Treatment of Asymptomatic Adults With Elevated Coronary Calcium Scores With Atorvastatin, Vitamin C, and Vitamin E

Arad, Yadon; Spadaro, Louise A.; Roth, Marguerite; Newstein, David; Guerci, Alan D.

doi:10.1016/j.jacc.2005.02.089

Cited by 360 publications

(88 citation statements)

References 27 publications

(20 reference statements)

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“…27,28 In a randomized controlled trial, a trend toward reduction of cardiovascular events was observed in patients with CAC scores >400 who were treated with statins in combination with antioxidant vitamins. 29 Although our study reflects true daily practice and included consecutive patients, we have to acknowledge several limitations. The observational design remains a major limitation of the current study as end points were not prespecified.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients

Engbers

Timmer

Ottervanger

et al. 2016

Circ: Cardiovascular Imaging

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Background— The prognostic value of coronary artery calcium (CAC) scoring on top of myocardial perfusion imaging with single-photon emission computed tomography (SPECT) in patients suspected for coronary artery disease is not well established. Methods and Results— Four thousand eight hundred ninety-seven symptomatic patients without a history of coronary artery disease referred for SPECT and CAC scoring were included. Major adverse cardiac events (MACEs) were defined as late revascularization (>90 days after scanning), nonfatal myocardial infarction, and all-cause mortality. The frequency of abnormal SPECT increased with higher CAC scores, from 12% in patients with CAC scores of 0 to 19%, 32%, 37%, and 50% among those with CAC scores 1 to 99, 100 to 399, 400 to 999, and ≥1000, respectively ( P <0.001). During a median follow-up of 940 days (25th to 75th percentile, 581–1377), a total of 278 MACEs were observed. Overall incidence of MACE was 2.3% per year. A stepwise increase of MACE was present with increasing CAC scores, both in patients with normal SPECT (annual event rate CAC score 0: 0.6%; CAC score ≥1000: 5.5%) and abnormal SPECT (annual event rate CAC score 0: 0.4%; CAC score ≥1000: 7.6%). After multivariate analysis, both SPECT and CAC score were independent predictors of MACE (CAC score ≥1000: hazard ratio, 7.7; P <0.001 and large perfusion defect on SPECT: hazard ratio, 3.7; P <0.001). Conclusions— CAC score and SPECT are independent predictors of MACE in patients suspected for coronary artery disease. Our findings strongly support performing a CAC score in addition to SPECT in symptomatic patients to better define the risk of events during follow-up.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients

Engbers

Timmer

Ottervanger

et al. 2016

Circ: Cardiovascular Imaging

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“…Limited data suggest that CAC influences physicians' management of CAD risk factors. 233 Although an exploratory subgroup analysis from a single randomized, clinical trial suggests that statin therapy in asymptomatic patients with CAC >400 may improve outcomes, 234 no dedicated, prospective studies have been performed to suggest that the detection of subclinical CAD by CAC leads to improvement in clinical events.…”

Section: Subclinical Cad Assessmentmentioning

confidence: 99%

Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence

Fox¹,

Golden²,

Anderson³

et al. 2015

Circulation

326

131

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Abstract-Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The input provided by Drs Fox, Ershow, Nelson, and Fradkin is from their own perspective, and the opinions expressed in this article do not reflect the view of the National Institutes of Health, Department of Health and Human Services, or the US government. Dr Pignone is a member of the US Preventive Services Task Force. His contributions here represent his views alone and not necessarily those of the US Preventive Services Task Force.The American Heart Association and the American Diabetes Association make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This document was approved by the American Heart Association Science Advisory and Coordinating Committee on April 30, 2015, the American Heart Association Executive Committee on May 22, 2015, and the American Diabetes Association on January 7, 2015.The American Heart Association requests that this document be cited as follows: Fox CS, Golden SH, Anderson C, Bray GA, Burke LE, de Boer IH, Deedwania P, Eckel RH, Ershow AG, Fradkin J, Inzucchi SE, Kosiborod M, Nelson RG, Patel MJ, Pignone M, Quinn L, Schauer PR, Selvin E, Vafiadis DK; on behalf of the American Heart Association Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health, Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Quality of Care and Outcomes Research, and the American Diabetes Association. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. 2015;132:691-718. This article has been copublished in Diabetes Care.Copies: This document is available on the World Wide Web sites of the American Heart Association (my.americanheart.org) and the American Diabetes Association (www.diabetes.org). A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://my.americanheart.org/statements and select the "Policies and Development" link.

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“…Many studies, which have examined gender differences among family-caregivers, have concluded that women spend more time in providing care and carry out personal-care tasks more often than men. This gender bias influences women to assume more substantial caregiving duties (25).…”

Section: Discussionmentioning

confidence: 99%

“…However, almost an equal number of studies have not found any differences between men and women on these aspects (1,25,28). We found that companion female had more diseases of the musculoskeletal system and connective tissue (44% vs. 21% in male companions; p=0.024), and they were taking more medications of the musculoskeletal system (26.2% vs. 5.4% in male companions; p=0.014), but we found no difference in diseases or treatments about mental health (Table 1).…”

Section: Discussionmentioning

confidence: 99%

The social and health gender differences in patients companion in the family medicine consultation

Turabián¹,

Minier-Rodriguez²,

Moreno-Ruiz³

et al. 2017

Curr Res Integr Med

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A ll over the world women are the predominant providers of informal care for family members with chronic medical conditions or disabilities, including the elderly and adults with mental illnesses. It has been suggested that there are several societal and cultural demands on women to adopt the role of a family-caregiver (1). So, spouses often serve as the primary caregivers to their ill or disabled partners (2).The domain of health includes the entire range of issues which touch on illness, sickness, disease, wellness, as well as those activities of preventing, diagnosing, healing, caring and curing. Thus, questions about women's participation in this domain profound and immediate concern to women, and involve roles and selves. Women have domestic activities which sustain, literally and symbolically, the way of life. As the providers of health, women are responsible for securing the domestic conditions necessary for the maintenance of health and for recovery from sickness. Women also serve as mediators of outside services. Their responsibilities with the domestic health service unavoidably bring them into contact with professional health service, among them the family doctor (3).In practice, a third person (companion) frequently accompanies a patient during medical encounter. There is a high prevalence of the presence of a companion, who is in almost one of every 4 visits served in Family Medicine. Companions of the patients in the medical office are usually family members in near 100% of cases (4-9).The major results of existing studies suggest that the regular presences of companions of the patients in consultations are often perceived as helpful. Accompaniment to medical visits is associated with better self-care maintenance and management, and this effect may be mediated through satisfaction with provider communication (10). Also, companions provide company, emotional support, and they have a role in mobility and decision making of the patients (11,12). However, their participation often poses challenges (13).Despite all the above, the reports, reviews or investigations about the gender OBJECTIVES:The purpose of this study is to describe gender differences in patient's companion, and their characteristics, in family medicine consultations. METHODS:A descriptive and prospective study in a family medicine office (Toledo, Spain) was carried out. For each patient and companion, the following variables were collected: age, gender, chronic illness, chief complaint, medications taken, social class, request for additional tests, kinship, social status and availability of companion. The bivariate comparisons were performed using the test of Chi squared, the Student t test, and the MannWhitney test.RESULTS: 104 companions to the patient in the family medicine office were obtained. Of these, 65 (62.5%) were female, and 39 (37.5%) male.In the female companions with regard to the male companions: there were 69% in the group of 40-64 years old vs. 49% (p = 0.02); were wife (34%) vs. husband (56%) (P=0.001); were unskilled...

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Treatment of Asymptomatic Adults With Elevated Coronary Calcium Scores With Atorvastatin, Vitamin C, and Vitamin E

Cited by 360 publications

References 27 publications

Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients

Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients

Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence

The social and health gender differences in patients companion in the family medicine consultation

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