吸烟与他汀类药物疗效在冠状动脉粥样硬化中的相互影响

吸烟增加冠状动脉粥样硬化的风险,他汀类药物降低血脂蛋白和炎性因子水平以及心血管发病率和死亡率,可稳定斑块且对斑块具逆转作用.吸烟会降低他汀类药物的有益作用.本文就吸烟与他汀类药物在冠状动脉粥样硬化中相互影响研究的进展作一综述.     

冠状动脉钙化研究进展

冠状动脉钙化是动脉粥样硬化的一个重要的危险因素,多项研究揭示冠状动脉钙化和粥样硬化斑块负荷有着密切的关系,因此冠状动脉钙化程度的测量在预测未来心血管事件及死亡率中起着重要的作用。现将通过对冠状动脉钙化的危险因素、发病机制、冠状动脉钙化积分评测及方法、钙化与心血管疾病的关系、冠状动脉钙化与肾脏疾病的关系、冠状动脉钙化与全因死亡及钙化的治疗等方面做一综述。     

血管内超声评价冠状动脉粥样硬化

血管内超声(IVUS)可以提供高分辩率的冠状动脉管腔和斑块的横界面图像和冠状动脉斑块和管壁的详细信息(包括斑块的体积、成分、钙化情况,是否稳定,有无破裂,血管壁体积和形态等)成为研究冠状动脉粥样硬化的有力武器。近来,IVUS研究揭示出胆固醇水平、他汀治疗、心血管危险因素等与冠状动脉斑块进展的关系,同时也有多项有关冠状动脉重构、不稳定斑块和斑块破裂的IVUS研究。     

冠状动脉钙化临床研究与诊断

冠状动脉钙化是判断冠状动脉粥样硬化的可靠指标,所以对冠状动脉钙化的研究是对亚临床动脉粥样硬化的干预与研究的重要内容,本文对冠状动脉钙化与血管狭窄、斑块稳定性与心血管事件关系及其诊断和治疗进展等方面进行综述。     

冠状动脉钙化临床研究与诊断

冠状动脉钙化是判断冠状动脉粥样硬化的可靠指标,所以对冠状动脉钙化的研究是对亚临床动脉粥样硬化的干预与研究的重要内容,本文对冠状动脉钙化与血管狭窄、斑块稳定性与心血管事件关系及其诊断和治疗进展等方面进行综述.     

老年人冠状动脉钙化定量测定的临床意义

冠心病是在冠状动脉粥样硬化基础上发展而来的。冠状动脉钙化是冠状动脉粥样硬化的标志。检出冠状动脉钙化就意味着冠状动脉粥样硬化的存在。早期、精确地检测出冠脉钙化是医学影像学责无旁贷的职责。1　冠脉钙化和冠心病的关系及影响因素　　冠心病是由于冠状动脉粥样硬化导致     

冠状动脉钙化的研究进展

冠状动脉钙化(CAC)始于微钙化，并发展为更大的钙碎片，最终形成片状沉积物甚至钙化结节，这些钙化可通过X线、CT和血管内成像来识别。最近的研究显示，冠状动脉内钙化斑块的体积与动脉粥样硬化(AS)的进展及未来严重心血管不良事件的发生率高度相关，或许可使用他汀类药物治疗。本综述主要回顾CAC的病理生理机制、目前的检测手段及治疗方法。     

他汀类药物的抗炎作用

近年有人提出冠状动脉粥样硬化应称为动脉粥样硬化性炎症更为确切。他汀类药物除具有明显的降脂作用 ,一些研究提示他汀类药物还具有明显的抗炎作用 ,包括抑制炎性细胞向病变处的迁移以及大量炎症因子的释放 ,抑制平滑肌细胞增殖 ,进而促进斑块稳定 ,改善血管内皮的功能 ,抑制细胞凋亡 ,降低病人急性相反应蛋白CRP的水平等作用。进而达到稳定粥样斑块 ,预防急性冠脉综合征的发生。     

高强度他汀类治疗对冠状动脉粥样硬化的消退作用

背景与目的血管内超声试验证明应用他汀类药物能减慢或延迟动脉粥样硬化的发展,但是,使用粥样瘤体积百分比法还没有找到确凿证据证明疾病进展减慢或消退,后者比血管内超声试验更准确。此项研究旨在评定高强度他汀类药物治疗是否如血管内超声成像显示的那样能延缓冠状动脉粥样硬     

他汀类药物在急性冠状动脉综合征中的抗炎作用

急性冠状动脉综合征是常见的冠状动脉粥样硬化性心脏病的急症,炎症在动脉粥样硬化过程中起重要作用。3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂他汀类药物现已广泛应用于冠心病的一级、二级预防,越来越多的证据显示他汀类药物具有显著抗炎作用。     

冠状动脉钙化研究进展

冠状动脉钙化越来越受到重视,发现钙化即意味着亚临床动脉粥样硬化的存在,而动脉硬化不一定都有钙化。通常钙化越严重,冠脉管腔狭窄程度也就越高。但有时二者却缺乏很好的相关性。现就冠脉钙化的发生机制,冠脉钙化及积分与冠心病及其严重程度的关系,冠脉钙化检测方法及积分,血管重构在严重的冠脉钙化却没有明显的管腔狭窄中的作用等方面做一综述。     

The value of computed tomography scanning for the detection of coronary artery disease in patients with idiopathic pulmonary fibrosis

Background and objective: Patients with idiopathic pulmonary fibrosis (IPF) have a higher prevalence of coronary artery disease and this could have an impact on their outcomes. We investigated the predictive ability of coronary artery calcification, assessed by routine CT, which may predict the presence of coronary artery disease. Methods: The study cohort consisted of patients with IPF and with left heart catheterization data plus CT scans from July 2003 to July 2008. Grades of coronary calcification on CT were compared with left heart catheterization determination of coronary artery disease. Results: There were 57 patients in whom left heart catheterization review demonstrated significant coronary artery disease in 28.1% (16/57), mild disease in 40.3% (23/57) and none in 31.6% (18/57). The median time interval between the catheterization and the reviewed CT scan was 39 days. The sensitivity of moderate to severe calcification for significant coronary artery disease was 81%, while the specificity was 85%, with an associated odds ratio of 25.2 (4.64–166, P < 0.005). There was excellent agreement among three radiologists in the grading of coronary calcification. Conclusions: Coronary calcification, as assessed by routine CT of the chest, has very good performance characteristics in predicting underlying significant coronary artery disease in patients with IPF. The routine availability of this study enables the ready screening for coronary artery disease in IPF patients.     

Aortic calcification is associated with coronary artery calcification and is a potential surrogate marker for ischemic heart disease risk: A cross-sectional study

Coronary artery calcification, an established marker of atherosclerotic plaque burden associated with increased risk of coronary artery disease, is routinely evaluated using electron beam computerized tomography or multidetector computed tomography (CT). However, aortic calcification, which is also a risk factor for adverse cardiac events, is not frequently assessed, despite being easily detected via standard chest radiography. We therefore sought to clarify the association between aortic calcification and significant coronary artery calcification to determine the feasibility of performing chest radiography to evaluate the risk of future cardiovascular events.Data from 682 consecutive patients who underwent cardiac CT scanning at our institution from May to September 2012 were included in this cross-sectional analysis. Electrocardiographic-gated CT was used to qualitatively evaluate calcification in 6 aortic segments. Cardiac contrast-ehnanced CT was performed to identify significant calcification of the coronary artery. Calcification was quantified by calculating the Agatston score, and the relationship between significant coronary artery calcification and calcification at each aortic site was evaluated.Among the aortic sites, calcification was most commonly observed in the aortic arch (77.4% of patients). Significant coronary artery calcification was observed in 267 patients (39.1%). Calcification in the ascending aorta, aortic arch, descending aorta, abdominal aorta, and aortic valve were significantly associated with the presence of coronary artery calcification after adjustment for cardiovascular risk factors and statin use (odds ratios [95% confidence intervals] 4.21 [2.55, 6.93], 1.65 [1.01, 2.69], 2.14 [1.36, 3.36], 2.87 [1.83, 4.50], and 3.32 [2.02, 5.46], respectively). Mitral valve calcification was weakly but nonsignificantly associated with coronary artery calcification (odds ratio 1.84 [95% confidence interval 0.94, 3.62]). Calcification of each aortic segment assessed was significantly associated with Agatston score ≥ 100.Aortic calcification was associated with coronary artery calcification. Calcification of the aortic arch, which can be readily detected by routine chest radiography, may be associated with coronary artery calcification and its assessment should therefore be considered to identify patients at increased risk of cardiovascular events. Further studies are warranted to confirm these findings.     

Incidence and clinical relevance of coronary calcification detected by electron beam computed tomography in heart transplant recipients.

BACKGROUND: Patients treated by cardiac transplantation who survive beyond one year are at significant risk from fatal coronary artery disease. The development of coronary artery calcification in these patients is discussed and methods available to detect it are reviewed. OBJECTIVES: To assess the clinical importance of coronary artery calcium in heart transplant recipients. METHODS: In a cohort of 102 cardiac transplant recipients, electron beam computed tomography was used to measure calcium in the coronary arterial wall 63 days to 9.1 years (median 4.6 years) after transplantation. The results were compared with angiographic findings and with conventional coronary disease risk factors. The patients were followed for a mean of 2.12 years (1.2-4.02 years) to assess the relationship between these findings and future cardiac events. RESULTS: Forty-one (40.2%) had a stenosis of > 24% in one or more major coronary artery at angiography. Forty-six (45%) had a coronary calcium score > 0. The absence of calcium had a negative predictive value with respect to angiographic disease in any vessels of 87.5%. Logistic regression revealed that dyslipidaemia, systemic hypertension and organ ischaemic time were significant predictors of calcification. At follow-up, both an abnormal coronary angiogram and coronary calcium were found to be the only significant predictors of late events. Multivariate analysis suggested that the detection of coronary calcium did not offer any additional predictive information over that provided by the angiogram itself. CONCLUSION: Electron beam computed tomography is well suited to the assessment of calcium in the coronary arteries of heart transplant recipients, although the mechanisms of this calcification remain poorly understood. Calcium is detected more frequently than would be suggested by studies using intravascular ultrasound. It is associated with the presence of angiographic disease, and with some conventional risk factors for coronary disease. At follow-up the presence of coronary calcium was associated with an adverse clinical outcome, as it is in conventional ischaemic heart disease.     

The association of coronary calcium score and conventional cardiovascular risk factors in Type 2 diabetic subjects asymptomatic for coronary heart disease (The PREDICT Study).

AIM: To determine the association between coronary calcification score (CACS) obtained by electron beam computed tomography (EBCT) and cardiovascular risk factors in Type 2 diabetic subjects entered into a prospective cohort study. METHODS: Type 2 diabetic subjects attending routine hospital diabetic clinics without known coronary heart disease (CHD) underwent EBCT to measure CACS. Demographic data were obtained and conventional cardiovascular risk factors were measured at baseline. RESULTS: Four hundred and ninety-five subjects were assessed of whom 67.7% were male. They had a mean (SD) age of 62.9 (7.1) years, with median (inter-quartile range) duration of diabetes of 8 (4-13) years. None had a history of coronary artery disease. Forty-five per cent were receiving lipid-lowering agents (including 36% statins). In a univariate analysis, there were significant associations between increased CACS and age, duration of diabetes, male gender, waist-hip ratio (WHR), systolic blood pressure, and the use of statins. In a multivariate model adjusting for the possible interaction of these and other factors, the significant association between CACS and WHR, systolic blood pressure, male gender and statin use remained. CONCLUSIONS: The close association between CACS and WHR and the association with systolic blood pressure suggest that coronary calcification may be particularly linked to the metabolic syndrome in Type 2 diabetes.     

Should standard medical therapy for angina include a statin?

Although a wealth of evidence supports the use of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) in patients with clinically evident coronary artery disease, these agents are still underutilized. Statins are the most effective agents in reducing low-density lipoprotein-cholesterol among lipid-lowering drugs, and studies have recently shown that they improve endothelial function and plaque stabilization, and induce regression of atherosclerotic lesions. This article reviews the most recent evidence and guideline recommendations supporting the use of statins in chronic stable angina pectoris and acute coronary syndromes.     

冠状动脉钙化的研究进展

冠状动脉钙化是冠状动脉粥样硬化患者不良预后的危险因素。多种因素与冠状动脉钙化的发生和发展相关,包括性别、年龄、持续的炎症状态、高血压、高脂血症和糖尿病等,近年来人们越来越关注非传统高危因素,以期为冠状动脉钙化的一级预防开辟新的思路。不断发展的影像学技术也为冠状动脉钙化的早期发现和发生机制的研究提供了很好的帮助。文章将重点回顾冠状动脉钙化的高危因素、发生机制、检查手段、临床意义及其治疗的研究进展,旨在提高人们对冠状动脉钙化的进一步认识和重视水平。     

Statins moderate coronary stenoses but not coronary calcification: Results from meta-analyses

Introduction

Coronary artery stenoses have been shown in various trials to be moderated by treatment with statins. A similar effect on coronary artery calcification has not been demonstrated. We therefore undertook meta-analyses of trials examining the effect of statin treatment on coronary artery stenoses and coronary artery calcification.

Methods

Literature searches identified five controlled trials suitable for inclusion in the analysis of the effect of statins (high dose versus either low dose or placebo) on coronary artery calcification and six trials suitable for inclusion in the analysis of the effect of statins on coronary artery stenoses.

Results

All trials reported substantial and significant reductions in LDL-C with statin treatment which results in net reductions of LDL-C in the CAC and coronary stenoses trials of 1.0 mmol/L and 0.9 mmol/L, respectively. Analysis of the CAC trials did not demonstrate any effect of statins on the progression of calcification. In contrast, in the coronary stenoses trials there was a consistent moderation of stenosis severity progression with statins (p < 0.0001).

Conclusions

Meta-analyses of the available trials have demonstrated a significant moderation of coronary stenoses associated with the statin-induced reduction in LDL-C. In contrast, there was no effect on coronary calcification despite a similar reduction in LDL-C levels. This suggests that the pathogenesis of the two conditions may be different, if not in aetiology, then certainly in their development. It further suggests that statin use to moderate arterial calcification is not effective.     

冠状动脉CT造影评估冠状动脉钙化进展及临床意义

冠状动脉粥样硬化是冠心病的病理学基础,而冠状动脉钙化是粥样硬化病变的重要标志。检测和评估冠状动脉钙化不仅对预测心血管事件有重要意义,还有助于了解疾病进展,从而更好地指导临床诊治。冠状动脉CT造影(CCTA)是对冠状动脉钙化斑块进行精确量化评估的无创检查手段,其对于定量冠状动脉钙化以及预后评估具有重要的临床价值。本文对冠状动脉钙化CCTA检测方法及其临床应用等进行综述。