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Ymittos Athens, Greece

Vlachopoulos C.,Peripheral Vessels Unit | Terentes-Printzios D.,Peripheral Vessels Unit | Stefanadis C.,Peripheral Vessels Unit
Current Vascular Pharmacology

Multisite artery or polyvascular disease is common. In the REACH registry, 15.9% of patients with either established atherosclerotic arterial disease or at least 3 risk factors for atherothrombosis had symptomatic polyvascular disease. History of risk factors and known co-morbidities, as well as a thorough physical examination, are mandatory in the initial screening and diagnostic work-up. Various non-invasive imaging techniques (duplex ultrasound, computed tomography angiography, magnetic resonance angiography) can be used for the identification of the polyvascular patient. Digital subtraction angiography is now used almost exclusively in association with endovascular procedures. Appropriate implementation of each technique is based on international guidelines and a multidisciplinary discussion for each case. The presence of co-existing disease in a different vascular bed is associated with a higher risk of recurrent symptoms and complications in the first site. In this context, accumulating evidence suggests that arterial biomarkers, such as arterial stiffness (pulse wave velocity), central blood pressures, wave reflections indices, ankle-brachial index, carotid intimamedia thickness, as well as vasculogenic erectile dysfunction, can predict cardiovascular morbidity and mortality beyond classical risk factors and prediction models. An important pending question is whether identification of multisite arterial disease may improve clinical outcomes in patients who are already in secondary prevention programs. Such screening of asymptomatic multisite artery disease in patients with known CVD would be of paramount importance if it is ultimately proven with hard evidence that it should lead to a different management from the one proposed for CVD patients without multisite artery disease. © 2012 Bentham Science Publishers. Source

Vlachopoulos C.,Peripheral Vessels Unit | Aznaouridis K.,Peripheral Vessels Unit | Stefanadis C.,Peripheral Vessels Unit
Journal of the American College of Cardiology

Objectives: The purpose of this study was to calculate robust quantitative estimates of the predictive value of aortic pulse wave velocity (PWV) for future cardiovascular (CV) events and all-cause mortality by meta-analyses of longitudinal studies. Background: Arterial stiffness is increasingly recognized as a surrogate end point for CV disease. Methods: We performed a meta-analysis of 17 longitudinal studies that evaluated aortic PWV and followed up 15,877 subjects for a mean of 7.7 years. Results: The pooled relative risk (RR) of clinical events increased in a stepwise, linear-like fashion from the first to the third tertile of aortic PWV. The pooled RRs of total CV events, CV mortality, and all-cause mortality were 2.26 (95% confidence interval: 1.89 to 2.70, 14 studies), 2.02 (95% confidence interval: 1.68 to 2.42, 10 studies), and 1.90 (95% confidence interval: 1.61 to 2.24, 11 studies), respectively, for high versus low aortic PWV subjects. For total CV events and CV mortality, the RR was significantly higher in high baseline risk groups (coronary artery disease, renal disease, hypertension) compared with low-risk subjects (general population). An increase in aortic PWV by 1 m/s corresponded to an age-, sex-, and risk factor-adjusted risk increase of 14%, 15%, and 15% in total CV events, CV mortality, and all-cause mortality, respectively. An increase in aortic PWV by 1 SD was associated with respective increases of 47%, 47%, and 42%. Conclusions: Aortic stiffness expressed as aortic PWV is a strong predictor of future CV events and all-cause mortality. The predictive ability of arterial stiffness is higher in subjects with a higher baseline CV risk. © 2010 American College of Cardiology Foundation. Source

Vlachopoulos C.,Peripheral Vessels Unit | Ioakeimidis N.,Peripheral Vessels Unit | Stefanadis C.,Peripheral Vessels Unit
Heart and Metabolism

Older patients with angina represent a patient group with many clinical challenges. Coronary artery disease is particularly common in older patients and the mortality associated with cardiovascular disease is high. Furthermore, diagnosis can be difficult and comorbidities are common. Unfortunately, evidence from clinical trials based on this group of patients is limited and current treatment guidelines do not fully address the needs of elderly patients. Several recent clinical trials have highlighted some of the main considerations one should make when treating comorbidities in elderly patients with coronary artery disease. Different treatment options in the pharmacological management of angina in this age group with comorbidities are also discussed in this review. Source

Vlachopoulos C.V.,Peripheral Vessels Unit | Terentes-Printzios D.G.,Peripheral Vessels Unit | Aznaouridis K.A.,Peripheral Vessels Unit | Pietri P.G.,Peripheral Vessels Unit | Stefanadis C.I.,Peripheral Vessels Unit
European Journal of Preventive Cardiology

Aims Streptococcus pneumoniae is the most common cause of community-acquired pneumonia (CAP) and CAP-related mortality in adults. Pneumococcal vaccination (PV) could protect subjects from cardiovascular events by reducing pneumonia severity or even preventing it. We sought to determine the ability of PV to protect from the risk of cardiovascular events. Methods and results A comprehensive search of electronic databases was conducted up to March 2014. Cohort studies that reported relative risk (RR) estimates with 95% confidence intervals (CI) were included. Eleven studies were included (332,267 participants, mean follow-up 20.1 months). The pooled RRs for cardiovascular events and cardiovascular mortality were 0.86 (95% CI: 0.76-0.97) and 0.92 (95% CI: 0.86-0.98; fixed-effects), respectively, for subjects with PV versus without PV. Protective ability was more prominent in high cardiovascular risk populations and with older age. The protective role of PV was attenuated after 1 year (RR: 0.72; 95% CI: 0.59-0.88 vs RR: 1.03; 95% CI: 0.93-1.14; p = 0.002, for follow-up >1 year vs ≤1 year, respectively). It also increased as the presence of cardiovascular and pulmonary disease increased. Regarding myocardial infarction (MI) and cerebrovascular events, the protective role of PV was statistically significant only in the elderly (RR: 0.90; 95% CI: 0.817-0.999; fixed-effects and RR: 0.86; 95% CI: 0.75-0.99, respectively). Conclusion PV is associated with decreased risk of cardiovascular events and mortality. This protective effect increases at older age and in high cardiovascular risk subjects and decreases as the time elapses from PV. PV decreases the risk of MI and cerebrovascular events in the elderly. © 2014 European Society of Cardiology. Source

Vlachopoulos C.,Peripheral Vessels Unit | Xaplanteris P.,Peripheral Vessels Unit | Baou K.,Peripheral Vessels Unit | Vassiliadou C.,Peripheral Vessels Unit | And 3 more authors.
Hellenic Journal of Cardiology

Introduction: Aortic stiffness is a valuable biomarker for stratifying cardiovascular risk. NADPH oxidase regulates oxidative status in vessels; its single nucleotide polymorphisms (SNPs) modify the redox state of carriers and may lead to noxious structural alterations and affect the vasomotor properties of arteries. We hypothesized that genetic variability of NADPH oxidase would be accompanied by differences in aortic stiffness; to this end, we explored the interplay of pulse wave velocity (PWV), a measure of aortic stiffness, with common SNPs of the CYBA gene that encodes the p22phox subunit of NADPH oxidase. Methods: 289 young, healthy adults were studied. The -930A/G, A640G and C242T CYBA SNPs were genotyped and PWV was measured. Differences in PWV across genotypes were examined in unadjusted models and after adjustment for confounders. Results: Genetic variability of the examined SNPs did not result in changes of aortic stiffness. In unadjusted models, PWV did not differ across genotypes for the -930A/G (p=0.20), A640G (p=0.65) or C242T SNP (p=0.50). In stepwise multiple linear regression analysis only sex, age and systolic blood pressure emerged as independent predictors of PWV. Conclusions: Common genetic variants of NADPH oxidase do not influence aortic stiffness in young, healthy adults. Source

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