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Coronary Artery Disease: HELP
Articles by Andreas Stang
Based on 22 articles published since 2010
(Why 22 articles?)
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Between 2010 and 2020, A. Stang wrote the following 22 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Clinical Trial Value of Progression of Coronary Artery Calcification for Risk Prediction of Coronary and Cardiovascular Events: Result of the HNR Study (Heinz Nixdorf Recall). 2018

Lehmann, Nils / Erbel, Raimund / Mahabadi, Amir A / Rauwolf, Michael / Möhlenkamp, Stefan / Moebus, Susanne / Kälsch, Hagen / Budde, Thomas / Schmermund, Axel / Stang, Andreas / Führer-Sakel, Dagmar / Weimar, Christian / Roggenbuck, Ulla / Dragano, Nico / Jöckel, Karl-Heinz / Anonymous570927. ·Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Germany (N.L. R.E., S. Moebus, A.S., U.R., K.-H.J.) nils.lehmann@uk-essen.de. · Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Germany (N.L. R.E., S. Moebus, A.S., U.R., K.-H.J.). · Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen (A.A.M.). · Clinic of Cardiology, Bethanien Hospital, Moers, Germany (S. Möhlenkamp). · Alfried-Krupp Hospital, Essen, Germany (H.K., T.B.). · Witten/Herdecke University, Germany (H.K.). · Cardioangiological Center Bethanien, CCB, Frankfurt am Main, Germany (A. Schmermund). · Department of Epidemiology, School of Public Health, Boston University, MA (A. Stang). · Institute of Clinical Chemistry and Laboratory Medicine, University Duisburg-Essen, Germany (D.F.-S.). · University Clinic of Neurology, University Duisburg-Essen, Germany (C.W.). · Institute of Medical Sociology, Medical Faculty, University Düsseldorf, Germany (N.D.). ·Circulation · Pubmed #29142010.

ABSTRACT: BACKGROUND: Computed tomography (CT) allows estimation of coronary artery calcium (CAC) progression. We evaluated several progression algorithms in our unselected, population-based cohort for risk prediction of coronary and cardiovascular events. METHODS: In 3281 participants (45-74 years of age), free from cardiovascular disease until the second visit, risk factors, and CTs at baseline (b) and after a mean of 5.1 years (5y) were measured. Hard coronary and cardiovascular events, and total cardiovascular events including revascularization, as well, were recorded during a follow-up time of 7.8±2.2 years after the second CT. The added predictive value of 10 CAC progression algorithms on top of risk factors including baseline CAC was evaluated by using survival analysis, C-statistics, net reclassification improvement, and integrated discrimination index. A subgroup analysis of risk in CAC categories was performed. RESULTS: We observed 85 (2.6%) hard coronary, 161 (4.9%) hard cardiovascular, and 241 (7.3%) total cardiovascular events. Absolute CAC progression was higher with versus without subsequent coronary events (median, 115 [Q1-Q3, 23-360] versus 8 [0-83], CONCLUSIONS: CAC progression is associated with coronary and cardiovascular event rates, but adds only weakly to risk prediction. What counts is the most recent CAC value and risk factor assessment. Therefore, a repeat scan >5 years after the first scan may be of additional value, except when a double-zero CT scan is present or when the subjects are already at high risk.

2 Article Cardiovascular Risk and Atherosclerosis Progression in Hypertensive Persons Treated to Blood Pressure Targets. 2019

Gronewold, Janine / Kropp, Rene / Lehmann, Nils / Stang, Andreas / Mahabadi, Amir A / Kälsch, Hagen / Weimar, Christian / Dichgans, Martin / Budde, Thomas / Moebus, Susanne / Jöckel, Karl-Heinz / Erbel, Raimund / Hermann, Dirk M. ·From the Department of Neurology, University Hospital Essen, Germany (J.G., R.K., C.W., D.M.H.). · Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Germany (N.L., S.M., K.-H.J., R.E.). · Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Germany (A.S.). · School of Public Health, Department of Epidemiology, Boston University (A.S.). · Department of Cardiology and Vascular Medicine, University Hospital Essen, Germany (A.A.M.). · Clinic of Cardiology, Alfried Krupp Hospital, Essen, Germany (H.K., T.B.). · Department of Medicine, Faculty of Health, University Witten-Herdecke, Germany (H.K.). · Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-Universität LMU, Munich, Germany (M.D.). · Munich Cluster of Systems Neurology (SyNergy), Germany (M.D.). ·Hypertension · Pubmed #31679426.

ABSTRACT: Arterial hypertension promotes atherosclerosis and cardiovascular events. We evaluated how cardiovascular risk and atherosclerosis progression are associated with blood pressure, antihypertensive treatment, and treatment efficacy. In 3555 participants of the population-based Heinz Nixdorf Recall study without previous cardiovascular disease (mean±SD; age, 58.9±7.6 years, 46.9% men), we analyzed associations of baseline antihypertensive treatment efficacy (normotension without antihypertensives, normotension with antihypertensives, hypertension without antihypertensives, hypertension with antihypertensives, based on 140/90 mmHg cutoffs) with incident coronary artery calcification (CAC) and CAC progression during 5-year-follow-up and with incident cardiovascular events during 13.5-year-follow-up. We further evaluated associations of incident arterial hypertension and efficacy of new antihypertensive treatment at the 5-year-follow-up with subsequent cardiovascular events. At baseline, 1706 participants had normotension without antihypertensives, 553 normotension with antihypertensives, 786 hypertension without antihypertensives, and 510 hypertension with antihypertensives. Six hundred forty-seven participants experienced rapid CAC progression. One hundred seven, 132, and 249 had incident stroke, coronary event, and cardiovascular event, respectively. Compared with normotensives without antihypertensives, normotensives with antihypertensives had an elevated stroke (hazard ratio, 2.33 [95% CI, 1.19-4.55]), coronary (2.04 [95% CI, 1.20-3.45]), and cardiovascular (2.23 [95% CI, 1.48-3.36]) risk, and increased baseline CAC, but not increased CAC progression. Participants without hypertension at baseline, who were newly hypertensive but achieved normotension with antihypertensives at the 5-year-follow-up, again exhibited elevated stroke (4.80 [95% CI, 1.38-16.70]) and cardiovascular (2.99 [95% CI, 1.25-7.16]) risk, whereas coronary risk was less elevated (2.24 [95% CI, 0.70-7.18]). Normotensives with antihypertensives have an elevated cardiovascular risk. They are characterized by elevated baseline CAC but show no signs of increased CAC progression.

3 Article Associations of metabolically healthy obesity with prevalence and progression of coronary artery calcification: Results from the Heinz Nixdorf Recall Cohort Study. 2019

Kowall, B / Lehmann, N / Mahabadi, A A / Moebus, S / Erbel, R / Jöckel, K H / Stang, A. ·Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany. Electronic address: bernd.kowall@uk-essen.de. · Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany. · West-German Heart and Vascular Center Essen, Department of Cardiology, University Clinic Essen, Essen, Germany. · Center for Urban Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, Essen, Germany. · Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany; School of Public Health, Department of Epidemiology, Boston University, 715 Albany, Street, Talbot Building, Boston, MA 02118, USA. ·Nutr Metab Cardiovasc Dis · Pubmed #30648599.

ABSTRACT: BACKGROUND AND AIMS: There is controversy on the potentially benign nature of metabolically healthy obesity (MHO), i.e., obese persons with few or no metabolic abnormalities. So far, associations between MHO and coronary artery calcification (CAC), a measure of subclinical atherosclerosis, have mainly been studied cross-sectionally in Asian populations. We assessed cross-sectional and longitudinal MHO CAC associations in a Caucasian population. METHODS AND RESULTS: In the Heinz Nixdorf Recall Study, a population-based cohort study in Germany, CAC was assessed by electron-beam tomography at baseline and at 5-year follow-up. For cross-sectional and longitudinal analyses, we included 1585 participants free of coronary heart disease at baseline, with CAC measurements at baseline and at follow-up, and with either normal weight (BMI 18.5-24.9 kg/m CONCLUSION: Our analyses on MHO CAC associations add to the evidence that MHO is not a purely benign health condition.

4 Article Sleep characteristics and progression of coronary artery calcification: Results from the Heinz Nixdorf Recall cohort study. 2018

Kowall, Bernd / Lehmann, Nils / Mahabadi, Amir-Abbas / Lehnich, Anna-Therese / Moebus, Susanne / Budde, Thomas / Seibel, Rainer / Grönemeyer, Dietrich / Erbel, Raimund / Jöckel, Karl-Heinz / Stang, Andreas. ·Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany. Electronic address: bernd.kowall@uk-essen.de. · Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany. · West-German Heart and Vascular Center Essen, Department of Cardiology, University Clinic Essen, Essen, Germany. · Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany. · Center for Urban Epidemiology, Institute for Medical Informatics, Biometry, and Epidemiology, University Clinic Essen, Essen, Germany. · Alfred Krupp Hospital, Essen, Germany. · Diagnosticum, Mülheim, Germany. · Department of Radiology and Microtherapy, University Witten/Herdecke, Bochum, Germany. · Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany; School of Public Health, Department of Epidemiology Boston University, 715 Albany Street, Talbot Building, Boston, MA 02118, USA. ·Atherosclerosis · Pubmed #29459265.

ABSTRACT: BACKGROUND AND AIMS: Sleep characteristics are associated with incident cardiovascular diseases (CVD), but there is a lack of studies on the association between sleep characteristics and incidence/progression of coronary artery calcification (CAC). METHODS: In the Heinz Nixdorf Recall Study, a population-based cohort study in Germany, CAC was assessed by electron-beam tomography at baseline and at 5-year follow-up. In an analysis set of 3043 subjects (age at baseline 45-74 years; 47% men), we fitted logistic and linear regression models to assess associations between self-rated sleep characteristics (nocturnal and total sleep duration; napping; various sleep disorders) and CAC incidence/CAC progression. Progression was measured as 5-year progression factor, as categories of absolute CAC change, and additionally characterized as rapid or slow compared to an extrapolation of baseline CAC values. RESULTS: We observed barely any association between sleep characteristics and CAC progression regardless of the chosen statistical approach; associations between sleep and CAC incidence were slightly larger, e.g., the geometric mean of the 5-year CAC progression factor was 6.8% (95% confidence interval: -9.5; 25.9) larger for ≤5 h, 2.9% (-7.3; 14.3) larger for 5.1-6.9 h and 7.1% (-2.4; 15.7) smaller for ≥7.5 h total sleep compared to 7- <7.5 h total sleep. For subjects with any regular sleep disorder, the geometric mean of the 5-year CAC progression was 3.5% (-4.7; 11.2) smaller compared to subjects without any regular sleep disorder. CONCLUSIONS: In this German cohort study, sleep characteristics were barely associated with CAC progression.

5 Article Aortic Calcification Onset and Progression: Association With the Development of Coronary Atherosclerosis. 2017

Kälsch, Hagen / Lehmann, Nils / Moebus, Susanne / Hoffmann, Barbara / Stang, Andreas / Jöckel, Karl-Heinz / Erbel, Raimund / Mahabadi, Amir A. ·Department of Cardiology and Vascular Medicine, West-German Heart and Vessel Center Essen, University Duisburg-Essen, Essen, Germany hagen.kaelsch@uk-essen.de. · Institute of Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Essen, Germany. · IUF-Leibniz Research Institute for Environmental Medicine and University of Düsseldorf, Germany. · Department of Cardiology and Vascular Medicine, West-German Heart and Vessel Center Essen, University Duisburg-Essen, Essen, Germany. ·J Am Heart Assoc · Pubmed #28360229.

ABSTRACT: BACKGROUND: Thoracic aortic calcification (TAC) and coronary artery calcification (CAC) are markers of subclinical atherosclerosis and are associated with incident major cardiovascular events. We investigated major determinants for incidence and progression of TAC and the association between TAC and CAC incidence and progression. METHODS AND RESULTS: In a population-based cohort study, 3270 participants (aged 45-74 years, 53.1% women) received cardiac computed tomography at baseline and after a mean follow-up of 5.1±0.3 years for quantification of calcification of the ascending (ATAC) and descending thoracic aorta (DTAC) and CAC. Multivariable relative risk regression analysis was used to investigate associations of cardiovascular risk factors with incident TAC, of baseline TAC with incident CAC, and of baseline CAC with incident TAC. Of 1243 participants with baseline TAC of 0, 517 (41.6%) revealed incident TAC after 5 years. Incidence of descending TAC was higher (34.5%) than ascending TAC (23.3%). Incident TAC after 5 years was associated with age (relative risk 1.26 [95% CI 1.21-1.33], per 5 years), blood pressure (relative risk 1.06 [95% CI 1.03-1.10], per 10 mm Hg), low-density lipoprotein cholesterol (relative risk 1.08 [95% CI 1.04-1.12], per 20 mg/dL), and smoking (relative risk 1.28 [95% CI 1.07-1.53]). Among the 1185 participants without CAC at baseline, the risk of developing CAC was 28.3% when baseline TAC was present compared with 22.2% among those without baseline TAC (excess risk 6.1% [95% CI 1.2-11.0%]). The point estimate of excess risk for incident CAC was higher for ascending TAC (10.8% [95% CI 4.8-16.7%]) and low for descending TAC (1.8% [95% CI -3.2% to 6.7%]). Excess risk for developing ascending and descending TAC with present baseline CAC was 16.4% (95% CI 12.7-20.0%) and 15.6% (95% CI 10.8-20.4%), respectively. CONCLUSION: TAC and CAC share similar major determinants for incident calcification. Participants with TAC, especially ascending TAC, are at elevated risk for development of CAC.

6 Article Progression of coronary artery calcification is stronger in poorly than in well controlled diabetes: Results from the Heinz Nixdorf Recall Study. 2017

Kowall, Bernd / Lehmann, Nils / Mahabadi, Amir-Abbas / Moebus, Susanne / Budde, Thomas / Seibel, Rainer / Grönemeyer, Dietrich / Erbel, Raimund / Jöckel, Karl-Heinz / Stang, Andreas. ·Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany. Electronic address: bernd.kowall@uk-essen.de. · Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany. · West-German Heart and Vascular Center Essen, Department of Cardiology, University Clinic Essen, Essen, Germany. · Center for Urban Epidemiology, Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, Essen, Germany. · Alfred Krupp Hospital, Essen, Germany. · Diagnosticum, Mülheim, Germany. · Department of Radiology and Microtherapy, University Witten/Herdecke, Bochum, Germany. · Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany; School of Public Health, Department of Epidemiology Boston University, 715 Albany Street, Talbot Building, Boston, MA 02118, USA. ·J Diabetes Complications · Pubmed #27665253.

ABSTRACT: AIM: To assess associations between HbA1c and progression of coronary artery calcification (CAC) in persons with and without diabetes. METHODS: In the Heinz Nixdorf Recall Study, a population-based cohort study in Germany (N=3453, aged 45-74years), CAC was assessed by electron-beam tomography at baseline and at 5-year follow-up. At baseline, participants were divided into five groups: poorly (HbA1c≥7.0%) and well (HbA1c<7.0%) controlled previously known diabetes (group I/II); no previously known diabetes with HbA1c ≥6.5% (group III), HbA1c 5.7-6.4% (group IV), and HbA1c <5.7% (group V). We fitted linear, logistic and robust Poisson regression models to assess associations between diabetes group and PF RESULTS: Relative to group V, adjusted percentage increase of the geometric mean of PF CONCLUSIONS: In known diabetes, CAC progression was stronger in poor diabetes control. For newly detected diabetes diagnosed by HbA1c ≥6.5%, associations with CAC progression were weak.

7 Article Accelerated progression of coronary artery calcification in hypertension but also prehypertension. 2016

Lehmann, Nils / Erbel, Raimund / Mahabadi, Amir A / Kälsch, Hagen / Möhlenkamp, Stefan / Moebus, Susanne / Stang, Andreas / Roggenbuck, Ulla / Strucksberg, Karl-Heinz / Führer-Sakel, Dagmar / Dragano, Nico / Budde, Thomas / Seibel, Rainer / Grönemeyer, Dietrich / Jöckel, Karl-Heinz / Anonymous6410877. ·aInstitute for Medical Informatics, Biometry & Epidemiology bDepartment of Cardiology cInstitute of Clinical Chemistry and Laboratory Medicine, University Clinic Essen, Essen dDepartment of Cardiology, Krankenhaus Bethanien, Moers, Germany eDepartment of Epidemiology, Boston University, Massachusetts, USA fInstitute of Medical Sociology, University Clinic Düsseldorf, Düsseldorf gAlfried Krupp Hospital Essen, Essen hDiagnosticum, Mülheim iInstitute of Diagnostic and Interventional Radiology, University Witten/Herdecke, Witten, Germany *Nils Lehmann and Raimund Erbel contributed equally to the article. ·J Hypertens · Pubmed #27512973.

ABSTRACT: OBJECTIVE: To determine the role of hypertension for coronary artery calcification (CAC) progression. METHODS: The population-based Heinz Nixdorf Recall study recruited 4814 participants from a German urban population in 2000-2003. CAC was measured using electron-beam computed tomography at baseline and after 5 years. The present analyses refer to 3481 participants with repeat scan (coronary heart disease until 5 years excluded, age at baseline 45-74 years, and 53.1% women). Blood pressure (BP), Framingham risk factors, and antihypertensive medication were recorded at baseline. BP was staged according to Joint National Committee 7 guidelines. Participants under antihypertensive medication were classified as stage 2. CAC at 5 years was predicted from baseline using our dedicated, publicly available algorithm. CAC progression was accordingly classified as slow, expected, or rapid. RESULTS: Normotension was found in 20.5%, prehypertension in 27.2%, stage 1 hypertension in 15.8%, and stage 2 (ST2) in 36.5%. The frequency of rapid progression increases with BP stage (normotension: 16.7% to ST2: 21.1%, P = 0.004). Risk factor adjusted relative risk [RR (95% confidence interval), reference: normotension] of rapid progression was for prehypertension: 1.22 (0.98;1.51), stage 1: 1.29 (1.01;1.65), and ST2: 1.45 (1.17;1.79). Risk factor adjusted measures of CAC progression per 10 mmHg SBP were already elevated in women with BP below 140/90 mmHg: CAC onset, RR = 1.22 (1.07;1.40), rapid progression, RR = 1.17 (1.05;1.31), 5-year CAC progression, 6.7% (0.5;13.4). In men below 140/90 mmHg, only RR of rapid progression was considerably increased [RR = 1.11 (0.96;1.29)]. CONCLUSION: CAC progression, a sign of ongoing target organ damage, is already accelerated in prehypertensive patients, a substantial proportion of our urban population.

8 Article GNB3 gene 825 TT variant predicts hard coronary events in the population-based Heinz Nixdorf Recall study. 2014

Frey, Ulrich H / Moebus, Susanne / Möhlenkamp, Stefan / Kälsch, Hagen / Bauer, Marcus / Lehmann, Nils / Nöthen, Markus / Mühleisen, Thomas W / Stang, Andreas / Erbel, Raimund / Jöckel, Karl-Heinz / Peters, Jürgen / Siffert, Winfried. ·Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany. Electronic address: Ulrich.frey@uk-essen.de. · Institut für medizinische Informatik, Biometrie und Epidemiologie, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany. · Medizinische Klinik II, Moers, Germany. · Klinik für Kardiologie, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany. · Institut für Humangenetik, Universität Bonn, Germany; Abteilung für Genomik, Life & Brain GmbH, Universität Bonn, Germany. · Institut für klinische Epidemiologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany; Department of Epidemiology, School of Public Health, Boston University, Boston, USA. · Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany. · Institut für Pharmakogenetik, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany. ·Atherosclerosis · Pubmed #25463071.

ABSTRACT: OBJECTIVE: The C825T polymorphism of the gene encoding the human G protein beta-3 subunit (GNB3) is associated with hypertension and obesity. Moreover, genotypes of the GNB3 polymorphism have been associated with development of coronary artery disease, and the 825T allele is thought to influence the process of atherosclerosis. However, the potential of the C825T polymorphism to predict coronary events has been poorly explored in a longitudinal setting at the population level. METHODS: In 4159 Caucasian subjects from the Heinz Nixdorf Recall study cohort (age: 45-75 years, 48% male), genotypes of the GNB3 C825T polymorphism (rs5443) were determined and associated with fatal and non-fatal myocardial infarction (hard coronary events). Established cardiovascular risk factors were used to adjust for confounders. RESULTS: The median follow-up time was 9.9 years (1st/3rd quartiles 9.5/10.2). 148 subjects (3.6%) experienced a hard coronary event. The 10-year event-free survival rate was CC, 96.1%; CT 96.9%, TT, 93.7% (p = 0.018). Multivariable analysis showed that the TT genotype is a significant risk factor for hard coronary events (hazard ratio (HR) = 1.9 (95% confidence interval (CI) 1.2-2.9); p = 0.008) after adjustment for age, sex, diabetes, systolic blood pressure, body mass index, high-density lipoprotein, and coronary artery calcification as determined by electron beam computed tomography at baseline. While prognosis in females was independent of GNB3 genotypes, analysis in males even elevated the HR for TT versus C-allele to 2.6 (95% CI 1.6-4.2; p < 0.001). CONCLUSION: The GNB3 825 TT genotype is a significant and independent risk factor for hard coronary events independent of other established cardiovascular risk factors at a population level in males.

9 Article Progression of coronary artery calcification seems to be inevitable, but predictable - results of the Heinz Nixdorf Recall (HNR) study. 2014

Erbel, Raimund / Lehmann, Nils / Churzidse, Sofia / Rauwolf, Michael / Mahabadi, Amir A / Möhlenkamp, Stefan / Moebus, Susanne / Bauer, Marcus / Kälsch, Hagen / Budde, Thomas / Montag, Michael / Schmermund, Axel / Stang, Andreas / Führer-Sakel, Dagmar / Weimar, Christian / Roggenbuck, Ulla / Dragano, Nico / Jöckel, Karl-Heinz / Anonymous3450801. ·University Clinic of Cardiology, West-German Heart Center Essen and erbel@uk-essen.de. · Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Hufelandstrasse 55, Essen D-45122, Germany. · University Clinic of Cardiology, West-German Heart Center Essen and. · University Clinic of Cardiology, West-German Heart Center Essen and Medical Clinic II, Bethanien Hospital, Moers, Germany. · Alfred-Krupp Hospital, Essen, Germany. · Cardioangiological Center Bethanien, Frankfurt am Main, Germany. · Institute of Clinical Epidemiology, Medical Faculty University Halle-Wittenberg, Wittenberg, Germany Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA. · Institute of Clinical Chemistry and Laboratory Medicine, University Duisburg-Essen, Essen, Germany. · University Clinic of Neurology, University Duisburg-Essen, Essen, Germany. · Institute of Medical Sociology Medical Faculty University of Düsseldorf, Düsseldorf, Germany. ·Eur Heart J · Pubmed #25062951.

ABSTRACT: AIM: Coronary artery calcification (CAC), as a sign of atherosclerosis, can be detected and progression quantified using computed tomography (CT). We develop a tool for predicting CAC progression. METHODS AND RESULTS: In 3481 participants (45-74 years, 53.1% women) CAC percentiles at baseline (CACb) and after five years (CAC₅y) were evaluated, demonstrating progression along gender-specific percentiles, which showed exponentially shaped age-dependence. Using quantile regression on the log-scale (log(CACb+1)) we developed a tool to individually predict CAC₅y, and compared to observed CAC₅y. The difference between observed and predicted CAC₅y (log-scale, mean±SD) was 0.08±1.11 and 0.06±1.29 in men and women. Agreement reached a kappa-value of 0.746 (95% confidence interval: 0.732-0.760) and concordance correlation (log-scale) of 0.886 (0.879-0.893). Explained variance of observed by predicted log(CAC₅y+1) was 80.1% and 72.0% in men and women, and 81.0 and 73.6% including baseline risk factors. Evaluating the tool in 1940 individuals with CACb>0 and CACb<400 at baseline, of whom 242 (12.5%) developed CAC₅y>400, yielded a sensitivity of 59.5%, specificity 96.1%, (+) and (-) predictive values of 68.3% and 94.3%. A pre-defined acceptance range around predicted CAC₅y contained 68.1% of observed CAC₅y; only 20% were expected by chance. Age, blood pressure, lipid-lowering medication, diabetes, and smoking contributed to progression above the acceptance range in men and, excepting age, in women. CONCLUSION: CAC nearly inevitably progresses with limited influence of cardiovascular risk factors. This allowed the development of a mathematical tool for prediction of individual CAC progression, enabling anticipation of the age when CAC thresholds of high risk are reached.

10 Article Beyond Framingham risk factors and coronary calcification: does aortic valve calcification improve risk prediction? The Heinz Nixdorf Recall Study. 2014

Kälsch, Hagen / Lehmann, Nils / Mahabadi, Amir A / Bauer, Marcus / Kara, Kaffer / Hüppe, Patricia / Moebus, Susanne / Möhlenkamp, Stefan / Dragano, Nico / Schmermund, Axel / Stang, Andreas / Jöckel, Karl-Heinz / Erbel, Raimund / Anonymous940784. ·Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany. · Biometry, and Epidemiology, Institute of Medical Informatics, University Duisburg-Essen, Essen, Germany. · Department of Cardiology, Krankenhaus Bethanien, Moers, Germany. · Medical Faculty, Centre for Health and Society, Institute of Medical Sociology, University Clinic Düsseldorf, Düsseldorf, Germany. · Cardioangiological Center Bethanien, Frankfurt/Main, Germany. · Medical Faculty, Institute of Clinical Epidemiology, University Halle-Wittenberg, Halle, Germany. ·Heart · Pubmed #24501258.

ABSTRACT: BACKGROUND: Aortic valve calcification (AVC) is considered a manifestation of atherosclerosis. In this study, we investigated whether AVC adds to cardiovascular risk prediction beyond Framingham risk factors and coronary artery calcification (CAC). METHODS: A total of 3944 subjects from the population based Heinz Nixdorf Recall Study (59.3±7.7 years; 53% females) were evaluated for coronary events, stroke, and cardiovascular disease (CVD) events (including all plus CV death) over 9.1±1.9 years. CT scans were performed to quantify AVC. Cox proportional hazards regressions and Harrell's C were used to examine AVC as event predictor in addition to risk factors and CAC. RESULTS: During follow-up, 138 (3.5%) subjects experienced coronary events, 101 (2.6%) had a stroke, and 257 (6.5%) experienced CVD events. In subjects with AVC>0 versus AVC=0 the incidence of coronary events was 8.0% versus 3.0% (p<0.001) and the incidence of CVD events was 13.0% versus 5.7% (p<0.001). The frequency of events increased significantly with increasing AVC scores (p<0.001). After adjustment for Framingham risk factors, high AVC scores (3rd tertile) remained independently associated with coronary events (HR 2.21, 95% CI 1.28 to 3.81) and CVD events (HR 1.67, 95% CI 1.08 to 2.58). After further adjustment for CAC score, HRs were attenuated (coronary events 1.55, 95% CI 0.89 to 2.69; CVD events 1.29, 95% CI 0.83 to 2.00). When adding AVC to the model containing traditional risk factors and CAC, Harrell's C indices did not increase for coronary events (from 0.744 to 0.744) or CVD events (from 0.759 to 0.759). CONCLUSIONS: AVC is associated with incident coronary and CVD events independent of Framingham risk factors. However, AVC fails to improve cardiovascular event prediction over Framingham risk factors and CAC.

11 Article Effect of smoking and other traditional risk factors on the onset of coronary artery calcification: results of the Heinz Nixdorf recall study. 2014

Lehmann, Nils / Möhlenkamp, Stefan / Mahabadi, Amir A / Schmermund, Axel / Roggenbuck, Ulla / Seibel, Rainer / Grönemeyer, Dietrich / Budde, Thomas / Dragano, Nico / Stang, Andreas / Mann, Klaus / Moebus, Susanne / Erbel, Raimund / Jöckel, Karl-Heinz. ·Institute for Medical Informatics, Biometry & Epidemiology, University Clinic Essen, Germany. · Clinic of Cardiology, West-German Heart Center Essen, University Clinic Essen, Germany; Clinic of Cardiology and Intensive Care Medicine, Bethanien Hospital, Moers, Germany. · Clinic of Cardiology, West-German Heart Center Essen, University Clinic Essen, Germany. · Cardioangiological Center Bethanien, Frankfurt am Main, Germany. · Diagnosticum Mülheim, Mülheim, Germany. · Department of Radiology and Microtherapy, University Witten/Herdecke, Bochum, Germany. · Clinic of Cardiology, Alfried Krupp Hospital, Essen, Germany. · Institute of Medical Sociology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany. · Institute of Clinical Epidemiology, Medical Faculty, University Halle-Wittenberg, Halle, Germany. · Department of Endocrinology and Metabolic Disorders and Division of Laboratory Research, University of Duisburg-Essen, Germany. · Institute for Medical Informatics, Biometry & Epidemiology, University Clinic Essen, Germany. Electronic address: k-h.joeckel@uk-essen.de. ·Atherosclerosis · Pubmed #24468147.

ABSTRACT: BACKGROUND: Coronary artery calcium (CAC) indicates coronary atherosclerosis and can be present in very early stages of the disease. The conversion from no CAC to any CAC reflects an important step of the disease process as cardiovascular risk is increased in persons even with mildly elevated CAC. We sought to identify risk factors that determined incident CAC>0 in men and women from an unselected general population with a special focus on the role of smoking. METHODS: All 4814 persons that were initially studied in the Heinz Nixdorf Recall Study were invited to participate in the follow-up examination after 5.1 ± 0.3 years. All traditional Framingham risk factors were quantified using standard techniques. Smokers were categorized in never, former and present smokers. The CAC scores were measured from EBCT using the Agatston method. RESULTS: Overall, out of 342 men and 919 women with zero CAC at baseline, 107 (31.3%) men and 210 (22.9%) women had CAC>0 at second examination. In multivariable analysis, age (OR estimate per 5 years: 1.34 (95%CI: 1.21-1.47)), LDL cholesterol (per 10 mg/dL: 1.05 (95%CI: 1.01-1.10)), systolic blood pressure (per 10 mmHg: 1.19 (95%CI: 1.11-1.28)) and current smoking (1.49 (95%CI: 1.04-2.15)) were independent predictors of CAC onset. The probability of CAC onset steadily increased with age from 23.3% (men) and 15.3% (women) at age 45-49 years to 66.7% (men) and 42.9% (women) at age 70-74 years. The difference in age-dependent conversion rates was quantified by years between reaching a given level of CAC onset probability. We found a consistent pattern with respect to smoking status: presently (formerly) smoking middle-aged men convert to positive CAC 10 (5) years earlier than never smokers, for women (middle-aged to elderly) this time span is 8 (5) years. CONCLUSION: Several traditional CVD risk factors are associated with CAC onset during 5 years follow-up. CAC onset is accelerated by approximately 10 (5) years for present (former) compared to never smokers.

12 Article Coronary artery calcification outperforms thoracic aortic calcification for the prediction of myocardial infarction and all-cause mortality: the Heinz Nixdorf Recall Study. 2014

Kälsch, Hagen / Lehmann, Nils / Berg, Marie H / Mahabadi, Amir A / Mergen, Paul / Möhlenkamp, Stefan / Bauer, Marcus / Kara, Kaffer / Dragano, Nico / Hoffmann, Barbara / Moebus, Susanne / Schmermund, Axel / Stang, Andreas / Jöckel, Karl-Heinz / Erbel, Raimund. ·West-German Heart Center Essen, University Duisburg-Essen, Germany Hagen.Kaelsch@uk-essen.de. · Institute of Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Germany. · West-German Heart Center Essen, University Duisburg-Essen, Germany. · Institute for Medical Sociology, University of Düsseldorf, Germany. · IUF-Leibniz Research Institute for Environmental Medicine, Germany; University of Düsseldorf, Germany. · Cardioangiological Center Bethanien, Germany. · Institute of Clinical Epidemiology, University Halle-Wittenberg, Halle, Germany. ·Eur J Prev Cardiol · Pubmed #23467675.

ABSTRACT: BACKGROUND: Thoracic aortic calcification (TAC) is associated with cardiovascular (CV) risk factors and prevalent coronary artery disease. We aimed to investigate whether TAC burden is associated with incident myocardial infarction (MI) and all-cause mortality in subjects without known coronary artery disease and to determine its predictive value for these endpoints. METHODS: We used longitudinal data from the population-based prospective Heinz Nixdorf Recall Study. TAC and coronary artery calcification (CAC) scores were quantified from non-contrast enhanced electron beam computed tomography. Cox regression analysis was used to determine the association of TAC with incident MI or all-cause mortality, adjusting for CV risk factors and additionally for CAC-score in a separate step. Predictive value of TAC was assessed using Harrell's C index. RESULTS: Overall, 4040 participants without known coronary artery disease (59.4 years, 47% male) were included in this analysis. During a mean follow-up of 8.0 ± 1.5 years, we observed 136 coronary events and 304 deaths. In subjects with TAC>0 vs TAC = 0, the incidence of nonfatal MI was 4.2% vs 2.0% (p < 0.001), and all-cause mortality was 8.9% vs 5.2% (p < 0.001). Risks for coronary events and for all-cause mortality increased significantly with increasing TAC-scores (p < 0.001). After adjustment for CV risk factors, body mass index (BMI) and CV medication, a unit increase of TAC on a logarithmic scale (log(TAC + 1)) remained independently associated with coronary events (hazard ratio (HR) (95% confidence interval (CI)): 1.06 (1.00-1.14), p = 0.03) and all-cause mortality (HR 1.06 (1.01-1.12), p < 0.01). After further adjustment for CAC-score (log(CAC + 1)), hazard ratios were attenuated for both endpoints (coronary events: 0.98 (0.91-1.05), p = 0.56, all-cause mortality: 1.03 (0.98-1.08), p = 0.33). When adding log(TAC + 1) to the model containing traditional risk factors and CAC, Harrell's C indices did not increase for coronary events (0.773-0.772, p = 0.66) or for all-cause mortality (0.741-0.743, p = 0.49). CONCLUSION: TAC is associated with incident coronary events and all-cause mortality independent of traditional CV risk factors in the general population. TAC fails to improve event prediction over CAC in both coronary events and all-cause mortality.

13 Article Association of obstructive sleep apnoea with subclinical coronary atherosclerosis. 2013

Weinreich, Gerhard / Wessendorf, Thomas E / Erdmann, Timo / Moebus, Susanne / Dragano, Nico / Lehmann, Nils / Stang, Andreas / Roggenbuck, Ulla / Bauer, Marcus / Jöckel, Karl-Heinz / Erbel, Raimund / Teschler, Helmut / Möhlenkamp, Stefan / Anonymous3890776. ·Department of Pneumology, Ruhrlandklinik, West German Lung Center, University Clinic Essen, Tüschener Weg 40, D-45239 Essen, Germany. Electronic address: gerhard.weinreich@ruhrlandklinik.uk-essen.de. ·Atherosclerosis · Pubmed #24267225.

ABSTRACT: BACKGROUND: Accumulating evidence suggests a role of obstructive sleep apnoea (OSA) as a risk factor for coronary atherosclerosis. This study aimed i) to assess the prevalence of OSA in the general population and ii) to analyse the association of this disorder with traditional cardiovascular disease risk factors and subclinical coronary atherosclerosis. METHODS: In a cross-sectional analysis of the Heinz Nixdorf Recall study a subgroup of 1604 subjects (791 men, age 50-80 years) underwent OSA screening. Furthermore, coronary artery calcium (CAC) was measured. OSA was defined as apnoea-hypopnoea index (AHI) ≥ 15/h. RESULTS: OSA was observed in 29.1% of men and 15.6% of women. In a multiple linear regression analysis adjusted for risk factors AHI was associated with CAC in men aged ≤65 years (estimated log-transformed increase of CAC = 0.25, 95% confidence interval (CI) = -0.001-0.50, p = 0.051) and in women of any age (estimated log-transformed increase = 0.23, 95% CI = 0.04-0.41, p = 0.02). Doubling of the AHI was associated with a 19% increase of CAC in men aged ≤65 years and with a 17% increase in women of any age. CONCLUSIONS: In the general population aged ≥50 years OSA is associated with subclinical atherosclerosis in men aged ≤65 years and in women of any age, independent of traditional cardiovascular risk factors.

14 Article Gender-specific association of coronary artery calcium and lipoprotein parameters: the Heinz Nixdorf Recall Study. 2013

Erbel, Raimund / Lehmann, Nils / Churzidse, Sofia / Möhlenkamp, Stefan / Moebus, Susanne / Mahabadi, Amir A / Schmermund, Axel / Stang, Andreas / Dragano, Nico / Grönemeyer, Dietrich / Seibel, Rainer / Kälsch, Hagen / Bauer, Marcus / Bröcker-Preuss, Martina / Mann, Klaus / Jöckel, Karl-Heinz / Anonymous2050759. ·Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Germany. erbel@uk-essen.de ·Atherosclerosis · Pubmed #23701995.

ABSTRACT: BACKGROUND: Coronary atherosclerosis can be detected by computed tomography. The amount of coronary artery calcification (CAC) is related to cardiovascular risk factors, the strength of the gender specific relation between lipoprotein parameters and CAC has not extensively been studied. Especially, the role of routinely determined lipoproteins in contrast to less common and computed lipid parameters (e.g. ratios) remains to be clarified. METHODS AND RESULTS: The study cohort (n = 3956, 52% women, age 45-75 years) was randomly selected from three cities of a German metropolitan area. Lipoproteins-low-and high density lipoprotein (LDL-C/HDL-C), total cholesterol, apolipoprotein A-1 and B (apoA-1/apoB) as well as lipoprotein (a) (Lp(a)) were measured, while non-HDL-C was calculated. All participants received an electron-beam computed tomography (EBCT) for quantification of CAC. Adjusted for age and cardiovascular risk factors, CAC increased by a factor of 1.97 (1.51-2.57, 95% CI) and 1.94 (1.53-2.45, 95% CI) comparing the fourth to the first quartile of LDL-C for men and women, respectively. This association with LDL-C was also found after dichotomization of CAC at thresholds >0, ≥ 100 and ≥ 400. The best association of CAC was, however, found to be apoB and the second best was non HDL-C, in both men and women. For apoB, the model including all risk factors reached an explained variance for CAC of 20.2% in men and of 21.6% in women. When using LDL-C as a given parameter according to the current practice and advice, HDL-C in men and apoB in women provided an additional but small benefit. CONCLUSION: ApoB showed the best association with CAC compared to all other tested lipoproteins. Neither the ratio LDL-C/HDL-C nor apoB/apoA-1, or Lp(a) revealed a closer association with CAC. While lipoproteins are related to CAC more closely in women than in men, their association with CAC is, however, not particularly strong. Our results may influence primary and secondary prevention advices in order to improve detection of subclinical atherosclerosis, for which lipoprotein parameters can only play a minor role.

15 Article Prevalence of thoracic aortic calcification and its relationship to cardiovascular risk factors and coronary calcification in an unselected population-based cohort: the Heinz Nixdorf Recall Study. 2013

Kälsch, Hagen / Lehmann, Nils / Möhlenkamp, Stefan / Hammer, Cornelia / Mahabadi, Amir A / Moebus, Susanne / Schmermund, Axel / Stang, Andreas / Bauer, Marcus / Jöckel, Karl-Heinz / Erbel, Raimund / Anonymous1880724. ·West-German Heart Center Essen, Department of Cardiology, University Clinic Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany. hagen.kaelsch@uk-essen.de ·Int J Cardiovasc Imaging · Pubmed #22527262.

ABSTRACT: Thoracic aortic calcification (TAC) and coronary artery calcium (CAC) have been proposed for risk assessment of coronary artery and cardiovascular disease events. The aim of this analysis is to assess the prevalence of TAC and to determine its relationship with cardiovascular risk factors and CAC in a general unselected population. TAC was measured from electron beam computed tomography scans and quantified by Agatston-Score in 4,025 participants aged 45-75 years (mean age 59.4 ± 7.8 years, 53% female) from the Heinz Nixdorf Recall Study. Multivariable generalized linear regression was used to evaluate relationships between TAC and cardiovascular risk factors and CAC. Overall 2,538/4,025 (63.1%) participants revealed TAC. Prevalence of TAC was greater in men than in women (65.2 vs. 61.7%, p = 0.009). TAC was most strongly associated with age, systolic blood pressure, smoking and high levels of LDL-cholesterol. Prevalence of CAC was significantly higher in participants with TAC than without (74.0 vs. 57.6%, p < 0.0001) demonstrating an increased risk of having CAC in the presence of TAC (prevalence ratio (PR) 1.29 [95% CI: 1.22-1.35], p < 0.0001, PR adjusted for risk factors 1.14 [1.09-1.20], p < 0.0001). In general population, TAC has high prevalence and largely shares cardiovascular risk factors with CAD while being independently associated with present CAC.

16 Article Midday naps and the risk of coronary artery disease: results of the Heinz Nixdorf Recall Study. 2012

Stang, Andreas / Dragano, Nico / Moebus, Susanne / Möhlenkamp, Stefan / Schmermund, Axel / Kälsch, Hagen / Erbel, Raimund / Jöckel, Karl-Heinz / Anonymous7660743. ·Institute of Clinical Epidemiology, University of Halle-Wittenberg, Halle, Germany. andreas.stang@medizin.uni-halle.de ·Sleep · Pubmed #23204613.

ABSTRACT: STUDY OBJECTIVES: Several studies have assessed the association between midday nap and cardiovascular outcomes and reported heterogenous results. Concern exists that confounding might have distorted these results and contributed to discrepancies among them. This study prospectively examines the association between midday nap habits and the occurrence of coronary artery disease in a non-Mediterranean population. PARTICIPANTS: The baseline examination of 4,123 participants aged 45-75 years. MEASUREMENTS: Measurements included interviews, physical examinations, laboratory tests, and electron beam computed tomography. We studied the influence of midday nap habits on risk of coronary artery disease. We adjusted for several potential confounders including measures of subclinical atherosclerosis-such as coronary calcium score and ankle brachial index-at baseline. Cardiac events during a median follow-up of 8.1 years were defined as nonfatal myocardial infarction and sudden cardiac death. RESULTS: Overall, 135 of 4,123 subjects (3.3%) either suffered from acute myocardial infarction (81 subjects) or died due to a sudden cardiac death (54 subjects) during follow-up. After adjustment for several confounders including measures of subclinical atherosclerosis, regular long (> 60 min) midday nap was associated with an increased hazard ratio of cardiac events (hazard ratio 2.12, 95% confidence interval 1.11-4.05). CONCLUSIONS: As our detailed confounder analyses showed, confounding is not the sole explanation for this finding. Future research on midday naps should focus on biological mechanisms that may be responsible for increasing the risk of coronary artery disease among subjects taking regular long midday naps.

17 Article Subclinical coronary atherosclerosis predicts cardiovascular risk in different stages of hypertension: result of the Heinz Nixdorf Recall Study. 2012

Erbel, Raimund / Lehmann, Nils / Möhlenkamp, Stefan / Churzidse, Sofia / Bauer, Marcus / Kälsch, Hagen / Schmermund, Axel / Moebus, Susanne / Stang, Andreas / Roggenbuck, Ulla / Bröcker-Preuss, Martina / Dragano, Nico / Weimar, Christian / Siegrist, Johannes / Jöckel, Karl-Heinz / Anonymous4450711. ·Department of Cardiology, University Clinic Essen, Essen, Germany. erbel@uk-essen.de ·Hypertension · Pubmed #22124435.

ABSTRACT: Prehypertension is a frequent condition and has been demonstrated to increase cardiovascular risk. However, the association with coronary atherosclerosis as part of target organ damage is not well understood. We investigated the cross-sectional relationship and longitudinal outcome between blood pressure categories and coronary artery calcification (CAC), quantified by electron beam computed tomography, in 4181 participants from the population-based Heinz Nixdorf Recall Study cohort. At baseline, we observed a continuous increase in calcium scores with increasing blood pressure categories. During a median follow-up period of 7.18 years, 115 primary end points (2.8%; fatal and nonfatal myocardial infarction) and 152 secondary end points (3.6%; stroke and coronary revascularization) occurred. We observed a continuous increase in age- and risk factor-adjusted secondary endpoints (hazard ratios [95% CI]) with increasing blood pressure categories (referent: normotension) in men: prehypertension, 1.80 (0.53-6.13); stage 1 hypertension, 2.27 (0.66-7.81); and stage 2 hypertension, 4.10 (1.27-13.24) and in women: prehypertension, 1.13 (0.34-3.74); stage 1 hypertension, 2.14 (0.67-6.85); and stage 2 hypertension, 3.33 (1.24-8.90), respectively, but not in primary endpoints. Cumulative event rates were determined by blood pressure categories and the CAC. In prehypertension, the adjusted hazard ratios for all of the events were, for CAC 1 to 99, 2.05 (0.80-5.23; P=0.13); 100 to 399, 3.12 (1.10-8.85; P=0.03); and ≥400, 7.72 (2.67-22.27; P=0.0002). Risk of myocardial infarction and stroke in hypertension but also in prehypertension depends on the degree of CAC. This marker of target-organ damage might be included, when lifestyle modification and pharmacotherapeutic effects in prehypertensive individuals are tested to avoid exposure to risk and increase benefit.

18 Article Quantification of coronary atherosclerosis and inflammation to predict coronary events and all-cause mortality. 2011

Möhlenkamp, Stefan / Lehmann, Nils / Moebus, Susanne / Schmermund, Axel / Dragano, Nico / Stang, Andreas / Siegrist, Johannes / Mann, Klaus / Jöckel, Karl-Heinz / Erbel, Raimund / Anonymous2110690. ·Clinic of Cardiology, West-German Heart Center Essen, University Clinic Duisburg-Essen, Hufelandstrasse 55, Essen, Germany. stefan.moehlenkamp@uk-essen.de ·J Am Coll Cardiol · Pubmed #21435514.

ABSTRACT: OBJECTIVES: This study sought to determine whether the evaluation of the combined presence of coronary artery calcium (CAC) and high-sensitivity C-reactive protein (hsCRP) improves discrimination and stratification of hard coronary events and all-cause mortality in the general population. BACKGROUND: Coronary atherosclerosis is a chronic inflammatory disease. Both hsCRP as a measure of inflammation and CAC as a measure of coronary plaque burden have been shown to improve risk appraisal. METHODS: Framingham risk variables, hsCRP, and CAC were measured in 3,966 subjects without known coronary artery disease or acute inflammation. After 5 years, incident coronary deaths, nonfatal myocardial infarction, and all-cause mortality were determined. RESULTS: CAC and hsCRP independently predicted 91 coronary events (adjusted hazard ratios [HRs]: log(2)(CAC+1) = 1.25 [95% confidence interval (CI): 1.16 to 1.34], p < 0.0001; hsCRP = 1.11 [95% CI: 1.02 to 1.21], p = 0.019) and 130 deaths (adjusted HRs: log(2)(CAC+1) = 1.12 [95% CI: 1.06 to 1.19], p < 0.0001; hsCRP = 1.11 [95% CI: 1.04 to 1.19], p = 0.004). For coronary events, net reclassification improvement (NRI) was 23.8% (p = 0.0007) for CAC and 10.5% (p = 0.026) for hsCRP. Adding CAC to Framingham risk variables and hsCRP further improved discrimination of coronary risk but not vice versa. Among persons without CAC, those with hsCRP >3 mg/l versus <3 mg/l had a significantly higher coronary risk (p = 0.006). For all-cause mortality, integrated discrimination improvement (IDI) was positive when CAC or hsCRP were added to age and sex (+0.51%, p < 0.001 and +0.43%, p = 0.012, respectively). Adjusted HRs in the highest versus lowest category of a risk index derived from established CAC and hsCRP thresholds (i.e., CAC = 100 and hsCRP = 3 mg/l) were 5.92 (95% CI: 3.14 to 11.16) for coronary events and 3.02 (95% CI: 1.82 to 5.01) for all-cause mortality (p < 0.0001 each). The adjusted HR for coronary events in intermediate risk subjects was 6.98 (95% CI: 2.47 to 19.73), p < 0.001. CONCLUSIONS: The risk of coronary events and all-cause mortality that is mediated by the presence of coronary atherosclerosis and systemic inflammation can be estimated by CAC and hsCRP. An improvement in coronary risk prediction and discrimination was predominantly driven by CAC, whereas hsCRP appears to have a role especially in persons with very low CAC scores.

19 Article Coronary artery calcium score improves cardiovascular risk prediction in persons without indication for statin therapy. 2011

Möhlenkamp, Stefan / Lehmann, Nils / Greenland, Philip / Moebus, Susanne / Kälsch, Hagen / Schmermund, Axel / Dragano, Nico / Stang, Andreas / Siegrist, Johannes / Mann, Klaus / Jöckel, Karl-Heinz / Erbel, Raimund / Anonymous2910684. ·Clinic of Cardiology, West-German Heart Center Essen, University Clinic Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany. stefan.moehlenkamp@uk-essen.de ·Atherosclerosis · Pubmed #21251655.

ABSTRACT: BACKGROUND: Recent revision to the Canadian Cardiovascular Society (CCS) guidelines on cardiovascular disease (CVD) risk stratification provides expanded recommendations for statin therapy. If CVD risk in the remaining individuals can further be stratified and discriminated by additional risk assessment using coronary artery calcium (CAC) scoring is unknown. METHODS AND RESULTS: In a retrospectively analyzed subgroup comprising 1934 participants from the Heinz Nixdorf Recall study, who did not meet criteria for statin therapy based on current CCS guidelines, traditional CVD risk variables and CAC were measured. Between 2000 and 2008, incident CVD events, i.e. coronary deaths, non-fatal myocardial infarction, coronary revascularization, stroke and CV death were determined. Those 43 participants who experienced 55 CVD events (5-year risk to first event: 2.2% (1.6-3.0%)) had higher CAC scores than those who did not (p<0.0001). In multiple Cox regression analysis including age, sex, total-/HDL-cholesterol ratio, and antihypertensive medication, log2(CAC+1) remained an independent predictor of CVD events (HR=1.21 (1.09-1.33), p<0.001). Measures of discrimination improved with the addition of CAC into the model: the incremental discrimination improvement was 0.0167, p=0.014. Net reclassification improvement using risk categories of 0-<3%, 3-10% and >10% was 25.1%, p=0.01, largely driven by a 32.6% correct up-classification in persons with events. Yet, only 38 (2%) of participants were identified being at high risk using CAC imaging in addition to traditional risk factor assessment. CONCLUSION: Adding CAC to traditional risk assessment in persons without indication for statin therapy improves discrimination. However, reclassification to the high risk category and overall event rates seem too low to justify liberal CAC testing in all these individuals.

20 Article Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. 2010

Erbel, Raimund / Möhlenkamp, Stefan / Moebus, Susanne / Schmermund, Axel / Lehmann, Nils / Stang, Andreas / Dragano, Nico / Grönemeyer, Dietrich / Seibel, Rainer / Kälsch, Hagen / Bröcker-Preuss, Martina / Mann, Klaus / Siegrist, Johannes / Jöckel, Karl-Heinz / Anonymous640675. ·Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany. erbel@uk-essen.de ·J Am Coll Cardiol · Pubmed #20946997.

ABSTRACT: OBJECTIVES: The purpose of this study was to determine net reclassification improvement (NRI) and improved risk prediction based on coronary artery calcification (CAC) scoring in comparison with traditional risk factors. BACKGROUND: CAC as a sign of subclinical coronary atherosclerosis can noninvasively be detected by CT and has been suggested to predict coronary events. METHODS: In 4,129 subjects from the HNR (Heinz Nixdorf Recall) study (age 45 to 75 years, 53% female) without overt coronary artery disease at baseline, traditional risk factors and CAC scores were measured. Their risk was categorized into low, intermediate, and high according to the Framingham Risk Score (FRS) and National Cholesterol Education Panel Adult Treatment Panel (ATP) III guidelines, and the reclassification rate based on CAC results was calculated. RESULTS: After 5 years of follow-up, 93 coronary deaths and nonfatal myocardial infarctions occurred (cumulative risk 2.3%; 95% confidence interval: 1.8% to 2.8%). Reclassifying intermediate (defined as 10% to 20% and 6% to 20%) risk subjects with CAC <100 to the low-risk category and with CAC ≥400 to the high-risk category yielded an NRI of 21.7% (p = 0.0002) and 30.6% (p < 0.0001) for the FRS, respectively. Integrated discrimination improvement using FRS variables and CAC was 1.52% (p < 0.0001). Adding CAC scores to the FRS and National Cholesterol Education Panel ATP III categories improved the area under the curve from 0.681 to 0.749 (p < 0.003) and from 0.653 to 0.755 (p = 0.0001), respectively. CONCLUSIONS: CAC scoring results in a high reclassification rate in the intermediate-risk cohort, demonstrating the benefit of imaging of subclinical coronary atherosclerosis. Our study supports its application, especially in carefully selected individuals with intermediate risk.

21 Article Association of coronary artery calcium and congestive heart failure in the general population: Results of the Heinz Nixdorf Recall study. 2010

Kälsch, H / Lehmann, N / Möhlenkamp, S / Neumann, T / Slomiany, U / Schmermund, Axel / Stang, Andreas / Moebus, S / Bauer, M / Mann, K / Jöckel, K-H / Erbel, R / Anonymous6220647. ·Department of Cardiology, West-German Heart Center Essen, University Clinic Duisburg-Essen, Essen, Germany. Hagen.Kaelsch@uk-essen.de ·Clin Res Cardiol · Pubmed #20054694.

ABSTRACT: BACKGROUND: The main causes of congestive heart failure (CHF) are coronary artery disease (CAD) and arterial hypertension. Coronary artery calcification (CAC) evidencing coronary atherosclerosis may occur prior to clinical CAD. The aim of our study was to assess the association between CAC as a sign of subclinical CAD and CHF in a general unselected population. METHODS: Participants of the Heinz Nixdorf Recall Study without known CAD but with known CHF as defined by a physicians' diagnosis of CHF and dyspnea were identified. B-natriuretic peptide was measured and an exercise stress test was performed as possible. Cardiovascular risk factors and the EBCT-based CAC Agatston score were determined. RESULTS: Those 105/4,230 subjects (2.5%) with CHF (age 65 +/- 7 years, 44% males), had higher brain natriuretic peptide (BNP) levels (median BNP 36.8 [16.5-70.1] vs. 17.6 [9.5-31.7] pg/ml, p<0.01) and lower exercise capacity (108.7 +/- 39.4 vs. 130.0 +/- 40.7 W, p<0.01) than those without. CAC in subjects with CHF was significantly higher than in those without (median CAC 64.7 [8.5-312.3] vs. 11.6 [0-109.8], p<0.01). In univariate analysis, CAC-burden after logarithmic transformation according to log(2)(CAC + 1) showed a significant association with the presence of CHF (odds ratio (OR) (95% CI): 1.16 (1.1-1.23), p<0.0001). Adjustment for age and sex (OR 1.11 (1.04-1.18), p<0.001), additional Framingham risk score (OR 1.09 (1.02-1.16), p = 0.015), and additional cardiovascular medication (OR 1.07 (0.998-1.14), p = 0.058) attenuated this association. Age, systolic blood pressure, antihypertensive medication and increased body mass index also remained significantly associated with presence of CHF in the full multivariate model. CONCLUSION: The observed association between CAC and CHF in persons without clinically overt CAD is partly determined by risk factors that are involved in the natural history of both CAC and CHF. Whether CAC has a role to identify subjects at risk of future CHF remains to be determined using follow-up analyses.

22 Minor Reply to: "Methodological issues regarding "Decline in ankle-brachial index is stronger in poorly than in well controlled diabetes: Results from the Heinz Nixdorf Recall cohort study"". 2019

Kowall, Bernd / Stang, Andreas. ·Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany. Electronic address: bernd.kowall@uk-essen.de. · Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany; School of Public Health, Department of Epidemiology Boston University, 715 Albany Street, Talbot Building, Boston, MA, 02118, USA. ·Atherosclerosis · Pubmed #31130216.

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