July 17, 2023 — MRI shows that so-called “superagers” — people in their 80s who have the memory function of much younger individuals — have more gray matter in brain regions linked to memory function than their peers, a new study in Lancet Healthy Longevity reports.
The findings suggest that the brains of these individuals are less affected by the cognitive decline that tends to manifest as people age. Additionally, they are also more likely to have greater movement speed and lower rates of anxiety and depression, wrote a team led by doctoral candidate Marta Garo-Pascual of the Queen Sofia Foundation Alzheimer Centre at the Universidad Politécnica de Madrid in Spain.
“[Our study found] no differences in biomarkers or genetic risk factors for neurodegenerative disease … between superagers and typical older adults, suggesting superagers are resistant to age-related processes that lead to memory decline,” the investigators wrote in the study, which was published on July 13.
Whether superagers have different brains compared to typical older adults or whether they are more successful at dealing with aging has been unclear, according to Garo-Pascual.
“We are now closer to solving one of the biggest unanswered questions about superagers: whether they are truly resistant to age-related memory decline or they have coping mechanisms that help them overcome this decline better than their peers,” she said in a statement from the journal. “Our findings suggest superagers are resistant to these processes, though the precise reasons for this are still unclear. By looking further into links between superageing and movement speed we may be able to gain important insights into the mechanisms behind the preservation of memory function deep into old age.”
Previous research has found brain and lifestyle factor differences among superagers, but these studies have had small sample sizes and have not necessarily tracked changes over time. Garo-Pascual’s group sought to address the knowledge gap using data from a study called the Vallecas Project that aimed to identify early indicators of Alzheimer’s disease and included 1,213 participants.
From this total cohort, the investigators used data from 64 superagers and 55 typical older adults (all of whom were aged 79.5 years or older). Whether a person was a superager or a typical older person was based on their performance on the Free and Cued Selective Reminding Test, a tool that assesses memory function.
Study participants had up to six annual follow-up visits between 2011 and 2014 that tracked demographic and lifestyle factors. At each visit, the participants underwent brain MRI to measure gray matter volume and completed a variety of clinical tests. Researchers also took blood samples to screen for biomarkers for neurodegenerative disease and genetic risk factors for Alzheimer’s.
For the study, Garo-Pascual’s group used a machine-learning algorithm that included 89 demographic, lifestyle, and clinical predictors to identify any factors associated with superagers.
MRI showed that superagers had more gray matter — tissue key to brain function — in areas controlling memory and movement and that this gray matter tissue broke down more slowly over five years compared to the gray matter of typical older adults.
“Superagers performed better in the Timed Up and Go Test — which gauges people’s mobility — and a finger tapping test that measures fine motor function, indicating they have better mobility, agility, and balance than do typical older adults,” the team reported.
The researchers found that, compared to their peers, superagers were more active and more likely to have a musical background, greater independence in their day-to-day living, higher intelligence test scores, and lower levels of neurodegeneration biomarkers and APOE e4 (a genetic risk factor for Alzheimer’s) compared to their peers.
The AI algorithm produced similar results to the MRI data, although it was only able to distinguish superagers from typical older adults 66% of the time, which suggests that superaging could be affected by additional genetic factors, according to the investigators.
In any case, the study results add to the current knowledge base regarding superagers’ brain resilience, according to the authors.
“The brain structural signature and clinical and lifestyle factors associated with the superageing phenotype probably reflect a resistance to age-related memory decline, and these factors overlap with those associated with dementia prevention,” they concluded. “Additionally, the connection between preserved memory performance and motor function in people older than 80 provides novel insights into how to promote resistance to age-related memory loss. Taken together, the identified factors associated with superageing can inform the design of intervention trials to promote healthy ageing of episodic memory.”
Read the complete study.
August 12, 2022 — Cross-sectional supplemental imaging with MRI and CT can improve sensitivity when detecting tumors in axillary lymph nodes in breast cancer patients, a German study published August 10 in the Journal of Cancer Research and Clinical Oncology found.
Researchers led by Dr. Joachim Diessner from the Josef-Schneider-Strasse University Hospital in Würzburg found that using a combination of MRI and CT has a higher sensitivity than other combined imaging methods, allowing for safe detection of these lymph nodes at the time of diagnosis.
“Only the safe detection… enables the evaluation of the response to neoadjuvant therapy, thereby allowing access to prognosis and improving new post-neoadjuvant therapies,” Diessner and colleagues wrote.
The status of axillary lymph nodes is one of the most important prognostic factors for determining long-term survival of breast cancer patients. This includes finding out whether the nodes are infiltrated by tumors, since nodal involvement influences treatment decisions.
Supplemental imaging is used to evaluate lymph node status. While a combined method using ultrasound and mammography has been a go-to choice for radiologists, its sensitivity has a wide range depending on what previous research is cited. MRI and CT have also been explored for such supplemental imaging. However, research shows that these have lower specificity than conventional approaches.
Diessner and colleagues wanted to explore the sensitivity of pretherapeutic imaging modalities in nodal-positive breast cancer patients. They used sonography, mammography, MRI, and CT imaging. The researchers wanted to find out what further benefits could be had with cross-sectional imaging using MRI and CT for axillary staging compared with the mammography and sonography combination.
The team looked at retrospective data from 382 women who received surgery between 2014 and 2020, including 201 women who received cross-sectional imaging.
|Sensitivity of combined imaging methods for axillary staging of lymph nodes in breast cancer patients|
|All imaging modalities||68.89%|
As an example, the researchers noted the results of a 39-year-old patient with hormone receptor-positive, HER2-negative breast cancer. They wrote that while CT at the initial staging of the thorax and abdomen gave suspicion of lymph node infiltration, conventional imaging couldn’t clearly represent the tumor-infiltrated lymph node.
“During the period of data collection, we could detect an increasing importance of cross-sectional imaging,” the authors wrote about the MRI and CT combination.
They added that they could not prove any effect on imaging sensitivity for lymph node status when accounting for other clinical parameters such as age, intrinsic subtype, histological subtype, and body mass index.
Diessner et al noted that while prospective data would be “highly interesting,” such a study would be challenging when it comes to implementation and patient recruitment. Still, the team touted cross-sectional imaging with MRI and CT as being able to help guide treatment decisions with neoadjuvant chemotherapy with improved sensitivity.
May 4, 2021 — Venous disease is widespread and common, and it is particularly topical right now, given the potential side effects of COVID-19 vaccines. In a Q&A interview, Prof. Thomas Vogl outlines which venous disorders his team deals with in their daily clinical routine and how they diagnose and treat patients.
Vogl is head of the Institute for Diagnostic and Interventional Radiology at the University Hospital Frankfurt am Main and president of the 102nd German Radiology Congress, which takes place from 27 March to 8 November 2021. The interview was conducted by the German Röntgen Society (Deutsche Röntgengesellschaft, DRG).
Q: Which venous disorders do you deal with most frequently in your daily medical practice?
A: The human venous system and the diseases that can manifest themselves are an important field of activity for interventional radiology. Interventional radiology offers patients not only diagnostics but also minimally invasive therapeutic interventions using imaging.
I think a lot of people don’t even know what interventional radiology can do in this area. At our institute, we very often have to deal with patients who suffer from thrombosis. These blood clot occlusions most commonly occur in the veins in the leg. In diagnostics, we clarify thromboses and possibly resulting pulmonary embolisms. The topic of thrombosis is currently very much publicized by reports on the AstraZeneca COVID-19 vaccine and sinus vein thrombosis.
Patients also come to us who suffer from varices, i.e., superficial vein enlargements that are “knotty” and clearly visible through the subcutaneous tissue. Such varices or varicose veins show up in women and men. In the case of internal vein problems, for example, we see enlarged veins that can press on nerves in the pelvic area of affected women. This condition can also occur in men, with the result that their fertility can be severely impaired. What also plays a very important role in my everyday radiology practice and in my institute are venous diseases as a result of venous malformations, which we have to evaluate.
Q: Which imaging methods do you use at your institute to diagnose venous disease?
A: The first method is ultrasound, which can determine the velocities in the venous system very precisely. The course of the vein is well documented, and it also allows the detection of superficial and medium-depth diseases of the veins. If pathologies become apparent, we use advanced imaging methods, particularly CT. This rules out a pulmonary embolism, documents the course of the vein, and determines the extent of thrombosis. With MRI, sinus vein thromboses can be diagnosed very well.
Q: On which venous disorders do you work therapeutically as an interventional radiologist?
A: In principle, interventions on the veins do not differ significantly from interventions in other diseases. Interventional radiologists treat chronically ill patients, for example by inserting port systems into the veins. In addition, when it comes to veins, we also deal with the aforementioned venous malformations and thromboses.
A typical venous therapy is, for example, one we use on young men who have impaired fertility. The cause of this condition is dilated veins in the testicles and kidneys. Interventionally, we do it in such a way that we embolize these vein clusters and thereby restore the fertility of these — quite often — young men. We also remove foreign bodies from veins. To do this, we use instruments such as pliers, wires, and drum/barrel devices.
Q: What interventional methods are used for thrombosis?
A: In the case of thromboses, we offer the option of removing thrombi in interventional radiology. We reopen vessels that have become diseased due to chronic occlusion caused by thrombosis, and we can insert stents there to achieve outflow, for instance. We access mainly via the blood vessels — i.e., arteries or veins — with the help of catheter technology.
Q: Does interventional radiology also play a role in patient follow-up?
A: Chronic diseases of the veins in particular have to be checked again and again through imaging. This is especially true for venous malformations or when stents are placed in the veins. Unfortunately, diseases of the veins are usually chronic. If not handled carefully, they can lead to physical disfigurements such as varices. Above all, venous disease can have very dangerous consequences for the cardiovascular system. That is why the early detection of thromboses, tumors, or venous malformations is essential.
Editor’s note: This is an edited translation of an article published in German by the DRG on 22 April 2021. Translation by Frances Rylands-Monk. To read the original version, go to the DRG website.
August 28, 2020 — Lung injuries caused by electronic cigarette or vaping product use-associated lung injury (EVALI) have a particular pattern on CT — namely ground-glass opacity, according to a study published August 27 in Radiology: Cardiothoracic Imaging.
The study results could help clinicians make better diagnoses of the condition and patients avoid unnecessary biopsies, wrote a team led by Dr. Michael Gotway of the Mayo Clinic in Scottsdale, AZ.
“These radiological findings will be especially beneficial to physicians to help them determine potentially less invasive treatment options,” Gotway said in a statement released by the RSNA. “We could potentially make that diagnosis noninvasively through cooperation with our clinical colleagues … [and] by alerting them to a scan pattern that is suggestive of the possibility of EVALI, we may actually save patients from having to meet a surgeon.”
Electronic cigarettes (e-cigarettes) and vaporizers heat a mix of nicotine, flavorings, and other chemicals that the user inhales, and the use of these devices has increased over the past 10 years, the RSNA said. In 2019, the U.S. Centers for Disease Control and Prevention (CDC) received the first reports of EVALI, which is characterized by “e-cigarette use or vaping within 90 days from symptom onset, associated with infiltrates at chest imaging, in the absence of an alternative explanation,” the researchers wrote. Within six months of those first reports to the CDC, 3,000 more EVALI cases were reported and 68 deaths due to the condition verified, the society said.
Gotway and colleagues investigated patterns on chest CT that might correspond to pathological findings for EVALI through a study that included 26 patients who met criteria for the condition and had undergone both CT as well as biopsy. The team classified CT findings as either ground-glass opacity or consolidation.
The most common CT finding among patients with EVALI also confirmed by pathology was multifocal or diffuse ground-glass opacity, identified in 96% of the study cohort — a finding even more prevalent than that of subacute hypersensitivity pneumonitis, or lung tissue inflammation, according to the authors.
“We hope to make radiologists aware that if they see diffuse lung opacities in a younger patient without clearly defined causes, then they may want to seriously consider that the patient could have a vaping injury,” Gotway said in the RSNA statement. “Patients may not readily admit that they’re using the material, but if a radiologist recognizes these patterns and then tells the clinician that it could be vaping-induced injury, then maybe they could test for a nicotine metabolite or ask the patient about this exposure.”
June 28, 2019 — Current eligibility criteria for CT lung cancer screening from the U.S. Preventive Services Task Force (USPSTF) do not account for racial differences — leaving behind a large proportion of African American smokers who would benefit from the test, say Tennessee researchers in an article published online June 27 in JAMA Oncology.
Multiple studies have shown that African American smokers have a substantially higher risk of lung cancer than white smokers, despite smoking fewer cigarettes per day and having a lower pack-year smoking history. However, many CT lung screening guidelines set minimum age and smoking history requirements for screening without considering racial differences in smoking patterns, noted first author Melinda Aldrich, PhD, and colleagues from Vanderbilt University Medical Center.
As part of the ongoing Southern Community Cohort Study, the researchers evaluated the efficiency of using USPSTF screening guidelines in a low-income cohort consisting of predominantly African Americans (67%). The USPSTF recommends screening individuals between ages 55 and 80 with a smoking history of at least 30 pack-years.
Among 48,364 current or former smokers, the proportion of African American smokers who met the USPSTF eligibility criteria for CT lung screening was roughly half that of white smokers. This disparity in screening eligibility also applied to the subcohort of white and African American patients diagnosed with lung cancer.
The predominant reason that such a high percentage of African American smokers were deemed ineligible for CT lung screening was that they fell short of the 30 pack-year requirement, according to the authors. The proportion of African American smokers who did not meet the minimum smoking history needed for screening eligibility was roughly threefold that of white smokers.
In addition, the likelihood of developing lung cancer before reaching the minimum age requirement for screening was almost five percentage points higher for African American smokers than for white smokers (p < 0.03).
“Existing USPSTF lung cancer screening guidelines do not appear to be optimized for African American smokers and may result in a widening of racial disparities in late-stage diagnosis, potentially leading to higher mortality and worse outcomes among African American persons with lung cancer,” Aldrich and colleagues wrote. Yet simple adjustments to the USPSTF guidelines could help mitigate these disparities, they continued.
For example, the researchers showed that modifying the screening criteria to cover African American smokers with a history of 20 pack-years would increase the proportion of African Americans eligible for screening to 28.5%, compared with 17.4% for the current 30 pack-year requirement. Lowering the minimum screening age to 50 years from 55 years for African Americans would boost their eligibility even further.
What’s more, such revisions to the eligibility criteria would improve the sensitivity of CT lung screening for this cohort and narrow the gap between African American and white smokers, the authors noted.
“Current USPSTF lung cancer screening guidelines may be too conservative for African American smokers. The findings suggest that race-specific adjustment of pack-year criteria in lung cancer screening guidelines would result in more equitable screening for African American smokers at high risk for lung cancer,” they concluded.
Harvey S. Hecht; Leslee Shaw; Y.S. Chandrashekhar; Jeroen J. Bax; Jagat NarulaDISCLOSURES
Eur Heart J. 2019;40(18):1440-1453.
Abstract and Introduction
The 2016 National Institute of Health and Care Excellence clinical guideline for the assessment and diagnosis of chest pain positions coronary computed tomography angiography as the first test for all stable chest pain patients without confirmed coronary artery disease and discards the previous emphasis on calculation of pre-test likelihood recommended in their 2012 edition of the guidelines. On the other hand, the American College of Cardiology Foundation/American Heart Association and the European Society of Cardiology guidelines continue to present the stress testing functional modalities as the tests of choice. The aim of this review is to present, in the form of a debate, the pros and cons of these paradigm changing recommendations, with an emphasis on literature review and projection of future needs, with conclusions to be drawn by the reader.
Introduction: Nice Guidelines for Evaluation of Stable Coronary Disease
The National Institute of Health and Care Excellence (NICE) is the executive non-departmental public body of the Department of Health in the United Kingdom responsible for determination of health care policy for both the English and Welsh National Health Service. The 2016 NICE update for the Chest Pain of Recent Onset: Assessment and Diagnosis Clinical Guideline(Figure 1) was proposed after exhaustive review and analysis of accuracy, outcomes and cost effectiveness, and has since replaced the 2012 version. The guideline positions coronary computed tomography angiography (CCTA) as the first test for all stable chest pain patients without confirmed coronary artery disease (CAD), and (interestingly) discards the previous emphasis on calculation of pre-test likelihood recommended in the 2012 edition of the guidelines. In the penultimate version, the first line investigations were stratified as invasive coronary angiography (ICA) for estimated CAD likelihood of >60–90%, functional imaging for >30–60%, and coronary artery calcium (CAC) scan for estimated CAD likelihood of >10–30%. However, in patients with previously confirmed CAD, functional imaging and maximum endurance exercise treadmill testing (ETT) remain as the recommended first line tests for any change in clinical status or for timely follow-up. The NICE document has further added that fractional flow reserve (FFR) derived from computed tomography angiography (CTA) (FFRCT) should be considered as an option for patients with stable, recent onset chest pain who are offered CTA as part of the NICE pathway on chest pain, and have projected significant cost savings accruing from its utilization.
National Institute of Health and Care Excellence (NICE) guideline for ‘Chest Pain of Recent Onset Assessment and Diagnosis’.2 CAD, coronary artery disease; CT, computed tomography; ECG, electrocardiogram; MR, magnetic resonance. Reprinted with the permission of the publisher from Chest Pain of Recent Onset.1
On the other hand, 2012 American College of Cardiology and American Heart Association (ACCF-AHA) guidelines for the diagnosis and management of patients with stable ischaemic heart disease (Figure 2) and 2013 European Society of Cardiology (ESC) guidelines on the management of stable CAD (Figure 3), rely on pre-test likelihood and offer a multiplicity of functional imaging tests as the first line diagnostic tool. The ACCF-AHA Guidelines support Class Ib recommendation for ETT, stress echocardiography (SE), and myocardial perfusion radionuclide imaging (MPI) and IIa for magnetic resonance imaging (MRI). Computed tomography (CT) angiography is reserved for patients with low-to-intermediate pretest probability of CAD who are incapable of at least moderate physical activity or have disabling comorbidity (Class IIa recommendation), and for patients with an intermediate pretest probability of CAD who can undertake at least moderate physical activity or reveal no disabling comorbidity (Class IIb recommendation). The ESC Guideline designates a Class Ib recommendation for all functional modalities, including MRI and positron emission tomography (PET). European Society of Cardiology also includes a Class IIa recommendation for CTA in patients in the lower range of intermediate pre-test probability when adequate diagnostic image quality can be expected, as an alternative to stress imaging, or after an inconclusive stress test, or for patients who have contraindications to stress testing in order to avoid otherwise necessary ICA. However, neither ACCF-AHA nor ESC documents had the benefit of the extensive CTA literature published since 2012–2013, which weighed into formulation of the NICE guidelines 2016 update vis-à-vis their departure from the conventional practices reflected in the 2012 American and 2013 European guidelines. It is not certain whether or not the next ACCF-AHA and ESC guidelines will come to similar conclusions as 2016 NICE update. However, it is important to examine the implications for the practicing cardiologists if the NICE guidelines were to be implemented universally.
2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischaemic heart disease.4 CCTA, coronary computed tomography angiography; CMR, cardiac magnetic resonance; ECG, electrocardiogram; Echo, echocardiography; IHD, ischaemic heart disease; MI, myocardial infarction; MPI, myocardial perfusion imaging; Pharm, pharmacological; UA, unstable angina; UA/NSTEMI, unstable angina/non-ST-elevation myocardial infarction. Reprinted with the permission of Elsevier from Fihn et al.4
European Society of Cardiology 2013 non-invasive testing in patients with suspected stable coronary artery disease and an intermediate pre-test probability.5 CAD, coronary artery disease; CTA, computed tomography angiography; CMR, cardiac magnetic resonance; ECG, electrocardiogram; ICA, invasive coronary angiography; LVEF, left ventricular ejection fraction; PET, positron emission tomography; PTP, pre-test probability; SCAD, stable coronary artery disease; SPECT, single-photon emission computed tomography. Reprinted with permission of Oxford Academic from Montalescot et al.5
Published Sunday 23 June 2019 By Lauren Sharkey
Fact checked by Jasmin Collier
According to one new study, having high levels of calcium in the coronary arteries could be responsible for detrimental changes to the structure of the heart.
A new study investigates calcium and heart disease.
“Heart disease is the leading cause of death for men and women,” according to the Centers for Disease Control and Prevention (CDC).
Being able to identify people at risk is therefore a crucial public health issue.
Calcium plays a number of roles in the body, including keeping bones healthy. However, calcium present in coronary arteries can lead to the accumulation of plaque.
Over time, this calcified substance can cause atherosclerosis, or a narrowing of the arteries. Atherosclerosis restricts blood flow and oxygen supply to vital organs, potentially resulting in a heart attack or stroke.
High cholesterol levels can indicate that a person is at risk; but scientists can also test CAC levels directly.
Using a CT scan to take numerous sectional pictures of the heart, doctors can see specks of CAC. A person’s scores tend to range from zero to over 400. The higher the score, the higher the risk of developing cardiovascular disease.
Cholesterol guidelines from 2018 recommend a CAC scan for people ages 40–75 whose risk status is “uncertain,” note the American Heart Association (AHA).
A new study, the results of which now appear in the journal Circulation: Cardiovascular Imaging, has examined the CAC scores of younger people and drawn some interesting conclusions.
The scientists used data from almost 2,500 people to track CAC and heart structure differences between young adulthood and middle age. Women made up 57% of the group, and 52% of participants were white.
They took data from participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study, which began in the 1980s with the aim of identifying young adult risk factors for cardiovascular disease.
“We looked at early adulthood to middle age because this is a window in which we can see abnormalities that might not be causing symptoms, but could later increase the risk of heart problems,” explains study co-author Dr. Henrique Turin Moreira.
The researchers compared test results from years 15 and 25 of the CARDIA study period. At the 25-year mark, the average age of the group was around 50.
When it came to their CAC results, 77% of participants had a score of zero in year 15 of the study. However, in year 25, this had dropped to 72%i
A number of factors were linked to a rise in CAC scores, including being older, being male, being black, smoking, having higher cholesterol levels, and having higher systolic blood pressure.
Middle-aged people who had higher CAC scores also showed a 9% increase in left ventricular volume and a 12% increase in left ventricular mass.
When the left ventricle changes in this way, the heart has to put more effort into pumping blood. This, in turn, leads to a thickening of the heart, which increases the risk of heart failure.
The study authors also note that these abnormalities were more significant among black people. For these people, every one-unit change in their CAC score correlated with quadruple the increase in their left ventricular mass.
It is unclear why people exhibited such differences depending on their race. Dr. Moreira explains that it could be “due to genetic factors or perhaps greater exposure to cardiovascular risk factors that usually appear earlier” in black people.
What that do already know, however, is that black people are already more likely to develop cardiovascular disease. Although just 43% of white women and 50% of white men have cardiovascular disease, it affects 57% of black women and 60% of black men.
Further research, explains Dr. Moreira, will be needed to “examine the link between coronary artery calcium and heart health” — especially in relation to race. However, documenting the relationship between CAC and heart failure risk factors in a younger age group is significant.
“Given the burden of morbidity and mortality associated with heart failure, these are important findings,” says Dr. Salim Virani, a co-author of the AHA’s 2018 cholesterol guidelines.
“Prior studies from this cohort have also shown that a better risk factors profile in young adulthood is associated with much lower CAC and therefore, these results further highlight the importance of primordial prevention and risk factor modification in early adulthood.”
June 14, 2019 — The presence of coronary artery calcium (CAC) on the CT scans of middle-aged individuals, especially African Americans, was associated with an increased risk of structural heart abnormalities and future heart failure in a new study, published online June 14 in Circulation: Cardiovascular Imaging.
Over the past several years, multiple studies have confirmed the association between high CAC scores and cardiovascular disease. Recognizing this research, the American College of Cardiology (ACC) and American Heart Association (AHA) recently published a new guideline recommending CT CAC testing for individuals at risk of developing atherosclerotic heart disease.
Further adding to this work, researchers from the U.S. and Brazil tracked the cardiovascular health of 2,449 individuals as part of the Coronary Artery Risk Development in Young Adults (CARDIA) trial. The study participants were between 18 and 30 years old; they underwent a baseline CT CAC exam followed by subsequent CT CAC testing at 15 years and 25 years after the initial exam. Approximately half of them were African Americans, and 57% were women.
The researchers focused their study specifically on “early adulthood to middle-age because this is a window in which we can see abnormalities that might not be causing symptoms but could later increase the risk of heart problems,” co-author Dr. Henrique Moreira, PhD, from the University of São Paulo, said in a statement.
After analyzing the data, Moreira and colleagues found that individuals with positive CT CAC exams were more likely to have structural abnormalities in their heart’s left ventricle — a risk factor for heart failure — compared with those who had a negative CT CAC exam. CT CAC scores exceeding 0, for example, were associated with a 12% increase in left ventricular mass index and a 9% increase in left ventricular end-diastolic volume.
These structural abnormalities were particularly pronounced in African Americans, who had four times the increase in left ventricular mass for every single-digit increase in CT CAC score, compared with the cohort of white patients. Furthermore, the researchers identified a statistically significant association between an increase in CT CAC score between year 15 and year 25 and an increase in left ventricular mass — only in African Americans.
“Racial differences in our findings may be due to genetic factors or perhaps greater exposure to cardiovascular risk factors that usually appear earlier in blacks,” Moreira said. “We need more research to examine the link between coronary artery calcium and heart health.”
“The results of this study are important as they highlight that presence of CAC and higher CAC scores may also be associated with echocardiographic markers of subclinical left ventricular systolic and diastolic dysfunction. … [The results also] highlight the importance of primordial prevention and risk factor modification in early adulthood,” Dr. Salim Virani, from Baylor College of Medicine in Houston, said in response to the study.
Attention to Healthy Lifestyle at an Early Age Key to Preventing Heart Disease
By Reuters Staff
May 29, 2019
NEW YORK (Reuters Health) – Updated clinical practice guidelines on the management of blood cholesterol encourage adopting a heart-healthy lifestyle beginning in childhood to reduce lifetime risk for atherosclerotic cardiovascular disease (ASCVD), according to a new report.
The 78-page guideline from the American Heart Association (AHA), the American College of Cardiology (ACC) and other national associations was published in Circulation in November. To help disseminate the recommendations, Dr. Scott Grundy of the University of Texas Southwestern Medical Center in Dallas and colleagues now provide a six-page synopsis, published online May 27 in the Annals of Internal Medicine.
As a commentary (https://bit.ly/2QbHney) released with the guidelines in November noted, “Ultimately, the value of a guideline is determined by how effectively it is implemented into practice and by how much morbidity and mortality are avoided through its application.”
In addition to maintaining a healthy lifestyle over the lifespan, a theme stressed throughout the guideline, it advises:
– Maximally tolerated doses of statins in secondary prevention of ASCVD.
– Nonstatin medications (ezetimibe or pro-protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors) in addition to statin therapy for patients at very high risk for ASCVD.
– Statin therapy without risk stratification in severe primary hypercholesterolemia, often starting in childhood.
– Moderate-intensity statin therapy without risk stratification in adults aged 40 to 75 years with diabetes and an LDL cholesterol (LDL-C) level of 1.8 mmol/L (70 mg/dL) or higher.
– A risk discussion between the provider and patient about statin therapy for adults aged 40 to 75 years without diabetes who have LDL-C levels of at least 1.8 mmol/L (70 mg/dL), and a 10-year ASCVD risk of 7.5% or higher.
– Moderate-intensity statin therapy if a risk discussion favors their use in adults aged 40 to 75 years without diabetes who have LDL-C levels of at least 1.8 mmol/L (70 mg/dL) and a 10-year ASCVD risk of 7.5% or higher.
– A three-tiered decision-making process in primary prevention in adults aged 40 to 75 years to personalize the risk decision. This includes enhancing factors such as family history of premature coronary artery disease metabolic syndrome, chronic kidney disease, LDL-C level 160 mg/dL or higher; and in women, history of pre-eclampsia or premature menopause (< 40 years); inflammatory diseases such as psoriasis, rheumatoid arthritis, HIV), and high-risk ethnicity such as South Asian ancestry.
– Coronary-artery-calcium scoring to improve risk stratification in moderate-risk patients for whom the benefits of statin therapy are uncertain.
– Follow-up for adherence to medications and lifestyle and to assess adequacy of response.
According to the Centers for Disease Control and Prevention, cardiovascular disease is the number one cause of death in the United States, including for African-American, Hispanic, and white persons and for both women and men.
The leading cause of death attributable to cardiovascular disease is coronary heart disease (44%), followed by stroke (17%). In 2013-2014, ASCVD accounted for 14% of total health expenditures, more than any other major diagnostic group.
Ann Intern Med 2019.