race/ethnicity, age, or sex. In contrast, everyday discrimination interacted with sex (P = 0.03). Stratified models showed increased risk only among men (for each 1-standard deviation increase in score, adjusted HR = 1.14, 95% CI: 1.03, 1.27); controlling for chronic stress and depressive symptoms slightly reduced this association (HR = 1.11, 95% CI: 0.99, 1.25). This study suggests that perceived discrimination is adversely related to CVD risk in middle-aged and older adults.

Concepts: Epidemiology, Myocardial infarction, Atherosclerosis, Blood vessel, Cardiovascular disease, Low-density lipoprotein, Cardiovascular diseases, Lipoprotein(a)

1

Coagulation and prothrombotic potential have genuinely been associated with increased cardiovascular risk. However, not all studies in this regard are conclusive. Some clinical trials have shown an increased frequency of cardiovascular complications in patients receiving direct thrombin inhibitors. Previous data from human subjects after acute cardiovascular events showed an inverse association between the thrombin generation marker F1+2 and cardiovascular endpoints indicating that not the lowest, but a slightly elevated propensity for thrombin generation is associated with a lower risk of cardiovascular events. This observation has been supported by findings in animal models of atherosclerosis. Hence, we evaluated the association between the endogenous thrombin potential (ETP) and cardiovascular death (CVD) and markers of vascular dysfunction in a large prospective study with long-term follow up.

Concepts: Myocardial infarction, Atherosclerosis, Blood vessel, Cardiovascular disease, Low-density lipoprotein, Cardiovascular diseases, Direct thrombin inhibitor, Lipoprotein(a)

1

Clinical evidence has linked vascular calcification in advanced atherosclerotic plaques with overt cardiovascular disease and mortality. Bone resorbing monocyte-derived osteoclast-like cells are sparse in these plaques, indicating that their differentiation capability could be suppressed. Here, we seek to characterize the process of osteoclastogenesis by identifying novel regulators and pathways, with the aim of exploring possible strategies to reduce calcification.

Concepts: Death, Myocardial infarction, Atherosclerosis, Blood vessel, Cardiovascular disease, Low-density lipoprotein, Vitamin C, Lipoprotein(a)

0

Nonlaboratory-based (non-LB) algorithms have been developed to facilitate absolute cardiovascular risk assessment in resource-constrained settings. The non-LB Framingham algorithm, which substitute BMI for lipids in laboratory-based Framingham, exhibits best performance among non-LB algorithms. However, its external validity has not been evaluated.

Concepts: Myocardial infarction, Atherosclerosis, Blood vessel, Cardiovascular disease, Low-density lipoprotein, Cardiovascular diseases, Algorithmic efficiency, Lipoprotein(a)