Atherosclerosis Screening by Noninvasive Imaging for Cardiovascular Prevention: A Systematic Review

Abstract

Conclusion: Patients with Marfan syndrome who have ascending aorta diameters of Ͻ50 mm have a low risk of sudden death or aortic dissection. Fifty millimeters is a reasonable threshold for prophylactic aortic surgery in patients with Marfan syndrome. Summary: During the last 30 years, the life expectancy for patients with Marfan syndrome has increased by 30 years (Pyeritz RE, et al, Heart 2009;95:173-5). Improvement of survival in patients with Marfan syndrome is likely multifactorial but includes more widespread practice of routine imaging and timed prophylactic aortic surgery. Two recent task forces have proposed a 50-mm aortic diameter at the level of the sinus of Valsalva as the cutoff value for performing ascending aortic surgery; however, no value has been specifically proposed for patients with Marfan syndrome. All patients in this study fulfilled international criteria for Marfan syndrome and had not had previous aortic surgery or dissection. Patients must have come to the authors' center at least two times to be included in this study. Echocardiography was used to make aortic measurements every 2 years, and patients were given systemic ␤ blockade and advised to avoid intense sports activity. When the aortic root maximum diameter reached 50 mm, prophylactic surgery was proposed. There were 732 patients with Marfan syndrome followed up for a mean of 6.6 years. During follow-up, two dissections and five deaths occurred. Event rate (death/aortic dissection) was 0.17% per year. Risk increased if the aortic diameter increased within 2 years of the event, from 0.09% per year (95% confidence interval [CI], 0.00%-0.20%) when the aortic diameter was Ͻ40 mm to 0.3% (95% CI, 0.00%-0.71%) with aortic diameters of 45 to 49 mm and to 1.3% (95% CI, 0.00%-3.93%) with aortic diameters of 50 to 54 mm. Aortic diameters Ͼ50 mm increased the risk four times. The annual risk was Ͻ0.05% when the aortic diameter was Ͻ50 mm after the authors excluded a neonatal patient, a woman who became pregnant, and a 72-year-old woman with previous myocardial infarction. Comment: The results suggest that aortic dissection in patients with Marfan syndrome can be almost entirely prevented with the use of systemic ␤-blockers, avoidance of intense sporting activities, and scheduled surgery when the aortic root reaches 5 cm in diameter. Patients with Marfan syndrome can do very well with strict compliance with medical advice and timed prophylactic surgery.

Triptolide inhibits the progression of atherosclerosis in apolipoprotein E−/− mice

“…Atherosclerosis is the main pathology for cardiovascular and cerebrovascular diseases, and it progresses with chronic inflammation (31)(32)(33). TPL is a compound originally extracted from the plant T. wilfordii Hook.f., which has potent anti-inflammatory activity (34).…”

Mental distress and quality of life following provision of vascular imaging results of the coronary and carotid arteries to asymptomatic adults: a scoping review protocol

“…There is great interest (and value) in providing people with vascular imaging results of the coronary and carotid arteries to prompt healthful behaviour change and better management of CVD 7,40 . However, the provision of the imaging results may produce markedly different emotions-and as a result, downstream behaviours-depending upon the way in which they are received and appraised.…”

“…Scoping reviews aim to map key concepts, main sources and types of evidence available in a research area and can be undertaken where an area is complex or has not been comprehensively reviewed before 38 . Previous reviews reported very little evidence relating to QOL or mental distress following provision of vascular imaging results to asymptomatic adults 7,[39][40][41][42] . It is important, therefore, to collate evidence relating to the findings available in this field, how studies in this field have been conducted, the key characteristics of studies, and important knowledge gaps.…”

Rationale and design of a trial to personalize risk assessment in familial coronary artery disease

“…Showing subjects their CCS is strongly associated with subjects initiating therapy (28) and in a systematic review of eight non-randomised studies (n=2,994) evaluating the use of CCS in improving adherence to therapy, Rodondi et al (29) found that subjects with evidence of atherosclerosis showed better perception of cardiovascular risk and improved adherence to lifestyle advice. However, in four RCTs (n=709), screening did not influence risk for poorer outcomes, with the exception, in one study, of improved smoking cessation (18% vs. 6%, p=0.03).…”