MARCIO SOMMER BITTENCOURT
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- Coronary Calcium Score vs. Computed Tomography Angiography as Tools to Stratify Cardiovascular Risk(2018) BITTENCOURT, Marcio S.This review evaluates the evidence for and against the use of coronary artery calcium (CAC) score and coronary computed tomography angiography (CTA) on the cardiovascular risk stratification for primary prevention in asymptomatic individuals. Recent evidence suggests that the presence and extent of CAC are robust predictors of events across various populations and variable baseline risk. On the other hand, the absence of CAC is associated with a good prognosis event in older individuals or in those with multiple risk factor or high clinical risk. While coronary CTA is also useful for risk stratification, its results did not provide incremental discrimination of individuals once the CAC is accounted for. Thus, current evidence does not support its use in asymptomatic individuals. CAC is a powerful tool for additional cardiovascular risk stratification in individuals where the need for pharmacological therapy for risk reduction in primary prevention is uncertain, such as in individuals with intermediate risk. Since coronary CTA does not further improve risk stratification in this population, it is not currently recommended in asymptomatic individuals.
- Right coronary artery fistula to the coronary sinus and right atrium associated with giant right coronary enlargement detected by transthoracic echocardiography(2011) BITTENCOURT, Marcio Sommer; SELTMAN, Martin; ACHENBACH, Stephan; ROST, Christian; ROPERS, DieterWe present the case of a 54-year-old female with a previous history of lung fibrosis secondary to methotrexate used for rheumatoid arthritis who was referred to cardiology evaluation due to precordial pain. Echocardiography showed biatrial enlargement with an enlarged coronary sinus and tubular image posterior to the heart. On the coronary angiogram, the right coronary artery was enlarged, and a distal fistula was identified. The patient underwent a contrast enhanced cardiac computed tomography which demonstrated an aneurysmatic right coronary artery with a distal fistula to the right atrium and coronary sinus. As the chest pain did not recur and there was a high risk of the intervention to correct coronary fistula, the patient remained on conservative treatment.
- Associations Between Coronary Artery Calcification and Left Ventricular Global Longitudinal Strain and Diastolic Parameters: the ELSA-Brasil Study(2023) HAAS, Priscila; SANTOS, Angela B. S.; CANON-MONTANEZ, Wilson; BITTENCOURT, Marcio S.; TORRES, Felipe S.; RIBEIRO, Antonio L. P.; DUNCAN, Bruce B.; FOPPA, MuriloAtherosclerosis burden can be evaluated in asymptomatic patients by measuring coronary artery calcification (CAC), whereas the global longitudinal strain (GLS) and diastolic function parameters (mitral E/e' ratio, septal e', and lateral e') are used to evaluate sub-clinical left ventricular (LV) dysfunction. We investigated whether subjects with CAC (CAC >0 Agatston units) would present with an impairment in LV functional parameters. Among the participants of the ELSA-Brasil cohort free of clinically prevalent cardiovas-cular disease who performed cardiac computed tomography and echocardiography within the study protocol, we tested whether those with CAC >0 presented with worse GLS and diastolic function parameters. CAC >0 was present in 203 of the 612 included participants (33.17%; age 51.4 +/- 8.6 years, 52.1% women). Absolute CAC values did not correlate with GLS (ro = 0.07, p = 0.105) but did so with E/e' (ro = 0.19, p <0.001), septal e' (ro = 0.28, p <0.001), and lateral e' (ro = 0.30, p <0.001), with stronger correlations in men. Those with CAC >0 had worse mitral E/e' ratios (7.75 +/- 0.13 vs 7.01 +/- 0.09; p =0.001), septal e' (8.25 +/- 0.15 vs 9.59 +/- 0.11 cm/s; p <0.001), and lateral e' (10.13 +/- 0.20 vs 11.99 +/- 0.14 cm/s; p =0.001), respectively. However, these associations were not independent of diabetes, obesity, hypertension, smoking, and low-density lipoprotein cho-lesterol, persisting only as significant associations of CAC >0 with mitral E/e' ratio and septal e' in men. There is an association between subclinical coronary atherosclerosis and impaired LV functional parameters. These associations are more likely attributed to the presence of common cardiovascular risk factors in the general population. However, in men, it seems to exist as an independent association.
- Sex-specific performance of the ASCVD pooled cohort equation risk calculator as a correlate of coronary artery calcium in Kampala, Uganda(2022) KENTOFFIO, Katherine; DURSTENFELD, Matthew S.; SIEDNER, Mark J.; KITYO, Cissy; EREM, Geoffrey; SSINABULYA, Isaac; GHOSHHAJRA, Brian; BITTENCOURT, Marcio S.; LONGENECKER, Chris T.Introduction: The prevalence of cardiovascular disease (CVD) is rising in Sub-Saharan Africa, but it is not known whether current risk assessment tools predict coronary atherosclerosis in the region. Furthermore, sex-specific performance and interaction with HIV serostatus has not been well studied. Methods: This cross-sectional study compared ASCVD risk scores and detectable coronary artery calcium (CAC>0) by sex in Kampala, Uganda (n = 200). The cohort was enriched for persons living with HIV, and all participants had at least one CVD risk factor. We fit log binomial regression models and constructed ROC curves to assess the correlation between ASCVD scores and CAC>0. Results: The mean age was 56. 62% were female and 50% of both men and women were living with HIV. The median 10-year ASCVD risk score was significantly higher in men (11.0%, IQR 7.6???19.4%) than in women (5.1%, IQR 3.2???8.7%), although the prevalence of CAC>0 was similar (8.1 vs 10.5%, p = 0.63). Each 10% increase in ASCVD risk was associated with increased risk of CAC>0 in men (PR 1.59, 95% CI 1.00???2.55, p = 0.05) but not women (PR 1.15, 95% CI 0.44???3.00, p = 0.77). ROC curves demonstrated an AUC of 0.57 for women vs 0.70 for men. Adjustment for HIV serostatus improved the predictive value of ASCVD in women only (AUC 0.78, p = 0.02). Conclusions: ASCVD risk score did not correlate with the presence of CAC in women. When HIV status was added to the ASCVD risk score, correlation with CAC was improved in women but not in men.
- Whole-genome sequencing uncovers two loci for coronary artery calcification and identifies ARSE as a regulator of vascular calcification(2023) VRIES, Paul S. de; CONOMOS, Matthew P.; SINGH, Kuldeep; NICHOLSON, Christopher J.; JAIN, Deepti; HASBANI, Natalie R.; JIANG, Wanlin; LEE, Sujin; CARDENAS, Christian L. Lino; LUTZ, Sharon M.; WONG, Doris; GUO, Xiuqing; YAO, Jie; YOUNG, Erica P.; TCHEANDJIEU, Catherine; HILLIARD, Austin T.; BIS, Joshua C.; BIELAK, Lawrence F.; BROWN, Michael R.; MUSHAROFF, Shaila; CLARKE, Shoa L.; TERRY, James G.; PALMER, Nicholette D.; YANEK, Lisa R.; XU, Huichun; HEARD-COSTA, Nancy; WESSEL, Jennifer; SELVARAJ, Margaret Sunitha; LI, Rebecca H.; SUN, Xiao; TURNER, Adam W.; STILP, Adrienne M.; KHAN, Alyna; NEWMAN, Anne B.; RASHEED, Asif; FREEDMAN, Barry I.; KRAL, Brian G.; MCHUGH, Caitlin P.; HODONSKY, Chani; SALEHEEN, Danish; HERRINGTON, David M.; JACOBS JR., David R.; NICKERSON, Deborah A.; BOERWINKLE, Eric; WANG, Fei Fei; HEISS, Gerardo; JUN, Goo; KINNEY, Greg L.; SIGURSLID, Haakon H.; DODDAPANENI, Harshavardhan; HALL, Ira M.; BENSENOR, Isabela M.; BROOME, Jai; CRAPO, James D.; WILSON, James G.; SMITH, Jennifer A.; BLANGERO, John; VARGAS, Jose D.; MOSQUERA, Jose Verdezoto; SMITH, Joshua D.; VIAUD-MARTINEZ, Karine A.; RYAN, Kathleen A.; YOUNG, Kendra A.; TAYLOR, Kent D.; LANGE, Leslie A.; EMERY, Leslie S.; BITTENCOURT, Marcio S.; BUDOFF, Matthew J.; MONTASSER, May E.; YU, Miao; MAHANEY, Michael C.; MAHAMDEH, Mohammed S.; FORNAGE, Myriam; FRANCESCHINI, Nora; LOTUFO, Paulo A.; NATARAJAN, Pradeep; WONG, Quenna; MATHIAS, Rasika A.; GIBBS, Richard A.; DO, Ron; MEHRAN, Roxana; TRACY, Russell P.; KIM, Ryan W.; NELSON, Sarah C.; DAMRAUER, Scott M.; KARDIA, Sharon L. R.; RICH, Stephen S.; FUSTER, Valentin; NAPOLIONI, Valerio; ZHAO, Wei; TIAN, Wenjie; YIN, Xianyong; I, Yuan- Min; MANNING, Alisa K.; PELOSO, Gina; KELLY, Tanika N.; O'DONNELL, Christopher J.; MORRISON, Alanna C.; CURRAN, Joanne E.; ZAPOL, Warren M.; BOWDEN, Donald W.; BECKER, Lewis C.; CORREA, Adolfo; MITCHELL, Braxton D.; PSATY, Bruce M.; CARR, John Jeffrey; PEREIRA, Alexandre C.; ASSIMES, Themistocles L.; STITZIEL, Nathan O.; HOKANSON, John E.; LAURIE, Cecelia A.; ROTTER, Jerome I.; VASAN, Ramachandran S.; POST, Wendy S.; PEYSER, Patricia A.; MILLER, Clint L.; MALHOTRA, RajeevCoronary artery calcification (CAC) is a measure of atherosclerosis and a well-established predictor of coronary artery disease (CAD) events. Here we describe a genome-wide association study of CAC in 22,400 participants from multiple ancestral groups. We confirmed associations with four known loci and identified two additional loci associated with CAC (ARSE and MMP16), with evidence of significant associations in replication analyses for both novel loci. Functional assays of ARSE and MMP16 in human vascular smooth muscle cells (VSMCs) demonstrate that ARSE is a promoter of VSMC calcification and VSMC phenotype switching from a contractile to a calcifying or osteogenic phenotype. Furthermore, we show that the association of variants near ARSE with reduced CAC is likely explained by reduced ARSE expression with the G allele of enhancer variant rs5982944. Our study highlights ARSE as an important contributor to atherosclerotic vascular calcification and a potential drug target for vascular calcific disease. de Vries, Conomos, Singh and Nicholson et al. identify two additional loci associated with coronary artery calcification (ARSE and MMP16) via a genome-wide association study in 22,400 participants from multiple ancestral groups and prove that ARSE is a mediator of vascular smooth muscle cell calcification and phenotype switching.
- Ingestion of magnesium was not associated with coronary calcium score in a cross-sectional study(2021) LEVY, Jessica; MIRANDA, Andreia Alexandra Machado; CARLI, Eduardo De; BITTENCOURT, Marcio Sommer; BENSENOR, Isabela Judith; LOTUFO, Paulo Andrade; MARCHIONI, Dirce MariaBackground and aims: Magnesium plays a key role in glucose metabolism, vascular tone, and inflammation. Therefore, it might be a dietary risk factor for cardiovascular diseases. In vitro and animal studies have suggested a decrease in vascular calcification with an increase in the magnesium intake. The objective of the present study was to investigate the association between magnesium intake and coronary artery calcium (CAC) score among participants of the ELSA-Brasil. Methods: This is an observational, cross-sectional study undertaken with a sub-sample from the ELSA-Brasil baseline data. In this sub-sample, only participants with CAC examination data were included (n = 4,306). Dietary intake was assessed by a validated food frequency questionnaire. The association between magnesium intake and presence of CAC (0 versus > 0) was investigated using multiple logistic regression models. Results: The participants were predominantly female (54.4 %), with self-reported white skin color (59.1 %), no smoking habit (53.7 %) and undergraduate or postgraduate education (44.4 %). The range of magnesium consumption was 37.24 - 1266.31 mg/day. CAC prevalence was 28.4 %. No significant association was found between magnesium intake and CAC after adjustments for diet, lifestyle, and clinical characteristics. In a first univariate model, the fifth quintile of magnesium intake, in comparison to the first quintile (lowest intake), resulted in an OR = 1.25, 95 % CI: 1.01 - 1.54 (P-linear trend = 0.005). However, in the last fully adjusted model, the fifth quintile of magnesium intake resulted in OR = 0.86, 95 % CI: 0.64 - 1.17 (P-linear trend = 0.239). Conclusions: In ELSA-Brasil, the intake of magnesium was not associated with the presence of coronary artery calcification.
- Association of Lipoprotein Subfractions With Atherosclerosis in the Baseline Sample of ELSA-Brasil Cohort Study - A Cross-Sectional Analysis(2023) TEBAR, William R.; MENEGHINI, Vandrize; GOULART, Alessandra C.; SANTOS, Itamar S.; SANTOS, Raul D.; BITTENCOURT, Marcio S.; GENEROSO, Giuliano; PEREIRA, Alexandre; BLAHA, Michael J.; JONES, Steven R.; TOTH, Peter P.; OTVOS, James D.; LOTUFO, Paulo A.; BENSENOR, Isabela M.
- Renin-angiotensin System Antagonists and Beta-blockers in Prevention of Anthracycline Cardiotoxicity: a Systematic Review and Meta-analysis(2023) AVILA, Monica Samuel; SIQUEIRA, Suellen Rodrigues Rangel; WALDECK, Lucas; AYUB-FERREIRA, Silvia Moreira; TAKX, Richard; BITTENCOURT, Marcio Sommer; BOCCHI, Edimar AlcidesBackground: The evidence supporting the use of renin-angiotensin-aldosterone system (RAAS) inhibitors and beta-blockers for the prevention of anthracycline-induced cardiomyopathy is controversial. Objective: We performed a meta-analysis to assess the effectiveness of these drugs in preventing cardiotoxicity. Methods: The meta-analysis included prospective, randomized studies in adults receiving anthracycline chemotherapy and compared the use of RAAS inhibitors or beta-blockers versus placebo with a follow-up of 6 to 18 months. The primary outcome was change in left ventricular ejection fraction (LVEF) during chemotherapy. Secondary outcomes were the incidence of heart failure, all-cause mortality, and changes in end-diastolic measurement. Heterogeneity was assessed by stratification and meta-regression. A significance level of p < 0.05 was adopted. Results: The search resulted in 17 studies, totaling 1,530 patients. The variation (delta) in LVEF was evaluated in 14 studies. Neurohormonal therapy was associated with a lower delta in pre- versus post-therapy LVEF (weighted mean difference 4.42 [95% confidence interval2.3 to 6.6]) and higher final LVEF (p < 0.001). Treatment resulted in a lower incidence of heart failure (risk ratio 0.45 [95% confidence interval0.3 to 0.7]). There was no effect on mortality (p = 0.3). For analysis of LVEF, substantial heterogeneity was documented, which was not explained by the variables explored in the study. Conclusion: The use of RAAS inhibitors and beta-blockers to prevent anthracycline-induced cardiotoxicity was associated with less pronounced reduction in LVEF, higher final LVEF, and lower incidence of heart failure. No changes in mortalitywere observed. (CRD PROSPERO 42019133615)
- The risk of cardiometabolic disorders in lean non-alcoholic fatty liver disease: A longitudinal study(2020) ANENI, Ehimen C.; BITTENCOURT, Marcio Sommer; TENG, Catherine; CAINZOS-ACHIRICA, Miguel; OSONDU, Chukwuemeka U.; SOLIMAN, Ahmed; AL-MALLAH, Mouaz; BUDDOFF, Matthew; PARISE, Edison R.; SANTOS, Raul D.; NASIR, KhurramBackground: Recent studies suggest that non-alcoholic fatty liver disease (NAFLD) in lean (BMI<25 kg/m(2)) individuals presents a distinct phenotype. We sought to determine the cardiometabolic consequences of lean NAFLD in a population cohort of relatively young asymptomatic individuals who participated in a voluntary routine health promotion evaluation in Brazil. Methods: We analyzed data in our population collected from 2004 to 2016. Medical and demographic history, anthropometric measures, and fasting blood samples were obtained. Participants had ultrasonography to assess for fatty liver. We defined NAFLD as fatty liver in individuals scoring below 8 on the alcohol use disorders identification test (AUDIT). We included data from 9137 individuals who had complete data at baseline and at follow-up. Results: The prevalence of lean NAFLD in our cohort was 3.8%. Over the median follow-up period of 2.4 years (range 0.5 -9.9 years), lean individuals had 74% (HR: 1.74 (1.39 -2.18)) and 67% (1.67 (1.29 -2.15)) greater risk of developing elevated BP and elevated glucose, and nearly 3 times the risk of atherogenic dyslipidemia (HR: 2.98 (2.10 -4.24)) compared to lean individuals without NAFLD. Lean NAFLD individuals also had higher risk of developing elevated glucose (HR: 1.37 (1.07 -1.75)) and atherogenic dyslipidemia (1.46 (1.05 -2.01)) compared to non-lean individuals without NAFLD. However, there was no significant difference in the risk of elevated BP, elevated glucose or atherogenic dyslipidemia between lean NAFLD and non-lean individuals with NAFLD in fully adjusted models. Conclusion: Lean NAFLD is not metabolically benign. Further cardiovascular risk stratification and appropriate preventive measures should be considered in lean individuals who present with NAFLD.
- Neck circumference is associated with non-traditional cardiovascular risk factors in individuals at low-to-moderate cardiovascular risk: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)(2018) ALMEIDA-PITITTO, B.; SILVA, I. T.; GOULART, A. C.; FONSECA, M. I. H.; BITTENCOURT, M. S.; SANTOS, R. D.; BLAHA, M.; JONES, S.; TOTH, P. P.; KULAKARNI, K.; LOTUFO, P. A.; BENSENOR, I. M.; FERREIRA, S. R. G.Background: Neck circumference (NC) is associated with traditional cardiovascular risk factors (CVRF), but its usefulness to identify earlier atherogenic risk has been scarcely examined. Associations of NC with non-traditional CVRF were investigated in participants at low-to-moderate risk from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: 807 individuals (35-54 years) without obesity, diabetes or cardiovascular disease was stratified into quartiles of NC (cut-off for men: 36.5; 37.9 and 39.5 cm; women: 31.4; 32.5 and 34 cm) and traditional and non-traditional risk factors (lipoprotein subfractions by Vertical Auto Profile, adiponectin, leptin, E-selectin) were compared across groups. In linear regression models, associations of NC with non-traditional risk factors were tested for the entire sample and for low-risk group (<= 2 CVRF). Results: In both sexes, BMI, waist circumference, systolic and diastolic blood pressure, fasting and 2-h plasma glucose, HOMA-IR, triglycerides, leptin, E-selectin, small dense LDL-cholesterol, IDL-cholesterol, VLDL3-cholesterol and TG/HDL ratio increased significantly, while HDL2-cholesterol and HDL3-cholesterol decreased across NC quartiles. In linear regression models, a direct association [beta(95% CI)] of NC with leptin [(0.155 (0.068-0.242); 0.147 (0.075-0.220)], E-selectin [(0.105 (0.032-0.177); 0.073 (0.006 to 0.140)] and small-dense LDL [(1.866 (0.641-3.091); 2.372 (1.391-3.353)] and an inverse association with HDL2-cholesterol [(-0.519 (-0.773 to -0.266); -0.815 (-1.115 to 0.515)] adjusted for age were detected for men and women, respectively. Conclusion: Our findings indicate that measurement of NC may be useful for an earlier identification of unfavorable atherogenic metabolic profile in middle-aged individuals at lower cardiovascular risk level.