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Coronary Artery Disease: HELP
Articles by Eva Prescott
Based on 21 articles published since 2008
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Between 2008 and 2019, Eva Prescott wrote the following 21 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Guideline 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. 2013

Anonymous3190768 / Montalescot, Gilles / Sechtem, Udo / Achenbach, Stephan / Andreotti, Felicita / Arden, Chris / Budaj, Andrzej / Bugiardini, Raffaele / Crea, Filippo / Cuisset, Thomas / Di Mario, Carlo / Ferreira, J Rafael / Gersh, Bernard J / Gitt, Anselm K / Hulot, Jean-Sebastien / Marx, Nikolaus / Opie, Lionel H / Pfisterer, Matthias / Prescott, Eva / Ruschitzka, Frank / Sabaté, Manel / Senior, Roxy / Taggart, David Paul / van der Wall, Ernst E / Vrints, Christiaan J M / Anonymous3200768 / Zamorano, Jose Luis / Achenbach, Stephan / Baumgartner, Helmut / Bax, Jeroen J / Bueno, Héctor / Dean, Veronica / Deaton, Christi / Erol, Cetin / Fagard, Robert / Ferrari, Roberto / Hasdai, David / Hoes, Arno W / Kirchhof, Paulus / Knuuti, Juhani / Kolh, Philippe / Lancellotti, Patrizio / Linhart, Ales / Nihoyannopoulos, Petros / Piepoli, Massimo F / Ponikowski, Piotr / Sirnes, Per Anton / Tamargo, Juan Luis / Tendera, Michal / Torbicki, Adam / Wijns, William / Windecker, Stephan / Anonymous3210768 / Knuuti, Juhani / Valgimigli, Marco / Bueno, Héctor / Claeys, Marc J / Donner-Banzhoff, Norbert / Erol, Cetin / Frank, Herbert / Funck-Brentano, Christian / Gaemperli, Oliver / Gonzalez-Juanatey, José R / Hamilos, Michalis / Hasdai, David / Husted, Steen / James, Stefan K / Kervinen, Kari / Kolh, Philippe / Kristensen, Steen Dalby / Lancellotti, Patrizio / Maggioni, Aldo Pietro / Piepoli, Massimo F / Pries, Axel R / Romeo, Francesco / Rydén, Lars / Simoons, Maarten L / Sirnes, Per Anton / Steg, Ph Gabriel / Timmis, Adam / Wijns, William / Windecker, Stephan / Yildirir, Aylin / Zamorano, Jose Luis. ·The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines. ·Eur Heart J · Pubmed #23996286.

ABSTRACT: -- No abstract --

2 Review The prognostic value of coronary endothelial and microvascular dysfunction in subjects with normal or non-obstructive coronary artery disease: A systematic review and meta-analysis. 2018

Brainin, Philip / Frestad, Daria / Prescott, Eva. ·Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark. · Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark; Department of Cardiology, Hvidovre University Hospital, Copenhagen, Denmark. · Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark. Electronic address: epre0004@regionh.dk. ·Int J Cardiol · Pubmed #29407076.

ABSTRACT: AIMS: Coronary vascular dysfunction is linked with poor cardiovascular prognosis in patients without obstructive coronary artery disease (CAD) but a critical appraisal of the literature is lacking. METHODS AND RESULTS: We performed a systematic review and meta-analysis to quantify the cardiovascular risk associated with endothelial dependent and non-endothelial dependent coronary vascular dysfunction in patients with normal or non-obstructive CAD (epicardial stenosis <50%). Prospective cohort studies that reported coronary vascular dysfunction at baseline and cardiovascular outcomes at follow-up were included. We identified 52 papers of which 26 were included in the meta-analyses. Study populations included stable angina (n=15), heart failure (n=4), diabetes (n=2), hypertrophic obstructive cardiomyopathy (n=2), chronic kidney disease, aortic stenosis and left atrial enlargement (each n=1): RR estimates were similar in patients with stable angina and other patient groups. For epicardial endothelial dependent dysfunction (six studies, 243 events in 1192 patients) the summarized RR was 2.38 (95% confidence intervals (95% CI) 1.74-3.25), for non-endothelial dependent dysfunction assessed as coronary flow velocity reserve (CFVR) by echocardiography (10 studies, 428 events in 5134 patients) RR was 4.58 (95% CI 3.58-5.87) and for coronary flow reserve (CFR) by PET (10 studies, 538 events in 3687 patients) RR was 2.44 (95% CI 1.80-3.30). However, RR estimates were robust in a series of sensitivity analyses. CONCLUSION: The presence of coronary vascular dysfunction in patients with normal or non-obstructive CAD predicts adverse cardiovascular outcome. Multicentre studies and uniform guidelines for assessing coronary vascular dysfunction are encouraged.

3 Review Structural and Functional Coronary Artery Abnormalities in Patients With Vasospastic Angina Pectoris. 2015

Ong, Peter / Aziz, Ahmed / Hansen, Henrik Steen / Prescott, Eva / Athanasiadis, Anastasios / Sechtem, Udo. ·Department of Cardiology, Robert Bosch Krankenhaus. ·Circ J · Pubmed #26084380.

ABSTRACT: Coronary spasm is involved in many clinical scenarios, such as stable angina, acute coronary syndrome, sudden cardiac death, non-ischemic cardiomyopathy, arrhythmia and syncope. In recent years, imaging tools such as computerized tomographic angiography, intravascular ultrasound or optical coherence tomography have been applied to study the coronary pathology in patients with vasospastic angina. Patients with vasospastic angina represent a heterogeneous cohort of patients with regard to the extent of concomitant coronary atherosclerosis. They share the common pathophysiological phenomenon of vascular smooth muscle hyperreactivity leading to spasm caused by various factors that may also overlap. Focal coronary spasm is related to epicardial atherosclerosis and in the presence of obstructive coronary artery disease it may be useful to treat the lesion to prevent further spasm. The aim of this article is to review structural and functional coronary artery abnormalities in patients with vasospastic angina.

4 Article Accelerated collagen turnover in women with angina pectoris without obstructive coronary artery disease: An iPOWER substudy. 2018

Nielsen, Signe H / Mygind, Naja D / Michelsen, Marie M / Bechsgaard, Daria F / Suhrs, Hannah E / Genovese, Federica / Nielsen, Henning B / Brix, Susanne / Karsdal, Morten / Prescott, Eva / Kastrup, Jens. ·1 Fibrosis Biology and Biomarkers, Nordic Bioscience, Denmark. · 2 Department of Biotechnology and Biomedicine, Technical University of Denmark, Denmark. · 3 Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark. · 4 Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark. · 5 Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Denmark. · 6 ProScion, Herlev, Denmark. ·Eur J Prev Cardiol · Pubmed #29436257.

ABSTRACT: Aim Collagens are major cardiac extracellular matrix components, known to be actively remodelled and accumulated during diffuse myocardial fibrosis. We evaluated whether accelerated collagen turnover described by neo-epitope biomarkers reflecting collagen formation and degradation separates patients with diffuse myocardial fibrosis from asymptomatic controls. Methods and results Seventy-one women with angina pectoris without significant coronary artery disease assessed by invasive coronary angiogram were included. Competitive enzyme-linked immunosorbent assays (ELISAs) measuring circulating protein fragments in serum assessed the formation and degradation of collagen type III (Pro-C3, C3M and C3C), IV (P4NP7S and C4M), V (Pro-C5 and C5M) and VI (Pro-C6 and C6M), and degradation of collagen type I (C1M). Serum samples from 32 age-matched asymptomatic women were included as controls. Symptomatic women presented significantly elevated levels of Pro-C6, C3C, C3M, C4M and C8-C ( p < 0.0001-0.0058) and significantly decreased levels of Pro-C3, C5M and C6M ( p < 0.0001-0.041), reflecting accelerated collagen turnover and an imbalanced collagen formation and degradation compared to controls. Cardiac magnetic resonance T1 mapping was performed to determine extracellular volume fraction and thus diffuse myocardial fibrosis. A significant association was identified between C5M and extracellular volume fraction by cardiac magnetic resonance ( p = 0.01). Conclusion Women with angina pectoris, but without significant obstructive coronary artery disease, showed an imbalanced collagen turnover compared to asymptomatic controls. The examined biomarkers are tools to monitor active collagen remodelling in patients with angina pectoris, in risk of developing myocardial fibrosis.

5 Article Low diagnostic yield of non-invasive testing in patients with suspected coronary artery disease: results from a large unselected hospital-based sample. 2018

Therming, Christina / Galatius, Søren / Heitmann, Merete / Højberg, Søren / Sørum, Charlotte / Bech, Jan / Husum, Dorte / Dominguez, Helena / Sehestedt, Thomas / Hermann, Thomas / Reeh, Jacob / Simonsen, Lene / Prescott, Eva. ·Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark. · Department of Clinical Physiology and Nuclear Medicine, Bispebjerg-Frederiksberg University Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark. ·Eur Heart J Qual Care Clin Outcomes · Pubmed #29267950.

ABSTRACT: Aims: Stable angina is the most common presentation of heart disease and has a good prognosis. With declining coronary artery disease (CAD), rates a diagnostic approach balancing costs and benefits is a challenge, particularly in women. This study describes the real-life diagnostic workup in a large hospital to explore whether the diagnostic approach may be improved. Methods and results: We identified 4028 patients free of CAD, referred for and assessed with non-invasive (NIT) or invasive test for stable suspected CAD in 2012-15. In both the sexes, the majority (>85%) presented with chest pain as primary symptom. Women had more non-angina (60.2 vs. 54.5%) and less typical angina (8.2 vs. 11.8%, P < 0.001). Despite a mean pretest probability of 20.9% in women and 45.1% in men (P < 0.001), only 69 (3.1%) women and 190 men (10.4%) were diagnosed with obstructive CAD. In all, 93% underwent a NIT and 80% of these were normal. Among the 1238 men and 1595 women with non-angina or dyspnoea, only 6.1% and 2.9%, respectively, had positive NIT. After multiple adjustments, women remained less likely to have positive NIT [odds ratio (OR) 0.42 95% confidence interval (95% CI 0.32-0.56)] and given a positive test also less likely to have obstructive CAD [OR 0.30 (0.17-0.52)]. The C-statistics for predicting positive NIT was 0.77 (0.72-0.82) in women and 0.77 (0.74-0.80) in men. Conclusion: These data confirm the very low diagnostic yield of non-invasive and invasive assessment of CAD in current clinical practice, particularly in women and in patients with atypical symptoms. Data call for a more rational approach to avoid unnecessary testing.

6 Article Ventricular repolarization alterations in women with angina pectoris and suspected coronary microvascular dysfunction. 2018

Dose, Nynne / Michelsen, Marie Mide / Mygind, Naja Dam / Pena, Adam / Ellervik, Christina / Hansen, Peter R / Kanters, Jørgen K / Prescott, Eva / Anonymous4201055 / Kastrup, Jens / Gustafsson, Ida / Hansen, Henrik Steen. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark. Electronic address: nynned@gmail.com. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark. · Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark. · Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Denmark. · Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Production, Research and Innovation, Region Zealand, Sorø, Denmark. · Department of Biomedical Science, University of Copenhagen, Denmark. · Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Odense University Hospital, University of Southern Denmark, Denmark. ·J Electrocardiol · Pubmed #28939174.

ABSTRACT: OBJECTIVES: CMD could be the explanation of angina pectoris with no obstructive CAD and may cause ventricular repolarization changes. We compared T-wave morphology and QTc interval in women with angina pectoris with a control group as well as the associations with CMD. METHODS: Women with angina pectoris and no obstructive coronary artery disease (n=138) and age-matched controls were compared in regard to QTc interval and morphology combination score (MCS) based on T-wave asymmetry, flatness and presence of T-wave notch. CMD was assessed as a coronary flow velocity reserve (CFVR) by transthoracic echocardiography. RESULTS: Women with angina pectoris had significantly longer QTc intervals (429±20ms) and increased MCS (IQR) (0.73 [0.64-0.80]) compared with the controls (419±20ms) and (0.63 [(0.53-0.73]), respectively (both p<0.001). CFVR was associated with longer QTc interval (p=0.02), but the association was attenuated after multivariable adjustment (p=0.08). CONCLUSION: This study suggests that women with angina pectoris have alterations in T-wave morphology as well as longer QTc interval compared with a reference population. CMD might be an explanation.

7 Article Coronary microvascular function and myocardial fibrosis in women with angina pectoris and no obstructive coronary artery disease: the iPOWER study. 2016

Mygind, Naja Dam / Michelsen, Marie Mide / Pena, Adam / Qayyum, Abbas Ali / Frestad, Daria / Christensen, Thomas Emil / Ghotbi, Adam Ali / Dose, Nynne / Faber, Rebekka / Vejlstrup, Niels / Hasbak, Philip / Kjaer, Andreas / Prescott, Eva / Kastrup, Jens / Anonymous4760886. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. naja.dam.mygind.02@regionh.dk. · Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. naja.dam.mygind.02@regionh.dk. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark. ·J Cardiovasc Magn Reson · Pubmed #27809867.

ABSTRACT: BACKGROUND: Even in absence of obstructive coronary artery disease women with angina pectoris have a poor prognosis possibly due to coronary microvascular disease. Coronary microvascular disease can be assessed by transthoracic Doppler echocardiography measuring coronary flow velocity reserve (CFVR) and by positron emission tomography measuring myocardial blood flow reserve (MBFR). Diffuse myocardial fibrosis can be assessed by cardiovascular magnetic resonance (CMR) T1 mapping. We hypothesized that coronary microvascular disease is associated with diffuse myocardial fibrosis. METHODS: Women with angina, a clinically indicated coronary angiogram with <50 % stenosis and no diabetes were included. CFVR was measured using dipyridamole (0.84 mg/kg) and MBFR using adenosine (0.84 mg/kg). Focal fibrosis was assessed by 1.5 T CMR late gadolinium enhancement (0.1 mmol/kg) and diffuse myocardial fibrosis by T1 mapping using a modified Look-Locker pulse sequence measuring T1 and extracellular volume fraction (ECV). RESULTS: CFVR and CMR were performed in 64 women, mean (SD) age 62.5 (8.3) years. MBFR was performed in a subgroup of 54 (84 %) of these women. Mean native T1 was 1023 (86) and ECV (%) was 33.7 (3.5); none had focal fibrosis. Median (IQR) CFVR was 2.3 (1.9; 2.7), 23 (36 %) had CFVR < 2 indicating coronary microvascular disease, and median MBFR was 2.7 (2.2; 3.0) and 19 (35 %) had a MBFR value below 2.5. No significant correlations were found between CFVR and ECV or native T1 (R CONCLUSION: In women with angina and no obstructive coronary artery disease we found no association between measures of coronary microvascular disease and myocardial fibrosis, suggesting that myocardial ischemia induced by coronary microvascular disease does not elicit myocardial fibrosis in this population. The examined parameters seem to provide independent information about myocardial and coronary disease.

8 Article Coronary flow velocity reserve by echocardiography: feasibility, reproducibility and agreement with PET in overweight and obese patients with stable and revascularized coronary artery disease. 2016

Olsen, Rasmus Huan / Pedersen, Lene Rørholm / Snoer, Martin / Christensen, Thomas Emil / Ghotbi, Adam Ali / Hasbak, Philip / Kjaer, Andreas / Haugaard, Steen B / Prescott, Eva. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Building 67, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark. rasmus.huan.olsen@regionh.dk. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Building 67, Bispebjerg Bakke 23, DK-2400, Copenhagen NV, Denmark. · Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. · Department of Internal Medicine and Clinical Research Centre, Amager and Hvidovre Hospitals, University of Copenhagen, Copenhagen, Denmark. ·Cardiovasc Ultrasound · Pubmed #27267255.

ABSTRACT: BACKGROUND: Coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography of the LAD is used to assess microvascular function but validation studies in clinical settings are lacking. We aimed to assess feasibility, reproducibility and agreement with myocardial flow reserve (MFR) measured by PET in overweight and obese patients. METHODS: Participants with revascularized coronary artery disease were examined by CFVR. Subgroups were examined by repeated CFVR (reproducibility) or Rubidium-82-PET (agreement). To account for time variation, results were computed for scans performed within a week (1-week) and for all scans regardless of time gap (total) and to account for scar tissue for patients with and without previous myocardial infarction (MI). RESULTS: Eighty-six patients with median BMI 30.9 (IQR 29.4-32.9) kg × m(-2) and CFVR 2.29 (1.90-2.63) were included. CFVR was feasible in 83 (97 %) using a contrast agent in 14 %. For reproducibility overall (n = 21) limits of agreement (LOA) were (-0.75;0.71), within-subjects coefficient of variation (CV) 11 %, and reliability 0.84. For reproducibility within 1-week (n = 13) LOA were (-0.33;0.25), within-subjects CV 5 %, and reliability 0.97. Agreement with MFR of the LAD territory (n = 35) was without significant bias and overall LOA were (-1.40;1.46). Agreement was best for examinations performed within 1-week of participants without MI of the LAD-territory (n = 12); LOA = (-0.68;0.88). CONCLUSIONS: CFVR was highly feasible with a good reproducibility on par with other contemporary measures applied in cardiology. Agreement with MFR was acceptable, though discrepancy related to prior MI has to be considered. CFVR of LAD is a valid tool in overweight and obese patients.

9 Article Peripheral Reactive Hyperemia Index and Coronary Microvascular Function in Women With no Obstructive CAD: The iPOWER Study. 2016

Michelsen, Marie Mide / Mygind, Naja Dam / Pena, Adam / Aziz, Ahmed / Frestad, Daria / Høst, Nis / Prescott, Eva / Anonymous1100864. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark. Electronic address: marie.mide.michelsen@regionh.dk. · Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark. · Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark. · Department of Cardiology, Odense University Hospital, Denmark. · Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Denmark. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark. ·JACC Cardiovasc Imaging · Pubmed #27056160.

ABSTRACT: OBJECTIVES: This study investigated whether digital reactive hyperemia index (RHI) measured by digital pulse amplitude tonometry is a sensitive indicator of coronary microvascular dysfunction (CMD). BACKGROUND: CMD is an early marker of cardiovascular disease. However, CMD is a complex diagnosis and consists of multiple abnormalities of the coronary circulation. Impaired RHI is a noninvasive measure of peripheral vascular dysfunction that can identify individuals with acetylcholine induced coronary vascular dysfunction. It is largely unknown whether there is also an association between RHI and the endothelial-independent aspect of CMD assessed as a coronary flow velocity reserve (CFVR). METHODS: We included 339 women with chest pain suggestive of angina pectoris and a diagnostic invasive coronary angiogram without significant coronary artery stenosis (<50%). CFVR was measured by transthoracic pulsed wave Doppler echocardiography during dipyridamole infusion (0.84 mg/kg). RHI was assessed by digital pulse amplitude tonometry. Participants were categorized in 3 RHI and 3 CFVR groups. We examined the association between CFVR and RHI and the distribution of cardiovascular risk factors between the CFVR and RHI groups. RESULTS: CFVR and RHI were successfully measured in 322 participants. Median CFVR was 2.3 (interquartile range: 2.0 to 2.8) and median RHI was 2.1 (interquartile range: 1.6 to 2.6). No correlation was found between CFVR and RHI (Spearman's rho = -0.067, p = 0.23), and mean RHI did not differ between CFVR categories (p = 0.39). Participants with low CFVR were significantly older and had a significantly greater burden of hypertension, whereas participants with an impaired RHI had a higher body mass index and were more likely to have diabetes and be current smokers. CONCLUSIONS: RHI does not identify individuals with CMD assessed as impaired CFVR by dipyridamole stress echocardiography in women with no obstructive coronary artery disease. The two methods are likely to identify different aspects of vascular pathology, as indicated by the different association with cardiovascular risk factors.

10 Article Coronary Flow Velocity Reserve Assessed by Transthoracic Doppler: The iPOWER Study: Factors Influencing Feasibility and Quality. 2016

Michelsen, Marie M / Pena, Adam / Mygind, Naja D / Frestad, Daria / Gustafsson, Ida / Hansen, Henrik S / Kastrup, Jens / Bech, Jan / Høst, Nis / Prescott, Eva. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: marie.mide.michelsen@regionh.dk. · Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. ·J Am Soc Echocardiogr · Pubmed #27038514.

ABSTRACT: BACKGROUND: Coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography is a noninvasive measure of microvascular function, but it has not achieved widespread use, mainly because of concerns of validity and feasibility. The aim of this study was to describe the feasibility and factors associated with the quality of CFVR obtained in a large prospective study of women suspected of having microvascular disease. METHODS: Women with angina-like chest pain and no obstructive coronary artery disease on coronary angiography (<50% stenosis) were consecutively examined by transthoracic Doppler echocardiography of the left anterior descending coronary artery to measure CFVR (n = 947). Quality was evaluated on the basis of (1) identification of the left anterior descending coronary artery, (2) maintained probe position throughout the examination, (3) visibility and configuration of the left anterior descending coronary artery in two-dimensional color Doppler mode, and (4) gradual, consistent increases of characteristic, well-defined flow velocity curves in pulsed-wave mode. RESULTS: The mean age (SD) was 62.1 ± 9.7 years. On the basis of the evaluations, patients were divided into four groups according to quality score: nonfeasible (n = 28 [3%]), low quality (n = 80 [8%]), medium quality (n = 451 [48%]), and high quality (n = 388 [41%]). Quality score was associated with diabetes (P < .01), body mass index (P = .02), waist circumference (P = .05), nonsignificant atherosclerosis on coronary angiography (P = .03), and operator experience (P < .01). Low examination quality was associated with lower CFVR (P = .03), also after multivariate adjustment. CONCLUSIONS: Transthoracic Doppler echocardiographic measurement of CFVR is highly feasible and of good quality in experienced hands. However, CFVR is possibly underestimated when examination quality is low. Awareness of pitfalls and potential bias may improve the validity and interpretation of the measures obtained.

11 Article Weight loss is superior to exercise in improving the atherogenic lipid profile in a sedentary, overweight population with stable coronary artery disease: A randomized trial. 2016

Pedersen, Lene Rørholm / Olsen, Rasmus Huan / Anholm, Christian / Walzem, Rosemary L / Fenger, Mogens / Eugen-Olsen, Jesper / Haugaard, Steen Bendix / Prescott, Eva. ·Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: lrpedersen@gmail.com. · Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Internal Medicine, Hvidovre and Amager University Hospitals, University of Copenhagen, Copenhagen, Denmark. · Faculty of Nutrition, Texas A&M University, College Station, TX, USA. · Department of Medical Biochemistry, Genetics and Molecular Biochemistry, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. · Clinical Research Center, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. ·Atherosclerosis · Pubmed #26803431.

ABSTRACT: BACKGROUND: Dyslipidemia and low-grade inflammation are integral in the pathogenesis of atherosclerosis. We aim to compare the effects of a considerable weight loss and intensive exercise training on lipid atherogenicity and low-grade inflammation in a high-risk population with coronary artery disease (CAD). METHODS: Seventy non-diabetic participants with CAD, BMI 28-40 kg/m(2), age 45-75 years were randomized to 12 weeks' aerobic interval training (AIT) at 85-90% of peak heart rate three times/week or a low energy diet (LED, 800-1000 kcal/day) for 8-10 weeks followed by 2-4 weeks' weight maintenance diet. Lipid profile atherogenicity was described using lipoprotein particle size and density profiling. Low-grade inflammation was evaluated by tumor necrosis factor alpha (TNFα), C-reactive protein, interleukin 6 and soluble urokinase plasminogen activator receptor. RESULTS: Twenty-six (74%) AIT and 29 (83%) LED participants completed intervention per protocol. AIT and LED decreased total (AIT: -518 {-906;-129},P = 0.011, LED: -767 {-1128:-406},P < 0.001) and low-density lipoprotein (LDL, AIT: -186 {-306;-65},P = 0.004, LED: -277 {-433;-122},P < 0.001) assessed as the area under the density profile curve. LED was superior to AIT in decreasing atherogenicity reflected by increased LDL (between-group: 1.0 Å {0.4; 1.7},P = 0.003) and high-density lipoprotein (between-group: 1.2 Å {0.2; 2.4},P = 0.026) particle size and a decreased proportion of total lipoprotein constituted by the small, dense LDL5 subfraction (between-group: -5.0% {-8.4;-1.7},P = 0.004). LED decreased TNFα (9.5% {-15.8;-2.6},P = 0.009). No changes were seen following AIT. CONCLUSION: LED and AIT decreased total and LDL lipoprotein. LED was superior in decreasing atherogenicity assessed by a shift in density profile and increased particle size. Effect on low-grade inflammation was limited.

12 Article Coronary microvascular function, insulin sensitivity and body composition in predicting exercise capacity in overweight patients with coronary artery disease. 2015

Jürs, Anders / Pedersen, Lene Rørholm / Olsen, Rasmus Huan / Snoer, Martin / Chabanova, Elizaveta / Haugaard, Steen Bendix / Prescott, Eva. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. andersjurs@gmail.com. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. lrpedersen@gmail.com. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. rasmus.huan.olsen@gmail.com. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. snoer@dadlnet.dk. · Department of Radiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark. Elizaveta.Chabanova@regionh.dk. · Department of Internal Medicine, Amager Hospital and the Clinical Research Center, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. d299057@dadlnet.dk. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. Eva.Irene.Bossano.Prescott@regionh.dk. ·BMC Cardiovasc Disord · Pubmed #26613591.

ABSTRACT: BACKGROUND: Coronary artery disease (CAD) has a negative impact on exercise capacity. The aim of this study was to determine how coronary microvascular function, glucose metabolism and body composition contribute to exercise capacity in overweight patients with CAD and without diabetes. METHODS: Sixty-five non-diabetic, overweight patients with stable CAD, BMI 28-40 kg/m(2) and left ventricular ejection fraction (LVEF) above 35 % were recruited. A 3-hour oral glucose tolerance test was used to evaluate glucose metabolism. Peak aerobic exercise capacity (VO2peak) was assessed by a cardiopulmonary exercise test. Body composition was determined by whole body dual-energy X-ray absorptiometry scan and magnetic resonance imaging. Coronary flow reserve (CFR) assessed by transthoracic Doppler echocardiography was used as a measure of microvascular function. RESULTS: Median BMI was 31.3 and 72 % had impaired glucose tolerance or impaired fasting glucose. VO2peak adjusted for fat free mass was correlated with CFR (r = 0.41, p = 0.0007), LVEF (r = 0.33, p = 0.008) and left ventricular end-diastolic volume (EDV) (r = 0.32, p = 0.01) while it was only weakly linked to measures of glucose metabolism and body composition. CFR, EDV and LVEF remained independent predictors of VO2peak in multivariable regression analysis. CONCLUSION: The study established CFR, EDV and LVEF as independent predictors of VO2peak in overweight CAD patients with no or only mild functional symptoms and a LVEF > 35 %. Glucose metabolism and body composition had minor impact on VO2peak. The findings suggest that central hemodynamic factors are important in limiting exercise capacity in overweight non-diabetic CAD patients.

13 Article A randomized trial comparing the effect of weight loss and exercise training on insulin sensitivity and glucose metabolism in coronary artery disease. 2015

Pedersen, Lene Rørholm / Olsen, Rasmus Huan / Jürs, Anders / Anholm, Christian / Fenger, Mogens / Haugaard, Steen Bendix / Prescott, Eva. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: lrpedersen@gmail.com. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Internal Medicine, Amager Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Medical Biochemistry, Genetics and Molecular Biochemistry, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Internal Medicine, Amager Hospital, University of Copenhagen, Copenhagen, Denmark; The Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Copenhagen Denmark. ·Metabolism · Pubmed #26296452.

ABSTRACT: AIM: The majority of patients with coronary artery disease (CAD) exhibit abnormal glucose metabolism, which is associated with mortality even at non-diabetic glucose levels. This trial aims to compare the effects of a considerable weight loss and exercise with limited weight loss on glucose metabolism in prediabetic, CAD patients. METHODS AND RESULTS: Seventy non-diabetic participants with CAD, BMI 28-40 kg/m(2), age 45-75 years were randomized to 12 weeks' aerobic interval training (AIT) at 90% peak heart rate three times weekly or a low energy diet (LED, 800-1,000 kcal/day) for 8-10 weeks followed by 2-4 weeks' weight maintenance diet. Glucose tolerance, insulin action, β-cell function and suppression of lipolysis were assessed using a 3-h oral glucose tolerance test. ISI-composite and ISI-HOMA (=1/HOMA-IR) were calculated as surrogate measures of whole-body and hepatic insulin sensitivity, respectively. Magnetic resonance imaging estimated abdominal adipose tissue. Twenty-six (74%) AIT and 29 (83%) LED participants completed intervention per protocol. LED increased ISI-composite by 55% and ISI-HOMA by 70% (p<0.01) while AIT did not change insulin sensitivity (p>0.7) revealing a significant difference between the groups (p<0.05). No concurrent significant changes in lipolysis, β-cell responsiveness or insulin clearance were seen. Changes in ISI-HOMA and ISI-composite were associated with reduced visceral abdominal fat, waist circumference and body weight. Intention-to-treat analyses (n=64) yielded similar results. CONCLUSION: LED is superior to AIT in improving insulin sensitivity in prediabetic CAD patients. Changes in insulin sensitivity are associated with decreased visceral abdominal fat, waist circumference and body weight.

14 Article A randomised trial comparing the effect of exercise training and weight loss on microvascular function in coronary artery disease. 2015

Olsen, Rasmus Huan / Pedersen, Lene Rørholm / Jürs, Anders / Snoer, Martin / Haugaard, Steen B / Prescott, Eva. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: rasmus.huan.olsen@gmail.com. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. · Department of Internal Medicine, Amager Hospital & Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. ·Int J Cardiol · Pubmed #25802037.

ABSTRACT: BACKGROUND: Coronary microvascular function is associated with outcome and is reduced in coronary artery disease (CAD) and obesity. We compared the effect of aerobic interval training (AIT) and weight loss on coronary flow reserve (CFR) and peripheral vascular function in revascularised obese CAD patients. METHODS AND RESULTS: Seventy non-diabetic patients (BMI 28-40 kg × m(-2), age 45-75 years) were randomised to 12 weeks' AIT (three weekly sessions lasting 38 min with ≈ 16 min at 85-90% of VO2peak) or low energy diet (LED, 800-1000 kcal/day). Per protocol adherence was defined by training-attendance ≥ 60% and weight loss ≥ 5%, respectively. CFR was assessed by Doppler echocardiography of the LAD. Peripheral vascular function was assessed by arterial tonometry as reactive hyperaemia index (RHI) and augmentation index. Most participants had impaired CFR with a mean CFR of 2.38 (SD 0.59). Twenty-six AIT and 24 LED participants completed the study per protocol with valid CFR measurements. AIT resulted in a 10.4% improvement in VO2peak and LED in a 10.6% weight loss (between group differences both P<0.001). CFR increased by 0.26 (95%CI 0.04;0.48) after AIT and by 0.39 (95%CI 0.13;0.65) after LED without significant between-group difference (-0.13 (95%CI -0.45;0.20)). RHI and augmentation index remained unchanged after both interventions (P>0.50). Intention-to-treat analyses showed similar results. CONCLUSIONS: 12 weeks' AIT and LED increased CFR by comparable magnitude; thus both interventions might impact prognosis of CAD through improvement of coronary microvascular function. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01724567.

15 Article A randomised trial comparing weight loss with aerobic exercise in overweight individuals with coronary artery disease: The CUT-IT trial. 2015

Pedersen, Lene R / Olsen, Rasmus H / Jürs, Anders / Astrup, Arne / Chabanova, Elizaveta / Simonsen, Lene / Wisløff, Ulrik / Haugaard, Steen B / Prescott, Eva. ·Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark lrpedersen@gmail.com. · Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark. · Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark. · Department of Radiology, Herlev Hospital, University of Copenhagen, Denmark. · Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, University of Copenhagen, Denmark. · Department of Circulation and Medical Imaging, K.G. Jebsen Center of Exercise in Medicine, Norwegian University of Science and Technology, Norway. · Department of Internal Medicine, Amager Hospital and the Clinical Research Center, Hvidovre Hospital, University of Copenhagen, Denmark. ·Eur J Prev Cardiol · Pubmed #25082954.

ABSTRACT: BACKGROUND: We aimed to compare the effect of aerobic interval training (AIT) versus a low energy diet (LED) on physical fitness, body composition, cardiovascular risk factors and symptoms in overweight individuals with coronary artery disease (CAD). METHODS AND DESIGN: Seventy non-diabetic participants with CAD, a BMI>28 kg/m(2) and aged 45 to 75 years were randomised to 12 weeks' AIT at 90% peak heart rate three times a week or LED (800-1000 kcal/day) for 8-10 weeks followed by 2-4 weeks' weight maintenance diet. RESULTS: Twenty-six (74%) AIT and 29 (83%) LED participants completed intervention per protocol. VO2peak (mL/kg fat free mass(0.67)/min) increased by 10.4% (p = 0.002) following AIT, whereas no change was observed after LED (-3.0%, p = 0.095). The LED group lost 10.6% body weight and 26.6% body fat mass (p < 0.001) compared to 1.6% (p = 0.002) and 5.5% (p < 0.001) following AIT. Waist circumference and visceral abdominal fat were reduced by both interventions but were most pronounced following LED (between-group, p < 0.001). Total cholesterol, non-HDL-C and triglycerides decreased significantly in both groups whereas HDL-C and blood pressure were unchanged. Six participants had their antihypertensive treatment reduced following LED (between-group, p = 0.032). Canadian Cardiovascular Society (CCS), New York Heart Association (NYHA) and anxiety scores were improved, while depressive symptoms remained unchanged. Intention-to-treat analyses including 65 participants (93%) were similar to per protocol analysis. CONCLUSION: Both interventions were feasible and effective in achieving the desired effects. LED was superior in improving body composition and blood pressure, whereas effects on lipids and symptoms were similar in the two groups. Thus, both AIT and LED improve the cardiovascular risk profile in overweight individuals with contemporarily treated CAD.

16 Article Burden of hospital admission and repeat angiography in angina pectoris patients with and without coronary artery disease: a registry-based cohort study. 2014

Jespersen, Lasse / Abildstrom, Steen Z / Hvelplund, Anders / Madsen, Jan K / Galatius, Soren / Pedersen, Frants / Hojberg, Soren / Prescott, Eva. ·Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark. · National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark. · Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark. · Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark. · Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark; Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark. ·PLoS One · Pubmed #24705387.

ABSTRACT: AIMS: To evaluate risk of hospitalization due to cardiovascular disease (CVD) and repeat coronary angiography (CAG) in stable angina pectoris (SAP) with no obstructive coronary artery disease (CAD) versus obstructive CAD, and asymptomatic reference individuals. METHODS AND RESULTS: We followed 11,223 patients with no prior CVD having a first-time CAG in 1998-2009 due to SAP symptoms and 5,695 asymptomatic reference individuals from the Copenhagen City Heart Study through registry linkage for 7.8 years (median). In recurrent event survival analysis, patients with SAP had 3-4-fold higher risk of hospitalization for CVD irrespective of CAG findings and cardiovascular comorbidity. Multivariable adjusted hazard ratios(95%CI) for patients with angiographically normal coronary arteries was 3.0(2.5-3.5), for angiographically diffuse non-obstructive CAD 3.9(3.3-4.6) and for 1-3-vessel disease 3.6-4.1(range)(all P<0.001). Mean accumulated hospitalization time was 3.5(3.0-4.0)(days/10 years follow-up) in reference individuals and 4.5(3.8-5.2)/7.0(5.4-8.6)/6.7(5.2-8.1)/6.1(5.2-7.4)/8.6(6.6-10.7) in patients with angiographically normal coronary arteries/angiographically diffuse non-obstructive CAD/1-, 2-, and 3-vessel disease, respectively (all P<0.05, age-adjusted). SAP symptoms predicted repeat CAG with multivariable adjusted hazard ratios for patients with angiographically normal coronary arteries being 2.3(1.9-2.9), for angiographically diffuse non-obstructive CAD 5.5(4.4-6.8) and for obstructive CAD 6.6-9.4(range)(all P<0.001). CONCLUSIONS: Patients with SAP symptoms and angiographically normal coronary arteries or angiographically diffuse non-obstructive CAD suffer from considerably greater CVD burdens in terms of hospitalization for CVD and repeat CAG compared with asymptomatic reference individuals even after adjustment for cardiac risk factors and exclusion of cardiovascular comorbidity as cause. Contrary to common perception, excluding obstructive CAD by CAG in such patients does not ensure a benign cardiovascular prognosis.

17 Article Coronary flow reserve predicts cardiopulmonary fitness in patients with coronary artery disease independently of systolic and diastolic function. 2014

Snoer, Martin / Olsen, Rasmus Huan / Monk-Hansen, Tea / Pedersen, Lene Roerholm / Haugaard, Steen B / Dela, Flemming / Prescott, Eva. ·Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark. ·Echocardiography · Pubmed #24299009.

ABSTRACT: AIMS: Despite revascularization and optimal medical treatment, patients with coronary artery disease (CAD) have reduced exercise capacity. In the absence of coronary artery stenosis, coronary flow reserve (CFR) is a measure of coronary microvascular function, and a marker of future poor outcome in CAD patients. The aim of this study was to examine the relationship among CFR, systolic and diastolic function, peripheral vascular function, and cardiopulmonary fitness in CAD patients. METHODS AND RESULTS: Forty patients with median left ventricular ejection fraction (LVEF) 49 (interquartile 46-55) with documented CAD without significant left anterior descending artery (LAD) stenosis underwent cardiorespiratory exercise test with measurement of VO2 peak, digital measurement of endothelial function and arterial stiffness, and an echocardiography with measurement of LVEF using the biplane Simpson model, mitral early (E) and late (A) inflow velocities, and tissue Doppler diastolic (e') and systolic (s') velocities. Peak coronary flow velocity (CFV) was measured in the LAD using pulse-wave Doppler. CFR was calculated as the ratio between peak CFV at rest and during vasodilator stress. Median CFR was 2.22 (1.90-2.62) and VO2 peak was 21.8 (17.6-25.5). VO2 peak correlated significantly with CFR (r = 0.57, P < 0.001), E/e' (r = -0.35, P = 0.04), and s' (r = 0.41, P = 0.01) and with LVEF (r = 0.35, P = 0.03). CFR remained independently associated with VO2 peak after adjustment for systolic and diastolic function. CONCLUSIONS: Coronary flow reserve measured noninvasively predicts cardiopulmonary fitness independently of resting systolic and diastolic function in CAD patients, indicating that cardiac output during maximal exercise is dependent on the ability of the coronary circulation to adapt to the higher metabolic demands of the myocardium.

18 Article Copenhagen study of overweight patients with coronary artery disease undergoing low energy diet or interval training: the randomized CUT-IT trial protocol. 2013

Pedersen, Lene Rørholm / Olsen, Rasmus Huan / Frederiksen, Marianne / Astrup, Arne / Chabanova, Elizaveta / Hasbak, Philip / Holst, Jens Juul / Kjær, Andreas / Newman, John W / Walzem, Rosemary / Wisløff, Ulrik / Sajadieh, Ahmad / Haugaard, Steen Bendix / Prescott, Eva. ·Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark. lrpedersen@gmail.com. ·BMC Cardiovasc Disord · Pubmed #24252596.

ABSTRACT: BACKGROUND: Coronary artery disease (CAD) is accountable for more than 7 million deaths each year according to the World Health Organization (WHO). In a European population 80% of patients diagnosed with CAD are overweight and 31% are obese. Physical inactivity and overweight are major risk factors in CAD, thus central strategies in secondary prevention are increased physical activity and weight loss. METHODS/DESIGN: In a randomized controlled trial 70 participants with stable CAD, age 45-75, body mass index 28-40 kg/m2 and no diabetes are randomized (1:1) to 12 weeks of intensive exercise or weight loss both succeeded by a 40-week follow-up. The exercise protocol consist of supervised aerobic interval training (AIT) at 85-90% of VO2peak 3 times weekly for 12 weeks followed by supervised AIT twice weekly for 40 weeks. In the weight loss arm dieticians instruct the participants in a low energy diet (800-1000 kcal/day) for 12 weeks, followed by 40 weeks of weight maintenance combined with supervised AIT twice weekly. The primary endpoint of the study is change in coronary flow reserve after the first 12 weeks' intervention. Secondary endpoints include cardiovascular, metabolic, inflammatory and anthropometric measures. DISCUSSION: The study will compare the short and long-term effects of a protocol consisting of AIT alone or a rapid weight loss followed by AIT. Additionally, it will provide new insight in mechanisms behind the benefits of exercise and weight loss. We wish to contribute to the creation of effective secondary prevention and sustainable rehabilitation strategies in the large population of overweight and obese patients diagnosed with CAD. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01724567.

19 Article Persistent angina: highly prevalent and associated with long-term anxiety, depression, low physical functioning, and quality of life in stable angina pectoris. 2013

Jespersen, Lasse / Abildstrøm, Steen Z / Hvelplund, Anders / Prescott, Eva. ·Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark. lasjes@gmail.com ·Clin Res Cardiol · Pubmed #23636227.

ABSTRACT: AIMS: To evaluate persistent angina in stable angina pectoris with no obstructive coronary artery disease (CAD) compared to obstructive CAD and its relation to long-term anxiety, depression, quality of life (QOL), and physical functioning. METHODS AND RESULTS: We invited 357 patients (men = 191; women = 166; response rate 83 %) with no prior cardiovascular disease who had a first-time coronary angiography (CAG) in 2008-2009 due to suspected stable angina to participate in a questionnaire survey in 2011 with the Seattle Angina Questionnaire and the Hospital Anxiety and Depression Scale as key elements. Long-term persistent angina (i.e., symptoms at least once a month) was present in 64 % of patients with diffuse non-obstructive CAD (1-49 % stenosis), 49 % of patients with normal coronary arteries (0 % stenosis), and 41 % of patients with obstructive CAD (≥ 50 % stenosis) (P = 0.01). Depression and anxiety were more common in patients with persistent angina: 24 versus 7 % (P < 0.001) reported HADS-Depression-scores >7 and 42 versus 21 % (P < 0.001) reported HADS-Anxiety-scores >7. In multivariate regression models, persistent angina was associated with depression (OR 4.3, 95 % confidence interval (CI) 1.9-9.6, P < 0.001), anxiety (OR 2.9, 95 % CI 1.6-5.1, P < 0.001), the severity of persistent angina with impaired physical functioning (P < 0.001), and QOL (P < 0.001); whereas outcomes were not related to age, gender, or degree of CAD. CONCLUSIONS: The study indicates higher prevalence of persistent angina in patients with diffuse non-obstructive CAD or normal coronary arteries than in patients with obstructive CAD. Persistent angina symptoms were associated with long-term anxiety, depression, impaired physical functioning, and QOL irrespective of the degree of CAD. Contrary to common perception, excluding obstructive CAD in stable angina does not ensure a favorable disease course, and further risk stratification and treatment strategies are warranted.

20 Article Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. 2012

Jespersen, Lasse / Hvelplund, Anders / Abildstrøm, Steen Z / Pedersen, Frants / Galatius, Søren / Madsen, Jan K / Jørgensen, Erik / Kelbæk, Henning / Prescott, Eva. ·Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark. lasjes@gmail.com ·Eur Heart J · Pubmed #21911339.

ABSTRACT: AIMS: Patients with chest pain and no obstructive coronary artery disease (CAD) are considered at low risk for cardiovascular events but evidence supporting this is scarce. We investigated the prognostic implications of stable angina pectoris in relation to the presence and degree of CAD with no obstructive CAD in focus. METHODS AND RESULTS: We identified 11 223 patients referred for coronary angiography (CAG) in 1998-2009 with stable angina pectoris as indication and 5705 participants from the Copenhagen City Heart Study for comparison. Main outcome measures were major adverse cardiovascular events (MACE), defined as cardiovascular death, myocardial infarction, stroke or heart failure, and all-cause mortality. Significantly more women (65%) than men (32%) had no obstructive CAD (P< 0.001). In Cox's models adjusted for age, body mass index, diabetes, smoking, and use of lipid-lowering or antihypertensive medication, hazard ratios (HRs) associated with no obstructive CAD were similar in men and women. In the pooled analysis, the risk of MACE increased with increasing degrees of CAD with multivariable-adjusted HRs of 1.52 (95% confidence interval, 1.27-1.83) for patients with normal coronary arteries and 1.85 (1.51-2.28) for patients with diffuse non-obstructive CAD compared with the reference population. For all-cause mortality, normal coronary arteries and diffuse non-obstructive CAD were associated with HRs of 1.29 (1.07-1.56) and 1.52 (1.24-1.88), respectively. CONCLUSION: Patients with stable angina and normal coronary arteries or diffuse non-obstructive CAD have elevated risks of MACE and all-cause mortality compared with a reference population without ischaemic heart disease.

21 Article Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. 2010

Holst, Anders G / Jensen, Gorm / Prescott, Eva. ·Danish Arrhythmia Research Center, Department of Cardiology B2142, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. anders@kanten.dk ·Circulation · Pubmed #20404252.

ABSTRACT: BACKGROUND: Studies have suggested a link between risk factors for atherosclerotic disease and venous thromboembolism (VTE), but results are heterogeneous. We sought to identify risk factors for VTE with a focus on risk factors for atherosclerotic disease. METHODS AND RESULTS: Data were taken from the Copenhagen City Heart Study, a prospective cohort study of a random, age-stratified sample of people living in a defined area in Copenhagen, Denmark, started in 1976 with follow-up until 2007. First VTE (deep vein thrombosis and pulmonary embolism) diagnosis was retrieved from electronic national registries from study baseline to 2007. Of 18 954 subjects (median follow-up, 19.5 years) representing 360 399 person-years of follow-up, 969 subjects experienced at least 1 VTE, corresponding to a crude incidence rate of 2.69 (95% confidence interval [CI], 2.52 to 2.86) per 1000 person-years. The variables found to be significantly associated with VTE in a multivariable model adjusted for age and calendar time were as follows: body mass index (hazard ratio [HR] for >or=35 versus <20=2.10 [95% CI, 1.39 to 3.16]); smoking (HR for >or=25 g tobacco per day versus never smoker=1.52 [95% CI, 1.15 to 2.01]); gender (HR for men versus women=1.24 [95% CI, 1.08 to 1.42]); household income (HR for medium versus low=0.82 [95% CI, 0.70 to 0.95]); and diastolic blood pressure (HR for >100 versus <80 mm Hg=1.34 [95% CI, 1.08 to 1.66]). Other cardiovascular risk factors including total/high-density lipoprotein/low-density lipoprotein cholesterol levels, triglyceride levels, and diabetes mellitus were not associated with VTE. CONCLUSIONS: Obesity and smoking were both found to be important risk factors for VTE whereas total/high-density lipoprotein/low-density lipoprotein cholesterol levels, triglyceride levels, and diabetes mellitus were not.