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Find video protocols related to scientific articles indexed in Pubmed.
Clinical Factors Associated With High-Risk Carotid Plaque Features as Assessed by Magnetic Resonance Imaging in Patients With Established Vascular Disease (from the AIM-HIGH Study).
Am. J. Cardiol.
PUBLISHED: 05-05-2014
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Association between clinical factors and high-risk plaque features, such as, thin or ruptured cap, intraplaque hemorrhage, presence of lipid-rich necrotic core (LRNC), and increased LRNC volume as assessed by magnetic resonance imaging (MRI), was examined in patients with established vascular disease in the Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides (AIM-HIGH) trial. A total of 214 subjects underwent carotid MRI and had acceptable image quality for assessment of plaque burden, tissue contents, and MRI-modified American Heart Association lesion type by a core laboratory. We found that 77% of subjects had carotid plaques, 52% had lipid-containing plaques, and 11% had advanced American Heart Association type-VI lesions with possible surface defect, intraplaque hemorrhage, or mural thrombus. Type-VI lesions were associated with older age (odds ratio [OR] = 2.6 per 5 years increase, p <0.001). After adjusting for age, these lesions were associated with history of cerebrovascular disease (OR = 4.1, p = 0.01), higher levels of lipoprotein(a) (OR = 2.0 per 1 SD increase, p = 0.02), and larger percent wall volume (PWV [OR = 4.6 per 1 SD increase, p <0.001]) but, were negatively associated with metabolic syndrome (OR = 0.2, p = 0.02). Presence of LRNC was associated with the male gender (OR = 3.2, p = 0.02) and PWV (OR = 3.8 per 1 SD, p <0.001); however, it was negatively associated with diabetes (OR = 0.4, p = 0.02) and high-density lipoprotein cholesterol levels (OR = 0.7 per 1 SD, p = 0.02). Increased percent LRNC was associated with PWV (regression coefficient = 0.36, p <0.001) and negatively associated with ApoA1 levels (regression coefficient = -0.20, p = 0.03). In conclusion, older age, male gender, history of cerebrovascular disease, larger plaque burden, higher lipoprotein(a), and lower high-density lipoprotein cholesterol or ApoA1 level have statistically significant associations with high-risk plaque features. Metabolic syndrome and diabetes showed negative associations in this population.
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Benefits of migration in relation to nutritional condition and predation risk in a partially migratory moose population.
Ecology
PUBLISHED: 03-22-2014
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The costs and benefits of alternative migratory strategies are often framed in the context of top-down and bottom-up effects on individual fitness. This occurs because migration is considered a costly behavioral strategy that presumably confers explicit benefits to migrants in the form of either decreased predation risk (predation risk avoidance hypothesis) or increased nutrition (forage maturation hypothesis). To test these hypotheses, we studied a partially migratory moose (Alces alces) population and contrasted explicit measures of predation risk (i.e., offspring survival) and nutrition (i.e., accumulation of endogenous energy reserves) between resident and migratory subpopulations. We relied on data collected from migratory and nonmigratory radio-marked moose (n = 67) that inhabited a novel study system located in coastal Alaska between 2004 and 2010. In this area, 30% of the population resides year-round on a coastal foreland area, while 48% migrate to either a small island archipelago or a subalpine ridge system (the remainder exhibited one of six different low-occurrence strategies). Overall, we determined that accumulation of body fat during the growing season did not differ between migratory or resident modalities. However, calf survival was 2.6-2.9 times higher for individuals that migrated (survival, islands = 0.49 +/- 0.16 [mean +/- SE], n = 35; ridge = 0.52 +/- 0.16, n = 33) than those that did not (survival, resident = 0.19 +/- 0.08, n = 57). Our results support the predation risk avoidance hypotheses, and suggest that migration is a behavioral strategy that principally operates to reduce the risk of calf predation and does not confer explicit nutritional benefits. We did not directly detect trade-offs between predation risk and nutrition for migratory individuals. Yet we identify an indirect life history mechanism that may mildly dampen the apparent fitness benefits of migration. The proximate factors accounting for differences in migration-specific neonate survival are likely linked to accessibility of refugial habitats for moose at local and landscape scales, landscape factors that affect hunting efficacy of large carnivores, and interactions with rural human communities. Conservation of ungulate populations can be aided by integrating knowledge about migratory behavior, life history strategies, and factors that alter ungulate vulnerability, particularly those induced by human activity.
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Paradoxical Reduction in HDL-C with Fenofibrate and Thiazolidinedione Therapy In Type 2 Diabetes: the ACCORD Lipid Trial.
Diabetes Care
PUBLISHED: 12-02-2013
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ObjectiveTo determine the occurrence of extremely low HDL-C among participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid Trial and to examine the relationship of this finding with treatment with fenofibrate and thiazolidinedione (TZD).Research Design and MethodsThe ACCORD Lipid Trial was a randomized double blind placebo controlled study conducted in patients with type 2 diabetes at 77 clinical centers across the United States and Canada in a 5,518 patient sub-set of the larger 10,251 ACCORD Glycemia Trial. Patients were enrolled from January 11, 2001 until October 29, 2005 and followed until end of study visits between March 1 and June 30, 2009. Follow-up in ACCORD Lipid was 4 to 8 years (mean 4.7 years). Patients were treated with blinded fenofibrate or placebo on a background of simvastatin therapy. The main outcome measures for these descriptive, post hoc analyses was the occurrence of extremely low HDL-C (defined as < 25 mg/dl [0.647 mmol/L]) during the trial.ResultsAmong ACCORD Lipid Trial participants, the occurrence of extremely low HDL-C ever during study follow-up was 106% higher among those randomized to fenofibrate (10.1% fenofibrate vs. 4.9% placebo; P<0.001). The occurrence of low HDL-C was associated with concurrent treatment with fenofibrate and TZD (7.0% for both vs. 2.2% for neither at 48 months post-randomization).ConclusionsIdiosyncratic and marked reduction in HDL-C can occur in some patients treated with both fenofibrate and TZD. Practitioners should recognize this important potential idiosyncratic reaction and take appropriate corrective action.Trial registrationClinicalTrials.gov; identifier NCT00000620, http://clinicaltrials.gov/ct2/home.
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Algorithms to measure carotid intima-media thickness in trials: a comparison of reproducibility, rate of progression and treatment effect.
J. Hypertens.
PUBLISHED: 09-16-2011
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Current ultrasound protocols to measure carotid intima-media thickness (CIMT) in trials differ considerably. The best CIMT protocol would be one that combines high reproducibility, a large and precise estimate of the rate of CIMT progression and a large and precise estimate of the treatment effect. We performed a post-hoc analysis to determine the best algorithm for determining CIMT using data from the METEOR study, a randomized double-blind, placebo-controlled study of the effect of rosuvastatin on CIMT progression in 984 low coronary heart disease risk individuals with increased CIMT.
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The use of plaque score measurements to assess changes in atherosclerotic plaque burden induced by lipid-lowering therapy over time: the METEOR study.
J. Atheroscler. Thromb.
PUBLISHED: 05-27-2011
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To evaluate whether plaque scoring measurements are able to track changes in atherosclerotic plaque burden over time and to study whether this is affected by lipid-lowering therapy.
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Asymmetrical distribution of atherosclerosis in the carotid artery: identical patterns across age, race, and gender.
Eur J Prev Cardiol
PUBLISHED: 05-25-2011
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Small autopsy studies and clinical practice indicated that carotid atherosclerosis develops in an asymmetrical helical pattern coinciding with regions of low shear stress. We investigated the distribution of carotid atherosclerosis as determined by maximum carotid intima-media thickness (CIMT), to assess if we could confirm this atherosclerotic configuration across various populations with different cardiovascular risk.
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Effect of number of ultrasound examinations on the assessment of carotid intima-media thickness changes over time: the example of the METEOR study.
J. Hypertens.
PUBLISHED: 05-07-2011
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To evaluate the effect of the number and positioning during follow-up of ultrasound examinations on the rate of change in carotid intima-media thickness (CIMT) using METEOR (Measuring Effects on Intima-Media Thickness: an Evaluation of Rosuvastatin) as an example.
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The association between chronic stress type and C-reactive protein in the multi-ethnic study of atherosclerosis: does gender make a difference?
J Behav Med
PUBLISHED: 04-05-2011
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The objective of this study is to examine how chronic stress in major life domains [relationship, work, sympathetic-caregiving, financial] relates to CVD risk, operationalized using the inflammatory marker C-Reactive Protein (CRP), and whether gender differences exist. Participants were 6,583 individuals aged 45-84 years, recruited as part of the Multi-Ethnic Study of Atherosclerosis. Demographic and behavioral factors, health history, and chronic stress were self-reported. CRP was obtained through venous blood draw. In aggregate, gender by chronic stress interaction effects accounted for a significant, albeit small, amount of variance in CRP (P < .01). The sympathetic-caregiving stress by gender interaction was significant (P < .01); the work stress by gender effect approached significance (P = .05). Women with sympathetic-caregiving stress had higher CRP than those without, whereas no difference in CRP by stress group was observed for men. Findings underscore the importance of considering gender as an effect modifier in analyses of stress-CVD risk relationships.
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Factors associated with presence and extent of coronary calcium in those predicted to be at low risk according to Framingham risk score (from the Multi-Ethnic Study of Atherosclerosis).
Am. J. Cardiol.
PUBLISHED: 03-08-2011
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Even among asymptomatic persons at low risk (<10%) according to the Framingham risk score, high coronary artery calcium (CAC) scores signify a greater predicted risk of coronary heart disease events. We sought to determine the noninvasive factors (without radiation exposure) significantly associated with CAC in low-risk, asymptomatic persons. In a cross-sectional analysis, we studied 3,046 participants from the Multi-Ethnic Study of Atherosclerosis at a low 10-year predicted risk (Framingham risk score <10%) of coronary heart disease events. Multivariate logistic regression analysis was used to assess the association of novel markers with the presence of any CAC (CAC >0) and advanced CAC (CAC ? 300). A CAC level of >0 and of ? 300 was present in 30% and 3.5% of participants, respectively. Factor VIIIc, fibrinogen, and soluble intercellular adhesion molecule were each associated with the presence of CAC (p ? 0.02), and C-reactive protein, D-dimer, and the carotid intima-media thickness with advanced CAC (p ? 0.03). The base model combining the traditional risk factors had excellent discrimination for advanced CAC (C-statistic 0.808). The addition of the 2 best-fit models combining the biomarkers with or without carotid intima-media thickness improved the c-statistic to 0.822 and 0.820, respectively. All 3 models calibrated well but were similar in estimating the individual risk probabilities for advanced CAC (prevalence 9.97%, 10.63%, and 10.10% in the greatest quartiles of predicted probabilities vs 0.26%, 0.26%, and 0.26% in the lowest quartiles, respectively). In conclusion, in low-risk persons, the traditional risk factors alone predicted advanced CAC with high discrimination and calibration. The biomarker combinations with and without carotid intima-media thickness were also significantly associated with advanced CAC; however, the improvement in the prediction and estimation of the clinical risk were modest compared to the traditional risk factors alone.
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Extensive or restricted ultrasound protocols to measure carotid intima-media thickness: analysis of completeness rates and impact on observed rates of change over time.
J Am Soc Echocardiogr
PUBLISHED: 01-04-2011
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Ultrasound protocols to measure carotid intima-media thickness (CIMT) vary considerably with regard to carotid sites and angles that are assessed. Measurements from the carotid bifurcation and internal carotid artery are thought to be affected by large numbers of missing data. Actual published quantification of completeness rates and the relation with cardiovascular risk factors, however, is scarce. Also, it is currently unknown whether extensive ultrasound protocols including assessment of the carotid bifurcation and internal carotid artery add information in detecting rate of change in CIMT induced by drug therapy. These issues were addressed in this study using data from Measuring Effects on Intima-Media Thickness: An Evaluation of Rosuvastatin (METEOR).
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Effects of combination lipid therapy in type 2 diabetes mellitus.
N. Engl. J. Med.
PUBLISHED: 03-14-2010
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We investigated whether combination therapy with a statin plus a fibrate, as compared with statin monotherapy, would reduce the risk of cardiovascular disease in patients with type 2 diabetes mellitus who were at high risk for cardiovascular disease.
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30-year trends in serum lipids among United States adults: results from the National Health and Nutrition Examination Surveys II, III, and 1999-2006.
Am. J. Cardiol.
PUBLISHED: 03-03-2010
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Data from National Health and Nutrition Examination Survey (NHANES) II (1976 to 1980), NHANES III (1988 to 1994), and NHANES 1999 to 2006 were examined to assess trends in total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol, triglycerides (TGs), lipid-lowering medication use, and obesity. Age-adjusted decreases in TC (210 to 200 mg/dl) and LDL cholesterol (134 to 119 mg/dl) were observed. Those with high TC showed a decrease of 9% from NHANES II to NHANES 1999 to 2006, whereas those with LDL cholesterol ?160 mg/dl showed a decrease of 8%. A significant increase in mean high-density lipoprotein cholesterol was observed (50 to 53 mg/dl, p <0.001), most likely due to changes in methods. Those with TG levels ?150 mg/dl showed a decrease from NHANES II to NHANES III from 30% to 27% but then an increase from NHANES III to NHANES 1999 to 2006 from 27% to 33%. Since NHANES III, mean TG levels have increased 12% from 130 to 146 mg/dl. In the 2 most recent surveys, self-reported "high cholesterol" increased from 17% to 27%, and self-reported lipid medication use by those with high cholesterol increased from 16% to 38%. Mean body mass index increased from 26 to 29 kg/m(2), and prevalence of obesity doubled and was significantly associated with increased TG. In conclusion, recent favorable trends in TC and LDL cholesterol are likely due to increased awareness of high cholesterol and the greater use of lipid-lowering drugs. However, countertrends in obesity and TG levels, if continued, will likely have a negative impact on cardiovascular disease in the future.
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The epidemiology of subclavian stenosis and its association with markers of subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis (MESA).
Atherosclerosis
PUBLISHED: 01-08-2010
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Recent studies indicate that subclavian stenosis (SS), diagnosed by a large systolic blood pressure difference (SBPD) between the right and left brachial arteries, is associated with cardiovascular disease (CVD) risk factors and outcomes. We sought to describe the epidemiology of SS and determine its association with markers of subclinical CVD in the baseline cohort of the Multi-Ethnic Study of Atherosclerosis.
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Predictive value of brachial flow-mediated dilation for incident cardiovascular events in a population-based study: the multi-ethnic study of atherosclerosis.
Circulation
PUBLISHED: 07-27-2009
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Although brachial artery flow-mediated dilation (FMD) predicts recurrent cardiovascular events, its predictive value for incident cardiovascular disease (CVD) events in adults free of CVD is not well established. We assessed the predictive value of FMD for incident CVD events in the Multi-Ethnic Study of Atherosclerosis (MESA).
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Effect of rosuvastatin on the echolucency of the common carotid intima-media in low-risk individuals: the METEOR trial.
J Am Soc Echocardiogr
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The echolucency of the carotid intima-media is related to increased cardiovascular risk factor levels, morbidity, and mortality. The aim of this study was to assess the effect of statins on the echolucency of the common carotid intima-media in a low-risk population.
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Biologically implausible carotid intima-media thickness measurement values: effects on rate of change over time.
Curr Med Res Opin
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Carotid intima-media thickness (CIMT) is a marker of atherosclerosis that is commonly used to assess the effect of therapeutic interventions. It is currently unclear to what extent biologically implausible values affect treatment effects. We evaluated the impact of biologically implausible CIMT values on the estimated rate of change in CIMT.
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Multiple imputation of missing repeated outcome measurements did not add to linear mixed-effects models.
J Clin Epidemiol
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To assess the added value of multiple imputation (MI) of missing repeated outcomes measures in longitudinal data sets analyzed with linear mixed-effects (LME) models.
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Sample size requirements in trials using repeated measurements and the impact of trial design.
Curr Med Res Opin
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Sample size calculations for clinical trials generally use expected changes between groups, and variances obtained from the literature. However, this approach neglects the impact of differences in trial design. We studied the effects of variations in trial design on the required sample size.
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Reversibility of fenofibrate therapy-induced renal function impairment in ACCORD type 2 diabetic participants.
Diabetes Care
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To assess the reversibility of the elevation of serum creatinine levels in patients with diabetes after 5 years of continuous on-trial fenofibrate therapy.
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JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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