Individual Assessment of Arteriosclerosis by Empiric Clinical Profiling

Abstract

BackgroundArteriosclerosis is a common cause of chronic morbidity and mortality. Myocardial infarction, stroke or other cardiovascular events identify vulnerable patients who suffer from symptomatic arteriosclerosis. Biomarkers to identify vulnerable patients before cardiovascular events occur are warranted to improve care for affected individuals. We tested how accurately basic clinical data can describe and assess the activity of arteriosclerosis in the individual patient.Methodology/Principal Findings269 in-patients who were treated for various conditions at the department of general medicine of an academic tertiary care center were included in a cross-sectional study. Personal history and clinical examination were obtained. When paraclinical tests were performed, the results were added to the dataset. The numerical variables in the clinical examination were statistically compared between patients with proven symptomatic arteriosclerosis (n = 100) and patients who had never experienced cardiovascular events in the past (n = 110). 25 variables were different between these two patient groups and contributed to the disease activity score. The percentile distribution of these variables defined the empiric clinical profile. Anthropometric data, signs of arterial, cardiac and renal disease, systemic inflammation and health economics formed the major categories of the empiric clinical profile that described an individual patient's disease activity. The area under the curve of the receiver operating curve for symptomatic arteriosclerosis was 0.891 (95% CI 0.799-0.983) for the novel disease activity score compared to 0.684 (95% CI 0.600-0.769) for the 10-year risk calculated according to the Framingham score. In patients suffering from symptomatic arteriosclerosis, the disease activity score deteriorated more rapidly after two years of follow-up (from 1.25 to 1.48, P = 0.005) compared to age- and sex-matched individuals free of cardiovascular events (from 1.09 to 1.19, P = 0.125).Conclusions/SignificanceEmpiric clinical profiling and the disease activity score that are based on accessible, available and affordable clinical data are valid markers for symptomatic arteriosclerosis.

Invariant natural killer T cells: Linking inflammation and neovascularization in human atherosclerosis

“…Fifteen of these patients were known to have SA, active atherosclerosis and to have suffered from CV events, defined as myocardial infarction, angina pectoris with signs of myocardial ischemia, cerebrovascular ischemic stroke, transient ischemic attack, peripheral arterial occlusive disease, SA aortic aneurysm or any arterial revascularization procedure to treat atherosclerosis [5]. PBMC were obtained from a second cohort of 269 in-patients hospitalized for any reason and who, with written informed consent, participated in a cross-sectional observational study of atherosclerosis [45]. Twenty-eight of this second cohort had previous CV events in more than one organ system; among these SA patients, the ten oldest individuals (median age: 78, range 76-83 years) were selected for the analysis of the number of circulating iNKT cells (Supporting Information Table 1).…”

A CETP polymorphism improves diagnostic power of clinical examination in patients with cardiovascular disease

“…A. The 25 variables that differed significantly between patients with and without symptomatic atherosclerosis (12) are shown as labelled colour-coded columns. Eachcolumn visualises the quartile distribution of the symptomatic patients'variables.…”

“…For the 59 remaining patients, active atherosclerosis was neither definitely confirmed nor ruled out. The patient group with symptomatic atherosclerosis was significantly older and included more male participants [12]. To examine the diagnostic power of proatherosclerotic single nucleotide polymorphisms we selected amaximal total of 52 age-matched women and 62 age-matched men from the two patient groups for further analysis (table 2).…”

“…In the present study we hypothesised that molecular tests would improve a recently developed method to quantitatively assess the clinical appearance or phenotype of patients with active, symptomatic atherosclerosis [12]. Comprehensive, quantitative phenotyping in the field of cardiovascular diseases was first discovered and developed by physiologists and formed the basis for sophisticated phenotype-genotype correlations in an animal model of hypertension [13].…”

“…This method of clinical disease phenotyping revealed 25 numerical variables that were significantly different between patients with and without symptomatic atherosclerosis and contributed to the empirical clinical profile of atherosclerosis. These quantitative variables were transformed mathematically into score points and the average score per patient was named clinical disease activity score (cDAS), abiomarker that was remarkably accurate in discriminating between patients with and without symptomatic atherosclerosis [12].…”