The High-Risk Plaque Initiative: Primary Prevention of Atherothrombotic Events in the Asymptomatic Population (original) (raw)
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Journal of the American College of Cardiology, 2015
Although recent studies suggest that measuring coronary artery calcification (CAC) may be superior to indirect atherosclerotic markers in predicting cardiac risk, there are limited data evaluating imaging-based biomarkers that directly quantify atherosclerosis in different vascular beds performed in a single cohort. The BioImage Study (A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population) sought to identify imaging biomarkers that predict near-term (3-year) atherothrombotic events. The BioImage Study enrolled 5,808 asymptomatic U.S. adults (mean age: 69 years, 56.5% female) in a prospective cohort evaluating the role of vascular imaging on cardiovascular risk prediction. All patients were evaluated by CAC and novel 3-dimensional carotid ultrasound. Plaque areas from both carotid arteries were summed as the carotid plaque burden (cPB). The primary endpoint was the composite of major adverse cardiac events (MACE) (cardiovascular death, myocardial infarction, ...
2006
for the SHAPE Task Force † Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no governmentor healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the "vulnerable patient." These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement.
MESA: the NIH-sponsored study that validates atherosclerosis imaging for primary prevention
Current atherosclerosis reports, 2011
Coronary artery calcium (CAC) score correlates strongly with the burden of atherosclerotic plaques in the coronary arteries. It is the strongest predictor of future coronary events in asymptomatic individuals, being stronger than all traditional risk factors combined. It is also a better predictor of future events than carotid intima-media thickness (CIMT) measurement for the prediction of coronary artery disease but slightly weaker than CIMT for the prediction of cerebrovascular events such as stroke. These findings have been validated by the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective epidemiologic study sponsored by the National Institutes of Health (NIH) investigating the prevalence, correlates, and progression of atherosclerosis in an asymptomatic, ethnically diverse population. That is why the US national guidelines have recently elevated their recommendation levels to Class IIa for use of CAC and CIMT in risk stratification of the asymptomatic intermediate-ris...
Atherosclerotic plaque biomarkers: beyond the horizon of the vulnerable plaque
Current cardiology reviews, 2011
Cardiovascular disease (CVD) is the number one cause of death globally, and the majority of CVD is caused by atherosclerosis. Atherosclerosis is a systemic inflammatory disease that leads to myocardial infarction, stroke and lower limb ischemia. Pathological studies have given insight to development of atherosclerosis and the importance of local plaque vulnerability, leading to thrombus formation and cardiovascular events. Due to the burden of cardiovascular disease, identification of patients at risk for cardiovascular events and treatment stratification is needed. The predictive power of classical risk factors is limited, especially in patients with manifest atherosclerosis. Imaging modalities have focused on the characteristics of the vulnerable plaque. However, it has become evident that not all so-called vulnerable plaques lead to rupture and subsequent thrombosis. The latter obviously limits the positive predictive value for imaging assessment of plaques and patients at risk. ...
Atherothrombosis and High-Risk Plaque
Journal of The American College of Cardiology, 2005
This second part of the review on atherothrombosis highlights the diffuse nature of the disease analyzing the feasibility and potential of the noninvasive imaging modalities, including computed tomography (electron-beam computed and multi-detector computed tomography) and magnetic resonance imaging for its detection and monitoring. These imaging modalities are being established as promising tools in high-risk cardiovascular patients for identification and/or management of coronary calcification, stenotic or obstructive disease, high-risk plaques (not necessarily stenotic), and overall burden of the disease. In addition, such technology facilitates the understanding of the processes involved in the development and progression of atherothrombosis responsible for coronary, cerebral, and peripheral ischemic events. (J Am Coll Cardiol 2005;46:1209 -18)
Finding Vulnerable Atherosclerotic Plaques: Is It Worth the Effort?
Arteriosclerosis, Thrombosis, and Vascular Biology, 2004
Previous Brief Review in this Series: • Choudhury RP, Fuster V, Badimon JJ. Fisher EA, Fayad ZA. MRI and characterization of atherosclerotic plaque: emerging appliations and molecular imaging. 2002;22:1065-1074. • Bonetti PO, Lerman LO, Lerman A. Endothelial dysfunction: a marker of atherosclerotic risk. 2003;23:168 -175. • Oliver JJ, Webb DJ. Noninvasive assessment of arterial stiffness and risk of atherosclerotic events. 2003;23:554 -566.
The international journal of cardiovascular imaging, 2008
In the current issue of the journal, Knollmann et al. describe results from a quantitative post-mortem coronary plaque analysis with CT angiography (CTA) in comparison to histology . Plaque burden was quantified on a per-segment and a per-patient basis and demonstrated an overall fair correlation to histology, but significant overestimation with CT. Further analysis of calcified and non-calcified plaque components demonstrated best correlation for calcified plaque with overestimation of plaque burden. In contrast, there was relatively poor correlation for non-calcified plaque components and in particular the lipid core area, which was underestimated with CT in comparison to histology. Importantly, the correlation was better for patient-based analysis (average of all segments) versus segment-based analysis. For segment-based analysis of individual plaques the correlation between histology and CT was limited for small plaques.
European Heart Journal - Cardiovascular Imaging, 2020
Atherosclerotic plaques prone to rupture may cause acute myocardial infarction (MI) but can also heal without causing an event. Certain common histopathological features, including inflammation, a thin fibrous cap, positive remodelling, a large necrotic core, microcalcification, and plaque haemorrhage are commonly found in plaques causing an acute event. Recent advances in imaging techniques have made it possible to detect not only luminal stenosis and overall coronary atherosclerosis burden but also to identify such adverse plaque characteristics. However, the predictive value of identifying individual adverse atherosclerotic plaques for future events has remained poor. In this Position Paper, the relationship between vulnerable plaque imaging and MI is addressed, mainly for non-invasive assessments but also for invasive imaging of adverse plaques in patients undergoing invasive coronary angiography. Dynamic changes in atherosclerotic plaque development and composition may indicate...