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Abstract Background Characteristics and risk factors associated with electrocardiographic borderline Q-waves are not fully elucidated, especially in individuals without overt cardiovascular disease (CVD). Also, the relation of isolated and non-isolated borderline Q-waves with subclinical atherosclerosis and vascular stiffness is unknown. Methods and results We included 5746 Netherlands Epidemiology of Obesity study participants without overt CVD. Participants were divided in three groups: no Q-waves (93.7%), isolated (4.6%) and non-isolated borderline Q-waves (1.7%). Borderline Q-waves were defined as Minnesota Codes 1.2.x and 1.3.x and non-isolated as ≥1 of abnormal QRS axis, left ventricular hypertrophy or ST/T abnormalities. Several characteristics and measures of body fat were assessed. Vascular stiffness was assessed by pulse wave velocity (PWV) and subclinical atherosclerosis by carotid intima-media thickness (cIMT). Percentage of men, alcohol intake, blood pressure and fasting glucose concentrations were, compared with no Q-waves, higher in the isolated and highest in the non-isolated borderline Q-wave group. Isolated borderline Q-waves were associated with higher body mass index (difference compared with no Q-waves: 1.0 kg/m2; 95%CI: 0.3–1.7; p-value: 0.006), waist circumference (3.4 cm; 1.0–5.8; 0.005), and visceral adipose tissue (21.9 cm2; 7.4–36.3; 0.003) and differences were even larger for non-isolated borderline Q-waves. Compared with no Q-waves, non-isolated borderline Q-waves were associated with higher PWV (1.2 m/s; 0.4–2.0; 0.004) and cIMT (23.4 μm; 3.0–43.8; 0.024), whereas isolated borderline Q-waves were not. Conclusion Cardiovascular risk factors and measures of body fat, especially abdominal adiposity, were higher in participants with isolated borderline Q-waves, compared with no Q-waves, and highest in the non-isolated borderline Q-wave group. Non-isolated borderline Q-waves were associated with subclinical atherosclerosis and vascular stiffness. Future studies should investigate potential added value of borderline Q-waves in CVD prediction. Highlights • Borderline isolated Q-waves are often considered as non-pathological • Observed worse cardiovascular risk factor profile and higher measures of body fat • Non-isolated are associated with subclinical atherosclerosis and vascular stiffness [ABSTRACT FROM AUTHOR]

Objective Growing evidence suggested an association between aortic valve sclerosis (AVSc) and cardiovascular (CV) events. However, little is known about the association of AVSc with major markers of subclinical atherosclerosis. We performed a meta-analysis of literature studies to address this issue. Methods Studies on the relationship between AVSc and common carotid artery intima-media thickness (IMT), prevalence of carotid plaques (CPs), flow-mediated dilation (FMD), aortic pulse wave velocity (PWV) and augmentation index (AIx) were systematically searched in electronic databases. Thirteen studies enrolling 1086 AVSc patients and 2124 controls were included. Results Compared to controls, AVSc patients showed higher IMT (MD: 0.32 mm; 95%CI: 0.07, 0.58; p = 0.014), and higher prevalence of CPs (OR: 4.06; 95%CI: 2.38, 6.93; p < 0.001). Moreover, lower FMD (MD: − 4.48%; 95%CI: − 7.23, − 1.74; p = 0.001) and higher PWV (MD: 0.96%; 95%CI: 0.11, 1.81; p = 0.027) were found in AVSc subjects than in controls, with no differences in AIx (MD: 0.76%; 95%CI: − 0.97, 2.49; p = 0.389). In meta-regression analyses, body mass index and triglyceride levels have an impact on the difference in IMT between cases and controls, while male gender and smoking habit were associated with the difference in the prevalence of CPs between the two groups. Conclusions AVSc is significantly associated with altered markers of subclinical atherosclerosis, thus supporting the concept that AVSc and atherosclerosis share common etiopathological mechanism and/or risk factors. [ABSTRACT FROM AUTHOR]

Background/objectives Several studies reported an increased cardiovascular (CV) morbidity and mortality in patients with primary aldosteronism (PA). We performed a meta-analysis on the impact of PA on major markers of CV risk. Methods Studies on the relationship between PA and common carotid artery intima-media thickness (CCA-IMT), prevalence of carotid plaques, flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), pulse-wave velocity (PWV), augmentation index (AIx), and ankle-brachial index (ABI) were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. Results 12 case–control studies (445 cases, 472 controls) were included. Compared to subjects with essential hypertension (EH), PA patients showed a higher CCA-IMT (MD: 0.12 mm; 95% CI: 0.09, 0.16; P < 0.00001), and a higher aortic-PWV (272 cases and 240 controls, MD: 1.39 m/s; 95% CI: 0.90, 1.87; P < 0.00001). In contrast, non-significant differences were found in AIx and AIx normalized to a heart rate of 75 beats per minute (AIx@75). When compared to normotensive subjects, PA patients showed significantly higher CCA-IMT (MD: 0.16 mm; 95% CI: 0.05, 0.27; P = 0.004), aortic-PWV (MD: 3.74 m/s; 95% CI: 3.43, 4.05; P < 0.00001), AIx@75 (MD: 8.59%; 95% CI: 0.69, 16.50; P = 0.03), and a significantly lower FMD (MD: − 2.52%; 95% CI: − 3.64, − 1.40; P < 0.0001). Sensitivity and subgroup analyses substantially confirmed our results. Metaregression models showed that male gender, diabetes, and smoking habit impact on the observed results. Conclusions PA appears significantly associated with markers of subclinical atherosclerosis and CV risk. These findings could help establish more specific CV prevention strategies in this clinical setting. [ABSTRACT FROM AUTHOR]

Abstract: Background: The presence of cardiovascular risk factors during the menopausal transition could be critical in the development of atherosclerosis. In the present study, we evaluated whether the menopausal transition has impact on traditional and newly discussed risk factors. Methods: Six hundred ninety nine women from population-based study underwent ultrasound measurement of the intima-media thickness of the common carotid arteries (CIMT) — Prague Pre and Postmenopausal Females study (3PMFs). In addition, 40 women selected according to reproductive and smoking status were examined with regard to number of circulating endothelial progenitor cells, markers of reverse cholesterol transport and sex hormones, including their fluctuation — Hormone Variability study (HVs). Results: Age, smoking, body mass index, systolic blood pressure and HDL cholesterol were independently associated with the CIMT in 3PMFs group. The increase in the CIMT with age was markedly steeper in current/past smokers than in non-smokers among perimenopausal women (p for equality of slopes=0.005). This difference was not observed in premenopausal and menopausal women. In the HVs group, endothelial progenitor cells and reverse cholesterol transport were substantially higher while triglycerides and fluctuation of free testosterone were lower in non-smokers than in smokers in menopausal transition. In contrast, in menopausal women, the fluctuation of free testosterone was higher in non-smokers; no other differences between smokers and non-smokers were detected. Conclusions: These results suggest that atherogenic effect of smoking may be enhanced during menopausal transition. The mechanism could be impaired reparative vascular processes, impaired reverse cholesterol transport and rapidly changing status of sex hormones. [Copyright &y& Elsevier]

Abstract: Background: The menopausal status is closely related with cardiovascular disease (CVD). Nevertheless, it is still not included in risk stratification by total cardiovascular risk estimation systems. The present study aimed to evaluate the extent of subclinical vascular disorders in young healthy postmenopausal women. Methods: This cross-sectional study consecutively recruited 120 healthy postmenopausal women without clinically overt CVD or diabetes, aged 41–60years and classified as not high-risk by the Heartscore (<5%). In addition to risk factors used for Heartscore calculations, years since menopause and associated risk factors (triglycerides (range 37–278mg/dl), waist circumference (62–114cm), fasting blood glucose (69–114mg/dl) and HOMA-IR (0.44–5)) were also assessed. Carotid–femoral pulse wave velocity, carotid and femoral intima–media thickness in the abnormal range as well as atheromatous plaques both in carotid and femoral arteries were used to define the presence of subclinical atherosclerosis. Results: Subclinical atherosclerosis and the presence of at least one plaque were identified in 55% and 28% of women, respectively. Subjects with subclinical atherosclerosis had higher age, years since menopause, HOMA-IR and blood pressure. By multivariate analysis years since menopause and systolic blood pressure independently determined subclinical atherosclerosis while 79% of intermediate-risk women (Heartscore 2–4.9%) being in menopause for at least 4years would be reclassified to a higher risk for the presence of atherosclerosis. Conclusion: Subclinical atherosclerosis was highly prevalent in postmenopausal women with low to medium Heartscore. Thus our data suggest that menopausal status and associated risk factors should be additionally weighted in risk calculations, regarding primary prevention strategies in this population. [Copyright &y& Elsevier]

Abstract: Background: Early detection of atherosclerosis in elderly people is important because of high cardiovascular mortality. However, only few studies have evaluated the prevalence of subclinical atherosclerosis in Asian elderly people. We evaluated subclinical atherosclerosis using various methods in a population-based cohort study, the Korean Longitudinal Study on Health and Aging (KLoSHA). Methods: Subjects aged over 65years without symptomatic chest pain were recruited for the KLoSHA in 2006 by random stratified sampling (439 men and 561 women). Anthropometrics, biochemical parameters, body composition, and abdominal fat by computed tomography (CT) were measured. Multidetector-row cardiac CT for coronary artery calcium score (CACS) and severity of stenosis, and carotid sonography for intima-media thickness (IMT) were used to detect subclinical atherosclerosis. Pulse wave velocity (PWV) and ankle-brachial index (ABI) were also measured. Results: The prevalence of subclinical atherosclerosis defined by coronary stenosis >50%, CACS >100, PWV >9m/s, carotid-IMT >0.8mm, or ABI <0.9 was 17.6%, 28.1%, 37.9%, 39.2%, and 29.6%, respectively. There were significant, but modest correlations among parameters. Although male sex, diabetes mellitus, hypertension, abnormal BMI, and higher insulin resistance were associated with subclinical atherosclerosis, older age was found to be the most robust predictor after controlling for multiple factors. Conclusion: Our results suggest that proactive screening with multiple measurements in elderly subjects, particularly in men and those with diabetes mellitus or hypertension, may help to identify asymptomatic patient with atherosclerosis. Further studies exploring the predictive value of diagnostic tools can determine the most appropriate measurement for predicting future cardiovascular events. [Copyright &y& Elsevier]

Abstract: Background: Lp(a), implicated in both atherogenesis and thrombosis pathways, varies significantly by demographic and metabolic factors, providing challenges for its use in Coronary Heart Disease (CHD) risk. The purpose of this study was to investigate whether type-2 diabetic subjects, relative to non-diabetics, might benefit more from Lp(a) measurement in the prediction of CHD risk, as measured by coronary artery calcium (CAC). Methods: We performed cross sectional analyses in two community-based studies: the Penn Diabetes Heart Study [N =1299 with type-2 diabetes] and the Study of Inherited Risk of Coronary Atherosclerosis [N =860 without diabetes]. Results: Blacks had 2–3 fold higher Lp(a) levels than whites in diabetic and non-diabetic samples. There was significant difference by gender (interaction p <0.001), but not race, in the association of Lp(a) with CAC in type-2 diabetic subjects. In age and race adjusted analysis of diabetic women, Lp(a) was associated with CAC [Tobit regression ratio 2.76 (95% CI 1.73–4.40), p <0.001]. Adjustment for exercise, medications, Framingham risk score, metabolic syndrome, BMI, CRP and hemoglobin A1c attenuated this effect, but the association of Lp(a) with CAC remained significant [2.25, (1.34–3.79), p =0.002]. This relationship was further maintained in women stratified by race, or by the use of HRT or lipid lowering drugs. In contrast, Lp(a) was not associated with CAC in diabetic men, nor in non-diabetic men and women. Conclusions: Lp(a) is a strong independent predictor of CAC in type-2 diabetic women, regardless of race, but not in men. Lp(a) does not relate to CAC in men or women without type-2 diabetes. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate the clinical role of subcutaneous fat accumulation in subclinical arteriosclerosis, using computed tomography (CT), we measured the subcutaneous fat area (SFA), the visceral fat area (VFA) and the VFA/SFA ratio and compared these with the calcium score of the whole aorta (CSWA) in asymptomatic subjects who were undergoing general health screening. Methods: 122 consecutive asymptomatic subjects (40 female, mean age 56.2±8.4 years) were analyzed. Whole-body low-dose CT scan (mAs=50, slice thickness=5 mm) was performed. The SFA and VFA were measured at the umbilical level. Calcification of whole aorta was defined as an area with >90HU and 1 mm2, and CSWA was calculated using the modified Agatston method. Results: Mean±SD of SFA, VFA and log CSWA were 158±67.1 cm2, 94.0±44.8 cm2, and 7.93±1.08, respectively. SFA was significantly and inversely correlated with log CSWA (r =−0.219, P =0.015) but VFA was not (r =0.105, P =0.250) and as a result, the VFA/SFA ratio was significantly and positively correlated with log CSWA (r =0.221, P =0.015). Subsequently, all predictor variables were used in a stepwise multiple regression model with log CSWA as dependent variable, and age, SFA and fasting plasma glucose significantly influenced log CSWA (P <0.001) by the multiple regression formula Y =0.046X1***−0.005X2**+0.015X3*+4.426, (***P <0.001, **P <0.01, and *P <0.05) where Y =log CSWA, X1=age, X2=SFA, and X3=fasting plasma glucose). Conclusions: SFA was significantly and inversely associated with log CSWA, in an independent fashion. These results suggest that subcutaneous fat accumulation might have a protective role against atherosclerosis in asymptomatic subjects. [Copyright &y& Elsevier]

Abstract: Current possibilities for better detecting high risk of coronary heart disease (CHD) and stroke and peripheral arterial disease are described in this review. A first step is based on risk factors assessment that allows establishing high-risk diagnostic, either by detecting a condition termed as “CHD risk equivalent” and defined by one or more severe major risk factor, or by calculating multifactorial risk in asymptomatic subjects with a global risk score integrating several moderate risk factors. A second diagnostic step, concerning subjects not considered at high-risk by risk factors assessment, is based on non-invasive detection of sub clinical atherosclerosis via a wide variety of structural and functional arterial markers. A third step focuses on detection of myocardial ischemia that may add diagnostic and prognostic information in subjects with high CHD risk. The implementation of high-risk strategy is not yet standardized but it should allow improving cost-effectiveness of cardiovascular prevention, particularly in asymptomatic subjects. [Copyright &y& Elsevier]

Background and objective: Coronary heart disease (CHD) is the leading cause of death worldwide including Brazil. Improved precision in detecting early coronary disease may aid in more targeted preventive therapy. The National Cholesterol Education Program (NCEP) provides guidelines for determining the aggressiveness of primary prevention strategies including lipid lowering based on Framingham risk equation. Identification of subclinical atherosclerosis and coronary plaque burden is a step towards identifying high-risk individuals. This investigation was designed to determine how the updated NCEP guidelines classify asymptomatic individuals with presence of any as well as advanced CACS (coronary artery calcium score), a powerful intermediary for CHD events, in asymptomatic Brazilian men. Methods and results: Five hundred forty-six asymptomatic Brazilian men (mean age: 46±7 years) presented to a single electron beam tomography (EBT) facility in Sao Paulo. The study population was categorized into low risk (0–1 risk factors, n =166, 30%), intermediate risk (≥2 risk factors but <10% risk of CHD over 10 years, n =150, 27%), moderately high risk (2 risk factors and 10–20% risk of hard CHD events in 10 years, n =147, 28%) and high-risk (≥2 risk factors and >20% risk of hard CHD events in 10 years, n =83, 15%), respectively. In our study population, overall no CACS, mild CACS (1–99.9), moderate–severe CACS (≥100) were observed in 317 (58%), 160 (29%) and 69 (13%) men, respectively. Advanced calcification (CACS≥75th percentile for age) was present in 19% (n =104) men. Based on the LDL-C cutoffs recommended by the NCEP guidelines for initiation of lipid lowering, overall only 55% with CACS≥100 and 42% men with CACS≥75th percentile qualified for pharmacotherapy. As a result nearly half of individuals with CACS≥100 (45%) and CACS≥75th percentile (48%) missed eligibility for drug therapy. Conclusion: Our findings reveal the potential limitation of NCEP guidelines in identifying asymptomatic Brazilian men with significant coronary atherosclerosis who are potential candidates for aggressive primary prevention. Assessment of CACS may provide incremental value to global risk assessment in high-risk Brazilian men. [Copyright &y& Elsevier]

Background: To quantify the decline in recurrent major cardiovascular events (MCVE) risk in patients with clinically manifest vascular disease between 1996 and 2014 and to assess whether the improvements in recurrent MCVE-risk can be explained by reduced prevalence of risk factors, more medication use and less subclinical atherosclerosis., Methods and Results: The study was conducted in the Second Manifestations of ARTerial disease (SMART) cohort in patients entering the cohort in the period 1996-2014. The prevalence of risk factors and subclinical atherosclerosis was measured at baseline. Incidence rates per 100person-years for recurrent MCVE (including stroke, myocardial infarction, retinal bleeding, retinal infarction, terminal heart failure, sudden death, fatal rupture of abdominal aneurysm) were calculated, stratified by the year of study enrolment. For the attributable risk of changes in risk factors, risk factor treatment, and subclinical atherosclerosis on the incidence rates of recurrent MCVE, adjusted rate ratios were estimated with Poisson regression. 7216 patients had a median follow-up of 6.5years (IQR 3.4-9.9). The crude incidence of recurrent MCVE declined by 53% between 1996 and 2014 (from 3.68 to 1.73 events per 100person-years) and by 75% adjusted for age and sex. This improvement in vascular prognosis was 36% explained by changes in risk factors, medication use and subclinical atherosclerosis., Conclusion: The risk of recurrent MCVE in patients with clinically manifest vascular disease has strongly declined in the period between 1996 and 2014. This is only partly attributable to lower prevalence of risk factors, improved medication use and less subclinical atherosclerosis., (Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.)