The AQUARIUS trial: Aliskiren does not slow progression of atherosclerosis

The renin-angiotensin-aldosterone system (RAAS) appears to have an important role in the development of atherosclerosis.  The Aliskiren Quantitative Atherosclerosis Regression Intravascular Ultrasound Study (AQUARIUS) sought to determine if direct renin inhibition with aliskiren slows atherosclerosis progression in patients with already controlled blood pressure. […]

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Treatment of bystander coronary disease in primary PCI improves outcomes

In patients with ST-elevation myocardial infarction (STEMI), current guidelines support PCI of the infarct related artery and medical management of flow-limiting lesions in non-infarct related vessels (so-called bystander disease). This paradigm is challenged in the Preventive Angioplasty in Acute Myocardial Infarction (PRAMI) study. In this single-blind trial performed at five UK centres, patients presenting with […]

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Gut microbiota linked to coronary outcomes

There is a growing awareness in many fields of medicine that intestinal microbial organisms, collectively termed microbiota, play a crucial role in the global metabolism of their host. Recent animal studies have demonstrated mechanistic links between intestinal microbial metabolism of the choline moiety in dietary phosphatidylcholine (lecithin) and coronary artery disease through the production of […]

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Atherosclerosis: not just a disease of the modern age?

As life expectancy doubled between 1800 and 2000, atherosclerosis replaced infectious diseases as the main cause of death in the developed world. But is atherosclerosis a purely modern phenomenon, precipitated by lifestyle changes and an ageing population, or was it common in ancient societies too? […]

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Early atherosclerosis declines in autopsy study

In 1953 a report from the Armed Forces Institute of Pathology reported a 77% prevalence of coronary atherosclerosis among US soldiers killed in the Korean War. This revolutionary study demonstrated that atherosclerosis was present in a large number of young patients without clinical evidence of heart disease. A new study aimed to estimate the current […]

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Vascular stem cells and atherosclerosis

The development of atherosclerotic diseases involves the proliferation and migration of a variety of cell types.  It has been generally accepted that vascular smooth muscle cells in the arterial wall play a crucial role in this process through a process of ‘de-differentiation’ from a normal contractile phenotype to a proliferative and synthetic state that drives […]

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CT FFR – de facto?

In recent years invasive coronary angiography (ICA) has been supplemented by the measurement of fractional flow reserve (FFR) to determine whether a coronary stenosis impairs delivery of oxygen to the heart. However this technique has not previously been available through non-invasive methods. While the use of coronary computed tomography (CT) calcium scoring and angiography has […]

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HIV and arterial inflammation

Patients with Human Immunodeficiency Virus (HIV) demonstrate a high prevalence of noncalcified coronary atherosclerotic lesions.  However, the specific mechanisms that lead to this remain unknown.  In this study Subramanian et al. used 18fluorine-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) to assess arterial wall inflammation in patients with HIV, and compared this to traditional and nontraditional risk makers. […]

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cIMT progression poor predictor of cardiovascular outcomes

Carotid intima-media thickness (cIMT) is an ultrasound marker of early atherosclerosis.  Increasing cIMT thickness has been shown to correlate with an increased risk of subsequent cardiovascular events in general populations, independent of other major risk factors.  However, whether a change in cIMT thickness over time affects the risk of cardiovascular events has not been systematically […]

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