Coronary Calcium Score for the Prediction of Asymptomatic Coronary Artery Disease in Patients With Ischemic Stroke

The first question to ask your stroke hospital. Do they have anyone in charge of research analysis and creation of stroke interventions from such research? IF NOT, THEY ARE COMPLETELY INCOMPETENT AND HAVE NO BUSINESS BEING A STROKE HOSPITAL.

Coronary Calcium Score for the Prediction of Asymptomatic Coronary Artery Disease in Patients With Ischemic Stroke

Hye-Yeon Choi¹, Soo Jeong Shin², Joonsang Yoo^2,3, Kijeong Lee⁴, Dongbeom Song², Young Dae Kim², Hyo Suk Nam², Kyung Yul Lee², Hye Sun Lee⁵, Dong Joon Kim⁶ and Ji Hoe Heo^2,7*

• ¹Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
• ²Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
• ³Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
• ⁴Department of Neurology, College of Medicine, Eunpyeong St. Mary Hospital, Catholic University of Korea, Seoul, South Korea
• ⁵Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
• ⁶Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
• ⁷Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea

Purpose: 

Many patients with ischemic stroke have concomitant coronary artery disease (CAD). However, it remains unclear which stroke patients should undergo evaluation for asymptomatic CAD, and which screening tools are appropriate. We investigated the role of coronary artery calcium (CAC) score as a screening tool for asymptomatic but severe CAD in acute stroke patients. We determined the selection criteria for CAC screening based on risk factors and cerebral atherosclerosis.

Materials and Methods: 

The present study included consecutive patients with acute stroke who had undergone cerebral angiography and multi-detector computed tomography coronary angiography. Severe CAD was defined as left main artery disease or three-vessel disease. Enrolled patients were randomly assigned to two sets; a set for developing selection criteria and a set for validation. To develop selection criteria, we identified associated factors with severe CAD regarding clinical factors and cerebral atherosclerosis. CAD predictability of selection criteria with the CAC score was calculated.

Results: 

Overall, 2,658 patients were included. Severe CAD was present in 360 patients (13.5%). CAC score was associated with CAD severity (P < 0.001). In the development set (N = 1,860), severe CAD was associated with age >65 years [odds ratio (95% confidence interval), 2.62 (1.93–3.55)], male sex (1.81 [1.33–2.46]), dyslipidemia (1.77 [1.25–2.61]), peripheral artery disease (2.64 [1.37–5.06]) and stenosis in the cervicocephalic branches, including the internal carotid (2.79 [2.06–3.78]) and vertebrobasilar arteries (2.08 [1.57–2.76]). We determined the combination of clinical and arterial factors as the selection criteria for CAC evaluation. The cut-off criterion was two or more elements of the selection criteria. The area under the curve (AUC) of the selection criteria was 0.701. The AUC significantly improved to 0.836 when the CAC score was added (P < 0.001). In the validation set (N = 798), the AUC of the selection criteria only was 0.661, and that of the CAC score was 0.833. The AUC of the selection criteria + CAC score significantly improved to 0.861(P < 0.001).

Conclusion: 

The necessity for CAC evaluation could be determined based on the presence of risk factors and significant stenosis of the cervicocephalic arteries. CAC evaluation may be useful for screening for severe CAD in stroke patients.

Introduction

Ischemic heart disease is the leading cause of long-term mortality in patients with stroke (1). The annual risk of myocardial infarction in patients with ischemic stroke is ~2.2% (1, 2). The presence and extent of asymptomatic stenosis in coronary angiography is strongly predictive of major cardiovascular events. Previous studies identified significant (≥50%) stenosis of the coronary artery in 20–41% of patients with stroke via autopsy, coronary angiography, or multi-detector computed tomography angiography (MDCTA) (3–7). Therefore, coronary screening may be necessary for stroke patients at high risk of coronary artery disease (CAD). However, it still remains uncertain which group of patients with stroke should undergo evaluation for asymptomatic CAD, and which evaluation tools are most appropriate for coronary screening in such patients.

Atherosclerosis is a systemic disease and CAD shares several risk factors with cerebral atherosclerosis (8). In fact, previous studies have demonstrated a significant association between CAD and atherosclerosis of the cervicocephalic arteries including the vertebrobasilar artery (VBA) and carotid arteries (4, 6, 9, 10). These findings suggest that CAD may be predicted to some extent by the presence of cerebral atherosclerosis and vascular risk factors.

Previous studies have indicated that coronary artery calcium (CAC) is superior to risk factor-based prediction of CAD and coronary events (11–14). Additionally, other studies reported that CAC scores are associated with the severity of CAD (15). In a large prospective population cohort registry, the risk of coronary events increased as the CAC score increased (12). This study aimed to investigate the role of the CAC score as a screening tool for the diagnosis of asymptomatic but severe CAD in patients with acute stroke. We also sought to determine the selection criteria for CAC screening in patients with stroke based on the presence of risk factors and cerebral atherosclerosis.

More at link. 

Statin Medication Enhances Progression of Coronary Artery Calcification: The Heinz Nixdorf Recall Study

I don't have enough medical brain power to understand so ask your doctor for it in understandable terms.  So you can ask whether better stroke recovery is more important than calcifying your arteries.

Simvastatin attenuates axonal injury after experimental traumatic brain injury and promotes neurite outgrowth of primary cortical neurons  Oct. 2012

Or these competing narratives;

Statins associated with improved heart structure and function May 2017 

Stroke Rounds: Statin Users Have Better Outcomes February 2016

Statins induce angiogenesis, neurogenesis, and synaptogenesis after stroke

September 2011 

New study strengthens evidence of the connection between statin use and cataracts  December 2014 

Stroke Patients Boost Survival by Getting Statins in Hospital    October 2014

 

 

 

 

Statin Medication Enhances Progression of Coronary Artery Calcification: The Heinz Nixdorf Recall Study

Author links open overlay panelIrynaDykunMDNilsLehmannPhDHagenKälschMDStefanMöhlenkampMDSusanneMoebusPhDThomasBuddeMDRainerSeibelMDDietrichGrönemeyerMD

Karl-HeinzJöckelPhDRaimundErbelMDAmir A.MahabadiMD

https://doi.org/10.1016/j.jacc.2016.08.040Get rights and content

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Statins are suggested to stabilize plaque by decreasing lipid-rich and necrotic plaque components and increasing plaque calcification 1, 2. However, to date the relationship between statin administration and progression of coronary artery calcification (CAC) is poorly understood, and existing data are limited to patient cohorts and relatively short follow-up times. Therefore, in this study, we aimed to investigate whether the use of statins influences the progression of CAC during >5 years of follow-up in an observational study based on participants from the general population cohort of the Heinz Nixdorf Recall Study, free from clinical cardiovascular disease at baseline (3). CAC score was assessed using electron-beam computed tomography at baseline and after 5 years using an identical scanning protocol and quantified by the Agatston score. Regression analysis was used to determine the association of CAC progression with statin intake, with log transformation of CAC to normalize for its distribution.

We included 3,483 participants (mean age 59 ± 8 years, 47% men) in this analysis. Overall, 230 subjects received statin medications at baseline. Median CAC scores at baseline were 58.8 (interquartile range [IQR]: 2.6 to 273.3) for subjects with statin intake and 5.9 (IQR: 0 to 80.2) for subjects without. Median follow-up CAC scores were 141.3 (IQR: 19.6 to 554.7) for subjects with statin intake and 21.2 (IQR: 0.0 to 174.6) for those without.

In unadjusted regression analysis, taking a statin was associated with 39% higher progression in CAC+1 (Table 1). This relationship was slightly attenuated after adjustment for cardiovascular risk factors but remained statistically significant, with approximately 31% higher progression of CAC+1, attributable to statin intake. Likewise, subjects with statin intake had almost 2-fold odds for CAC progression greater than the expected range compared with subjects without statin medication in unadjusted and adjusted regression analyses.

Tables and more at link. 

Grey hair linked with increased heart disease risk in men

Wow, what an insight. What if you skip grey and go straight to white? My beard is mostly white so I must be safe from CVD risk then. Women, you must be fine.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=174237&CultureCode=en

06 April 2017 European Society of Cardiology (ESC)

• Under embargo until 08 April 2017 06:30 GMT

 Grey hair has been linked with an increased risk of heart disease in men, in research presented today at EuroPrevent 2017.1
“Ageing is an unavoidable coronary risk factor and is associated with dermatological signs that could signal increased risk,” said Dr Irini Samuel, a cardiologist at Cairo University, Egypt. “More research is needed on cutaneous signs of risk that would enable us to intervene earlier in the cardiovascular disease process.”
Atherosclerosis and hair greying share similar mechanisms such as impaired DNA repair, oxidative stress, inflammation, hormonal changes and senescence of functional cells. This study assessed the prevalence of grey hair in patients with coronary artery disease and whether it was an independent risk marker of disease.
This was a prospective, observational study which included 545 adult men who underwent multi-slice computed tomography (CT) coronary angiography for suspected coronary artery disease. Patients were divided into subgroups according to the presence or absence of coronary artery disease, and the amount of grey/white hair.
The amount of grey hair was graded using the hair whitening score: 1 = pure black hair, 2 = black more than white, 3 = black equals white, 4 = white more than black, and 5 = pure white. Each patients’ grade was determined by two independent observers.
Data was collected on traditional cardiovascular risk factors including hypertension, diabetes, smoking, dyslipidaemia, and family history of coronary artery disease.
The researchers found that a high hair whitening score (grade 3 or more) was associated with increased risk of coronary artery disease independent of chronological age and established cardiovascular risk factors. Patients with coronary artery disease had a statistically significant higher hair whitening score and higher coronary artery calcification than those without coronary artery disease.
In multivariate regression analysis, age, hair whitening score, hypertension and dyslipidaemia were independent predictors of the presence of atherosclerotic coronary artery disease. Only age was an independent predictor of hair whitening.
“Atherosclerosis and hair greying occur through similar biological pathways and the incidence of both increases with age,” said Dr Samuel. “Our findings suggest that, irrespective of chronological age, hair greying indicates biological age and could be a warning sign of increased cardiovascular risk.”
Dr Samuel said asymptomatic patients at high risk of coronary artery disease should have regular check-ups to avoid early cardiac events by initiating preventive therapy.
“Further research is needed, in coordination with dermatologists, to learn more about the causative genetic and possible avoidable environmental factors that determine hair whitening,” she added. “A larger study including men and women is required to confirm the association between hair greying and cardiovascular disease in patients without other known cardiovascular risk factors.”
She concluded: “If our findings are confirmed, standardisation of the scoring system for evaluation of hair greying could be used as a predictor for coronary artery disease.”
https://www.escardio.org/The-ESC/Press-Office/Press-releases/grey-hair-linked-with-increased-heart-disease-risk-in-men?hit=wireag

• Full bibliographic informationDr Samuel will present the abstract ‘The degree of hair graying in male gender as an independent risk factor for coronary artery disease, a prospective study’ during Poster Session III – Risk factors: others_Part 3 which takes place on 8 April from 08:30 to 12:30 in Poster Area.

Exclusive olive oil consumption has a protective effect on coronary artery disease: Overview of the THISEAS study

Doesn't really help because there is no quantification of amounts consumed.
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10255541&utm_source=Issue_Alert&utm_medium=RSS&utm_campaign=PHN

Maria Dimitriou^a1 c1, Loukianos S Rallidis^a2, Eirini V Theodoraki^a1, Ioanna Panagiota Kalafati^a1, Genovefa Kolovou^a3 and George V Dedoussis^a1 c1

^a1 Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, El. Venizelou 70, 17671 Athens, Greece
^a2 Second Department of Cardiology, Attikon Hospital, School of Medicine, University of Athens, Athens, Greece
^a3 First Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece

Abstract

Objective The aims of the current report are to present the demographic characteristics, clinical characteristics/biochemical indices and lifestyle habits of the population and to explore the potential association of exclusive olive oil consumption, in relation to lifestyle factors, with coronary artery disease risk.
Design Demographic, lifestyle, dietary and biochemical variables were recorded. Logistic regression analysis was performed in order to estimate the relative risks of developing coronary artery disease.
Setting The Hellenic study of Interactions between Single nucleotide polymorphisms and Eating in Atherosclerosis Susceptibility (THISEAS), a medical centre-based case–control study conducted in Greek adults.
Subjects We consecutively enrolled 1221 adult patients with coronary artery disease and 1344 adult controls.
Results A higher prevalence of the conventional established risk factors was observed in cases than in controls. Physical activity level was higher in controls (1·4 (sd 0·2) than in cases (1·3 (sd 0·3); P<0·001). Regarding current and ex-smokers, the case group reported almost double the pack-years of the control group (54·6 (sd 42·8) v. 28·3 (sd 26·3), respectively; P<0·001). Exclusive olive oil consumption was associated with 37 % lower likelihood of developing coronary artery disease, even after taking into account adherence to the Mediterranean diet (OR=0·63; 95 % CI 0·42, 0·93; P=0·02).
Conclusions Exclusive olive oil consumption was associated with lower risk of coronary artery disease, even after adjusting for adoption of an overall healthy dietary pattern such as the Mediterranean diet.

Antioxidant beverages: green tea intake and coronary artery disease

This one requires your doctor to decide what to do. Otherwise you could kill yourself. Be careful out there.
Other posts I've done on this:
There is research that suggests green tea extract can become toxic at median level at the equivalent of 24 cups in a day.

Green Tea Boosts Your Brain

Green Tea Or Coffee May Reduce Stroke Risk

Green Tea Boosts Memory

 

http://www.ncbi.nlm.nih.gov/pubmed/25574146

Ohmori R¹, Kondo K², Momiyama Y³.

Author information

Abstract

Coronary artery disease (CAD) is recognized as an inflammatory disease. In the present study, we investigated the effect of green tea consumption on plasma inflammatory markers and the association between green tea consumption and CAD. In 22 healthy volunteers, green tea consumption (7 cups/day) significantly decreased serum malondialdehyde-modified low-density lipoprotein (MDA-LDL) concentrations, whereas green tea consumption tended to decrease plasma C-reactive protein and interleukin (IL)-6 concentrations. In 725 patients undergoing coronary angiography, the percentage of patients drinking <1 cup/day of green tea was higher in patients with myocardial infarction (MI) than in CAD patients without MI and patients without CAD (29% vs. 15% and 18%, P < 0.01). Green tea consumption was found to be inversely associated with MI in Japanese patients. The protective effect of green tea against atherosclerosis is more likely to be because of the inhibitory effect of LDL oxidation than because of anti-inflammatory effect.

KEYWORDS:

antioxidant; coronary artery disease; green tea; inflammation; myocardial infarction

PMID:

25574146

[PubMed]

PMCID:

PMC4274049

Free PMC Article

High-dose statin therapy in patients with stable coronary artery disease: treating the right patients based on individualized prediction of treatment effect

Well shit, I thought high-dose statin therapy was no longer recommended for anyone not on it already. You will need to ask your doctor which research finding they are using for guidance.

FDA announces new safety recommendations for high-dose simvastatin 

The line from there;

The agency is recommending that simvastatin 80 mg be used only in patients who have been taking this dose for 12 months or more and have not experienced any muscle toxicity. It should not be prescribed to new patients.

And the new one here:

High-dose statin therapy in patients with stable coronary artery disease: treating the right patients based on individualized prediction of treatment effect

Dorresteijn JA¹, Boekholdt SM, van der Graaf Y, Kastelein JJ, LaRosa JC, Pedersen TR, DeMicco DA, Ridker PM, Cook NR, Visseren FL.

Author information

Abstract

BACKGROUND:

Clinicians need to identify coronary artery disease patients for whom the benefits of high-dose versus usual-dose statin therapy outweigh potential harm. We therefore aimed to develop and validate a model for prediction of the incremental treatment effect of high-dose statins for individual patients in terms of reduction of 5-year absolute risk for myocardial infarction, stroke, coronary death, or cardiac resuscitation.

METHODS AND RESULTS:

Based on data from the Treating to New Targets trial (TNT; n=10 001), a Cox proportional hazards model was developed comprising 13 easy-to-measure clinical predictors: age, sex, smoking, diabetes mellitus, total cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, history of myocardial infarction, coronary artery bypass grafting, congestive heart failure or abdominal aortic aneurysm, glomerular filtration rate, and treatment status (ie, atorvastatin 80 mg or 10 mg). External validation in the Incremental Decrease in End Points Through Aggressive Lipid Lowering trial (IDEAL; n=8888) confirmed adequate goodness-of-fit and calibration, but moderate discrimination (C-statistic, 0.63; 95% confidence interval, 0.62-0.65). Still, among participants of both trials combined, the model identified a group of 11.7% whose predicted 5-year number needed to treat was ≤25 and a group of 41.9% whose predicted needed to treat was ≥50. A decision curve shows that making treatment decisions on the basis of predictions using our model may improve net benefit.

CONCLUSIONS:

Estimation of the incremental treatment effect of high-dose versus usual-dose statin therapy in individual coronary artery disease patients enables selection of high-risk patients that benefit most from more aggressive therapy.

CLINICAL TRIAL REGISTRATION URL:

http://www.clinicaltrials.gov. Unique identifiers: NCT00327691 and NCT00159835.