The underappreciated impact of heart disease.

Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Women s Health Issues (Impact Factor: 1.61). 09/2010; 20(5):299-303. DOI: 10.1016/j.whi.2010.05.001
Source: PubMed

ABSTRACT The 2009 recommendations of the U.S. Preventive Services Task Force regarding mammography have called attention to the roles of prevention and screening in promoting women's health. We take this opportunity to raise awareness of another devastating illness in women, ischemic heart disease, and to suggest that screening for ischemic heart disease, by providing early detection and identifying women who would benefit most from intensified medical therapy, merits consideration.

  • Circulation Cardiovascular Imaging 03/2014; 7(2):390-397. DOI:10.1161/CIRCIMAGING.113.000470 · 6.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Currently, American Diabetes Association guidelines suggest statin use among persons with diabetes mellitus aged >40 years. The presence of calcified plaque in coronary arteries is a sensitive surrogate of coronary artery disease and has been shown to be an independent predictor of mortality and cardiac events. We aimed to assess the prevalence and severity of calcified plaque in coronary arteries in patients aged <40 years with and without diabetes. We included 3723 asymptomatic patients aged <40 years who had undergone coronary calcium scanning. Clinical and demographic data were collected. Agatston score was categorized into Agatston score 0 as normal, 1 to 99 as low, 100 to 399 as intermediate, and ≥400 as severe; and statistical analysis was performed. The study population consisted of 4% persons with diabetes (n = 142) and 56% men with a mean age of 35 ± 5 years. Young persons with diabetes had greater prevalence of Agatston score > 0 than persons without diabetes (43% vs 24%; P < .0001). In addition, 12% of persons with diabetes vs 2.5% of persons without diabetes had an Agatston score ≥ 100 (P < .0001). The prevalence of calcified plaque in coronary arteries was >50% in persons with diabetes aged >35 years. After taking into account risk factors, the presence of diabetes was associated with a 4-fold higher odds of an Agatston score ≥ 100 (odds ratio, 4.19; 95% CI, 2.29-7.65; P < .0001). Our study found that 43% of young patients with diabetes have detectable coronary atherosclerosis. Given the known clinical implications of calcified plaque in coronary arteries, future studies are needed to evaluate interventions in persons aged <40 years who exhibit subclinical atherosclerosis to reduce future cardiovascular disease events in this vulnerable population.
    Journal of cardiovascular computed tomography 07/2013; 7(4):241-7. DOI:10.1016/j.jcct.2013.08.004 · 4.51 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cardiovascular disease remains the leading cause of mortality in the US and worldwide, and no widespread screening for this number one killer has been implemented. Traditional risk factor assessment does not fully account for the coronary risk and underestimates the prediction of risk even in patients with established risk factors for atherosclerosis. Coronary artery calcium (CAC) represents calcified atherosclerosis in the coronary arteries. It has been shown to be the strongest predictor of adverse future cardiovascular events and provides incremental information to the traditional risk factors. CAC consistently outperforms traditional risk factors, including models such as Framingham risk to predict future CV events. It has been incorporated into both the European and American guidelines for risk assessment. CAC is the most robust test today to reclassify individuals based on traditional risk factor assessment and provides the opportunity to better strategize the treatments for these subjects (converting patients from intermediate to high or low risk). CAC progression has also been identified as a risk for future cardiovascular events, with markedly increased events occurring in those patients exhibiting increases in calcifications over time. The exact intervals for rescanning is still being evaluated.
    09/2012; 2012:812046. DOI:10.6064/2012/812046


Available from
Nov 18, 2014
Available from