Prognostic significance of progression of coronary atherosclerosis.

Waters, David D.; Craven, Thomas; Lespérance, Jacques

doi:10.1161/01.cir.87.4.1067

Cited by 260 publications

(124 citation statements)

References 43 publications

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“…The relative risk (95% confidence interval) of subjects with progression compared with those without was 7.3 (2.2 to 24.7, P-c.001) for cardiac death, 2.3 (1.3 to 4.2, />=.009) for cardiac death or nonfatal myocardial infarction, 1.4 (1.0 to 2.0, P=.O57) for revascularization, and 1.7 (1.3 to 2.3, P<.001) for any cardiac event. 60 Ten-year follow-up (median, 85.2 months after 2-year angiogram) in CLAS indicates that per-patient assessment of coronary artery lesion progression by both GCS and QCA predicts subsequent cardiac events. Relative risk (95% confidence interval) predicted by GCS for nonfatal myocardial infarction was 1.6 (1.0 to 2.5, P=.Q5) and for nonfatal myocardial infarction and cardiac death combined, 1.6 (1.1 to 2.5, F=.O4).…”

Section: Sequential Coronary Angiographic Determination Of Progressiomentioning

confidence: 97%

George Lyman Duff Memorial Lecture. Arterial imaging and atherosclerosis reversal.

Blankenhorn

Hodis

1994

Arterioscler Thromb

202

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This review explores evidence for the reversibility of atherosclerosis and augmentation of angiography with noninvasive arterial wall imaging. Meta-analysis from coronary angiographic trials demonstrates that regression and stabilization are 1.5 to 2 times more common in treated than placebo subjects, and progression is reduced by half in treated subjects. Odds ratios for clinical coronary events are significantly reduced with treatment. Lesion improvement occurs more readily in women than men and more so in women receiving concomitant estrogen replacement therapy. Lesions with >50% diameter stenosis (%S) at baseline respond more readily to lipid lowering than those <50%S, whereas reduction in coronary events is related to stabilization of lesions <50%S. Lipoproteins have a differential effect on lesion progression according to lesion size, and triglyceride-rich lipoproteins play an important role in the progression of coronary artery lesions <50%S. Improved therapeutic regimens to alter progression of atherosclerosis may require adjunctive therapy, such as with antioxidants or hormone replacement therapy, in concert with low-density lipoprotein cholesterol reduction to prevent new lesion formation or early lesion progression. Sequential coronary angiographic determination of progression evaluated by both quantitative coronary angiography and global change score, a visual assessment of overall lesion change, predicts clinical coronary events. Only inferences about the state of the arterial wall can be made from angiography, because it delineates only the lumen. Therapy testing and study of atherosclerosis progression can be improved with noninvasive B-mode ultrasonographic imaging of the distal common carotid artery far-wall intima-media thickness (IMT), a reliable measure of early preintrusive atherosclerosis. Measurement of common carotid IMT is useful for the study of coronary artery risk factors and can augment studies of coronary artery intrusive lesions, because it is associated with coronary artery disease. B-mode measurement of common carotid IMT has the potential of serving as a noninvasive surrogate end point for clinical coronary events. Screening for peripheral vessel changes indicative of high risk for coronary artery disease is possible and cost-effective with the noninvasive procedures now available. (Arterioscler Thromb. 1994;14:177-192.) Key Words • atherosclerosis • angiography • ultrasound • regression • clinical trials • intima-media thickness • quantitative computerized angiography • common carotid artery • coronary arteries • meta-analysis E vidence that progression of atherosclerosis can be retarded and atherosclerotic lesions can regress derives from several sources. These sources include studies of arterial lesions obtained at autopsy from starved human populations, animal experimentation, and clinical trials using serial angiography. In the first half of this article, we review serial angiographic evidence for atherosclerotic lesion improvement induced by diverse modes of int...

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Section: Sequential Coronary Angiographic Determination Of Progressiomentioning

confidence: 97%

George Lyman Duff Memorial Lecture. Arterial imaging and atherosclerosis reversal.

Blankenhorn

Hodis

1994

Arterioscler Thromb

202

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“…This could be problematic as the adductor canal region of the SFA has a known predilection for atherosclerosis and is a common site of disease progression (38,39). In the coronary vasculature, even modest changes in plaque progression may be associated with large differences in vascular outcomes (20,21,23). Whether this relationship between plaque progression and vascular events holds true in the periphery remains undetermined.…”

Section: Limitationsmentioning

confidence: 99%

Reproducibility and Reliability of Atherosclerotic Plaque Volume Measurements in Peripheral Arterial Disease with Cardiovascular Magnetic Resonance

Isbell

Meyer

Rogers

et al. 2007

Journal of Cardiovascular Magnetic Resonance

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A high resolution, noninvasive approach to quantify atherosclerotic plaque in the peripheral vasculature could have significant clinical and research utility. Seventeen patients with peripheral arterial disease (PAD) were studied in a 1.5T CMR scanner. Atherosclerotic plaque volume in the superficial femoral artery was measured and interobserver, intraobserver, and test-retest variability determined. Nineteen vessels were studied with mean acquisition time of 13.1 minutes per vessel. Mean plaque volume was 7.27 ± 3.73 cm 3 . Intra-observer intraclass correlation was R = 0.997, inter-observer was R = 0.987, and test-retest reproducibility was R = 0.996. Thus, high resolution measurement of plaque volume in PAD is reliable and reproducible.

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“…6,8,10 The progression of coronary lesions is a strong predictor of coronary events, especially fatal events, 25 and the rupture of a vulnerable plaque often precedes occlusive coronary thrombosis and death. 26,27 The evidence for an association of ⑀4 with increased progression rate is weak, however, 28 -30 and we are not aware of studies investigating the association of apoE genotype and the occurrence of vulnerable plaques.…”

Section: Possible Reasons Why ⑀4 Specifically Associated With Risk Ofmentioning

confidence: 99%

The Apolipoprotein ε4 Allele Determines Prognosis and the Effect on Prognosis of Simvastatin in Survivors of Myocardial Infarction

et al. 2000

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Background-Carriers of the ⑀4 allele of the apolipoprotein E gene are at a higher risk of coronary heart disease than individuals with other genotypes. We examined whether the risk of death or a major coronary event in survivors of myocardial infarction depended on apolipoprotein E genotype and whether the benefits of treatment with simvastatin differed between genotypes. Methods and Results-Cox proportional hazards models were used to analyze 5.5 years of follow-up data from 966 Danish and Finnish myocardial infarction survivors enrolled in the Scandinavian Simvastatin Survival Study. A total of 16% of the 166 ⑀4 carriers in the placebo group died compared with 9% of the 312 patients without the allele, which corresponds to a mortality risk ratio of 1.8 (95% confidence interval, 1.1 to 3.1). The risk ratio was unaffected by considerations of sex, age, concurrent angina, diabetes, smoking, and serum lipids in multivariate analyses. Simvastatin treatment reduced the mortality risk to 0.33 (95% confidence interval, 0.16 to 0.69) in ⑀4 carriers and to 0.66 (95% confidence interval, 0.35 to 1.24) in other patients (Pϭ0.23 for treatment by genotype interaction). Apolipoprotein E genotype did not predict the risk of a major coronary event.Baseline serum levels of lipoprotein(a) also predicted mortality risk and could be combined with ⑀4-carrier status to define 3 groups of patients with different prognoses and benefits from treatment. Conclusions-Myocardial infarction survivors with the ⑀4 allele have a nearly 2-fold increased risk of dying compared with other patients, and the excess mortality can be abolished by treatment with simvastatin. (Circulation.

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Prognostic significance of progression of coronary atherosclerosis.

Abstract: Coronary progression is a strong, independent predictor of future coronary events, particularly cardiac death, and its use as a surrogate end point in clinical trials is justified.

Cited by 260 publications

References 43 publications

George Lyman Duff Memorial Lecture. Arterial imaging and atherosclerosis reversal.

George Lyman Duff Memorial Lecture. Arterial imaging and atherosclerosis reversal.

Reproducibility and Reliability of Atherosclerotic Plaque Volume Measurements in Peripheral Arterial Disease with Cardiovascular Magnetic Resonance

The Apolipoprotein ε4 Allele Determines Prognosis and the Effect on Prognosis of Simvastatin in Survivors of Myocardial Infarction

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