Risk of Subclinical Atherosclerosis in Patients with Antiphospholipid Syndrome and Subjects With Antiphospholipid Antibody Positivity: A Systematic Review and Meta-analysis

Karakasis, Paschalis; Lefkou, Elmina; Pamporis, Konstantinos; Nevras, Vasileios; Βουγιούκας, Κωνσταντίνος; Haidich, Anna‐Bettina; Fragakis, Nikolaos

doi:10.1016/j.cpcardiol.2023.101672

Cited by 9 publications

(4 citation statements)

References 63 publications

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“…Nevertheless, in terms of risk-stratified ASCVR factor modification, 19 20 the presence of atherosclerotic plaques on VUS has equivalent importance to incident cardiovascular events. 16 19 20 Additionally, aGAPSS and aGAPSS CVD have not been specifically designed to assess ASCVR, though our results—considering also the inclusion of traditional ASCVR factors in these models and the high ASCVR in APS 6 —suggest that recalibration based on studies comprising prospectively recorded atherosclerotic and non-atherosclerotic thrombotic events could help to improve the use of these risk tools in patients with APS. Our study population included only white Europeans and was recruited in an academic hospital centre, limiting conclusive validity and generalisation of our findings permitted by ethnic diversity and primary care settings.…”

Section: Discussionmentioning

confidence: 97%

“… 5 Besides their role in immune-mediated thrombosis, aPL has been shown to also have a proatherogenic effect even in the absence of comorbidities or concomitant ASCVR factors. 6 35 Importantly, comprehensive aPL profiling 2 5 35 according to the type, titres and number of autoantibodies may be necessary to improve CVR assessment strategies in APS. Likewise, traditional ASCVR factors generally recognised as promoters of atherosclerosis may also act as precipitating factors for first and recurrent thrombotic events in APS.…”

Section: Discussionmentioning

confidence: 99%

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Cardiovascular risk assessment in patients with antiphospholipid syndrome: a cross-sectional performance analysis of nine clinical risk prediction tools

Drosos,

Konstantonis,

Sfikakis

et al. 2023

RMD Open

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ObjectivesThis study aimed to assess the performance of cardiovascular risk (CVR) prediction models reported by European Alliance of Associations for Rheumatology and European Society of Cardiology recommendations to identify high-atherosclerotic CVR (ASCVR) patients with antiphospholipid syndrome (APS).MethodsSix models predicting the risk of a first cardiovascular disease event (first-CVD) (Systematic Coronary Risk Evaluation (SCORE); modified-SCORE; Framingham risk score; Pooled Cohorts Risk Equation; Prospective Cardiovascular Münster calculator; Globorisk), three risk prediction models for patients with a history of prior arterial events (recurrent-CVD) (adjusted Global APS Score (aGAPSS); aGAPSSCVD; Secondary Manifestations of Arterial Disease (SMART)) and carotid/femoral artery vascular ultrasound (VUS) were used to assess ASCVR in 121 APS patients (mean age: 45.8±11.8 years; women: 68.6%). We cross-sectionally examined the calibration, discrimination and classification accuracy of all prediction models to identify high ASCVR due to VUS-detected atherosclerotic plaques, and risk reclassification of patients classified as non high-risk according to first-CVD/recurrent-CVD tools to actual high risk based on VUS.ResultsSpiegelhalter’s z-test p values 0.47–0.57, area under the receiver-operating characteristics curve (AUROC) 0.56–0.75 and Matthews correlation coefficient (MCC) 0.01–0.35 indicated moderate calibration, poor-to-acceptable discrimination and negligible-to-moderate classification accuracy, respectively, for all risk models. Among recurrent-CVD tools, SMART and aGAPSSCVD(for non-triple antiphospholipid antibody-positive patients) performed better (z/AUROC/MCC: 0.47/0.64/0.29 and 0.52/0.69/0.29, respectively) than aGAPSS. VUS reclassified 34.2%–47.9% and 40.5%–52.6% of patients classified as non-high-ASCVR by first-CVD and recurrent-CVD prediction models, respectively. In patients aged 40–54 years, >40% VUS-guided reclassification was observed for first-CVD risk tools and >50% for recurrent-CVD prediction models.ConclusionClinical CVR prediction tools underestimate actual high ASCVR in APS. VUS may help to improve CVR assessment and optimal risk factor management.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Cardiovascular risk assessment in patients with antiphospholipid syndrome: a cross-sectional performance analysis of nine clinical risk prediction tools

Drosos,

Konstantonis,

Sfikakis

et al. 2023

RMD Open

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“…Past research and experience therefore illustrate the importance of the prompt diagnosis and treatment of carotid artery stenosis, the consequences of which may be lethal. It has been shown that neurologic symptoms in patients with APS can range from non-existent to severe, and that their outcomes can be fatal [ 18 , 19 , 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Quantitative and Qualitative Characteristics of Atherosclerotic Plaques on Carotid Arteries in Patients with Antiphospholipid Syndrome: The Role of MDCT Angiography

Saponjski,

Stojanovich,

Stanisavljevic

et al. 2023

Diseases

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Introduction: Antiphospholipid syndrome (APS) is an autoimmune disease characterised by arterious and venous thrombosis, miscarriage, and the presence of antiphospholipid antibodies (aPL) in the blood. As we know, APS is also characterised by accelerated atherosclerotic degeneration with an increased risk of thrombosis in all blood vessels, including the carotid arteries. Carotid artery stenosis can manifest in many different ways. The aim of this study is to present the results of our multidetector computerised tomography angiography (MDCTA) analysis of the carotid arteries in patients with primary and secondary APS compared with a control group. Materials and Methods: This study examined 50 patients with primary antiphospholipid syndrome (PAPS) and 50 patients with secondary antiphospholipid syndrome (SAPS). The results were compared with a control group also comprising 50 patients. The groups were analysed with respect to age, sex and the presence of well-established risk factors for vascular disease. The study was conducted using MDCTA, where we analysed the quantitative and qualitative (morphologic) characteristics of carotid artery lesions. Results: Patients from the control group had significantly elevated levels of cholesterol and triglycerides in comparison with patients with PAPS and SAPS (p < 0.001 and p < 0.05). The results show that carotid artery lesions were significantly more common in patients with APS (PAPS, n = 40, CI95: 0.50–0.75, p = 0.0322 and SAFS, n = 54, CI95: 0.59–0.80, p = 0.0004) than within the control group (n = 23). There was a statistically significant difference between patients with APS and the control group with respect to lesions in the distal segments (n = 27, CI95: 0.67–0.95, p = 0.0001), bulbi and proximal segments (n = 21, CI95: 0.84–1.00, p = 0.000005). The number of patients with one lesion (L) (n = 27) was significantly greater than the number of those with three (n = 10, CI95: 0.56–0.86, p = 0.0051) or four (n = 3, CI95: 0.73–0.98, p = 0.00001) lesions. There were also more patients with two lesions (n = 24) than those with four (n = 3) (CI95: 0.71–0.97, p = 0.00005). Carotid artery stenosis was shown as a percentage of the carotid artery lumen diameter (%DS). Stenosis of up to 30%, was more common in patients in the PAPS group (n = 12) than in the control group (n = 3) (CI95: 0.52–0.96, p = 0.0201), while the SAPS group (n = 17) had an even larger disparity (CI95: 0.62–0.97, p = 0.0017). We observed a highly significant difference in the frequency of stenoses between 30% and 50% DS between the PAPS group (n = 24) and the control group (n = 7) (CI95: 0.59–0.90, p = 0.0023), as well as the SAPS group (n = 30) (CI95: 0.65–0.92, p = 0.0002). A qualitative analysis of plaque morphology revealed that patients with PAPS had significantly more soft tissue lesions (n = 23) compared with calcified lesions (n = 2) (CI95: 0.74–0.99, p = 0.00003), as well as more mixed plaques (n = 9) and calcified plaques (n = 2) (CI95: 0.48–0.98, p = 0.0348). Patients within the SAPS group had significantly more soft tissue (n = 35) than calcified lesions (n = 3) (CI95: 0.79–0.98, p = 0.00000021), as well as more mixed lesions (n = 21) compared with calcified (n = 3) (CI95: 0.68–0.97, p = 0.0002). Conclusions: Our study shows that subclinical manifestations of carotid artery lesions were more common in patients with APS. We came to the conclusion that MDCTA is an accurate diagnostic method because it is a safe method that provides us with a great quantity of accurate information about the characteristics of atheromatous plaques, which aids us in the further planning of treatment for patients with APS.

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“…В литературе достаточно широко обсуждается связь АФС с ранним развитием атеросклероза [33], что в итоге обусловило добавление раннего дебюта атеросклероза к вариантам манифестации АФС [34]. Несмотря на это, ни в одних текущих КР, посвященных ААЗ, АФС не значится как возможная причина развития атеросклероза и, соответственно, отсутствуют рекомендации по его диагностике.…”

Section: Myocardial Infarction In Young Patientsunclassified

Myocardial infarction in young patients. Is everything so obvious?

Zykov,

Barbarash

2024

Evrazijskij kardiologičeskij žurnal

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The review is devoted to the analysis of literature data on the features of the course, diagnosis and treatment of myocardial infarction at a young age. Despite the relevance of the problem of myocardial infarction in young people, there is no specific approach to the management and examination of such patients in current clinical guidelines. Literature search was carried out in the following databases: PubMed, Google Scholar, Web of Science from 1990 to 2023 for all studies with the keywords “myocardial infarction and young age”, “atherosclerosis and young age”, “atherothrombosis and young age”. An analysis of all available clinical recommendations of leading specialized societies in the field of cardiology, hematology, and angiology was also carried out. The presented review is not systematic view of the specifics of the subject, its breadth, as well as the task set – to expand the clinical thinking of the doctor. It is undeniable that primary prevention of myocardial infarction is more effective. Given the annual increase in the number of myocardial infarctions at a young age, it is necessary to create a special tool for risk stratification in young patients, since there is no such tool in the clinical guidelines. Despite the greater contribution of non-atherogenic causes to the development of myocardial infarction in young patients, atherosclerosis is still the main cause of its development. The authors of the review confirm the fact that there is currently no specially developed algorithm for managing patients with myocardial infarction at a young age, based on the identification of a number of traditional and non-traditional risk factors, on enhanced rehabilitation measures. All these positions are currently formulated in the aims and objectives of a special sevenyear study of myocardial infarction in young patients planned at our institute.

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Risk of Subclinical Atherosclerosis in Patients with Antiphospholipid Syndrome and Subjects With Antiphospholipid Antibody Positivity: A Systematic Review and Meta-analysis

Cited by 9 publications

References 63 publications

Cardiovascular risk assessment in patients with antiphospholipid syndrome: a cross-sectional performance analysis of nine clinical risk prediction tools

Cardiovascular risk assessment in patients with antiphospholipid syndrome: a cross-sectional performance analysis of nine clinical risk prediction tools

Quantitative and Qualitative Characteristics of Atherosclerotic Plaques on Carotid Arteries in Patients with Antiphospholipid Syndrome: The Role of MDCT Angiography

Myocardial infarction in young patients. Is everything so obvious?

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