Highlighted Articles - Atherosclerosis February 2015 Issue
27 February 2015
Volume 238 | Issue 2| February 2015
By Elvira Mambetisaeva, Sarah Leigh and Steve Humphries (Editor–in-Chief)
Abdelbaky et al presented a study showing a relationship between aortic valve inflammation and calcification. To determine whether aortic valve inflammation precedes subsequent valvular calcification, they utilised sequential PET/CT scans performed for cancer surveillance in patients without active cancer or aortic stenosis. Their findings suggest that early valvular inflammation appears to be associated with future aortic valve calcification. In his invited commentary, Paolo Raggi discusses whether inflammation is the “chicken” or the “egg” in this issue, or alternatively are calcium and inflammation part of a “vicious cycle”? None the less, he states that the study by Abdelbaky et al. makes a useful contribution to a greater understanding of human valvular disease.
From their study of 914 consecutive ischemic stroke patients without chest pain, Hur et al were able to conclude that coronary computed tomography angiography (CCTA) provided additional risk-discrimination of coronary artery disease (CAD) over coronary artery calcium scores (CACS), which in turn allows early detection and potentially prevention of major adverse cardiac events. Johann Auer analyses the implications of Hur et al’s findings in his invited commentary and concludes that based on current evidence, CCTA cannot be recommended for CAD screening in unselected asymptomatic patients after ischemic stroke. Thus, unless large trials prove otherwise the current guidelines (as shown in figure 1 in the commentary) remain valid.
Tavori et al present a detailed review of the function and homeostasis of PCSK9 and its interactions with LDLR; they go on to emphasize that there are still gaps in our understanding of the full physiological effects of PCSK9 which may have many clinically significant implications.
Prenner & Chirinos conducted a systematic literature review to summarise recent finding from clinical and population-based studies assessing arterial stiffness in populations with diabetes mellitus (DM). The analysis of key studies reveal that arterial stiffness is closely related to the progression of complications of DM and can be increased even in pre-diabetic populations with impaired glucose tolerance, and in those with the metabolic syndrome. The authors suggest that additional prospective studies are needed to determine whether interventions targeting glucose dysregulation or arterial stiffness would be associated with improved clinical outcome.
The review by Challoumas et al present the analysis of identified 14 randomised controlled trials and 2 meta-analyses reporting on effects of calcium and vitamin D on different cardiovascular parameters when they are administered together. Overall, the existing evidence suggests that the combined vitamin D–Calcium (CaD) supplementation has neither a beneficial nor an adverse clinical effect on cardiovascular events, blood pressure, lipid profile, glucose metabolism and weight. In order to reach definite conclusions, further well-designed randomised clinical trials will be needed, and in the meantime the guidelines for CaD supplementation use will not be changed.
Papers in this issue include: