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The AQUARIUS trial: Aliskiren does not slow progression of atherosclerosis

28 Nov, 13 | by Alistair Lindsay

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. more…

Treatment of bystander coronary disease in primary PCI improves outcomes

22 Nov, 13 | by Alistair Lindsay

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 STEMI were randomly assigned to preventive PCI or no further PCI of non-infarct related vessels with >50% stenosis, immediately following reperfusion of the infarct related artery. The primary outcome was a composite of death from cardiac causes, nonfatal myocardial infarction, or refractory angina and the mean follow-up was 23 months. The trial was stopped early by the data and safety monitoring committee following enrolment of 465 out of a planned 600 patients due to a highly significant result favouring preventive PCI;  the primary outcome occurred in 21 patients assigned to preventive PCI and in 53 patients assigned to no preventive PCI.  This translates into an absolute risk reduction of 14% in the preventive PCI group (HR 0.35; 95% CI, 0.21 to 0.58; NNT 8; P<0.001). The hazard ratios were 0.34 (95% CI, 0.11 to 1.08) for death from cardiac causes, 0.32 (95% CI, 0.13 to 0.75) for nonfatal myocardial infarction, and 0.35 (95% CI, 0.18 to 0.69) for refractory angina.  Although procedure times and contrast loads were significantly higher in the preventive PCI group, this did not translate into an increase in procedure-related adverse events. more…

Gut microbiota linked to coronary outcomes

15 Jul, 13 | by Alistair Lindsay

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 a proatherosclerotic metabolite, trimethylamine-N-oxide (TMAO). The relevance of this connection in humans is unknown but was investigated in two linked studies. more…

Atherosclerosis: not just a disease of the modern age?

21 Apr, 13 | by Alistair Lindsay

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? more…

Early atherosclerosis declines in autopsy study

1 Jan, 13 | by Alistair Lindsay

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 prevalence of coronary and aortic atherosclerosis in the US armed forces, to assess the impact of risk factor reduction and lifestyle measures. more…

Vascular stem cells and atherosclerosis

21 Oct, 12 | by Alistair Lindsay

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 remodelling and disease development.  In this study, Tang et al re-examine this paradigm and provide compelling evidence to challenge the status quo.  more…

CT FFR – de facto?

8 Oct, 12 | by Alistair Lindsay

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 been increasing, it remains a limitation of the technique that the haemodynamic significance of any lesions seen cannot be assessed. more…

HIV and arterial inflammation

22 Aug, 12 | by Alistair Lindsay

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. more…

cIMT progression poor predictor of cardiovascular outcomes

28 Jul, 12 | by Alistair Lindsay

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 investigated.  The first stage of the PROG-IMT project (individual progression of carotid intima media thickness as a surrogate of vascular risk) analysed the association of cIMT progression with the risk of cardiovascular events on a large dataset derived from general populations. more…

Low vitamin D levels linked to subclinical atherosclerosis

9 Aug, 11 | by Alistair Lindsay

In recent epidemiological studies, 25-hydroxyvitamin D deficiency has been identified as a novel cardiovascular risk factor.  However, the mechanisms by which vitamin D deficiency affect cardiovascular risk remain unclear. more…

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