Context: Very-long-chain n-3 polyunsaturated fatty acids(omega-3 PUFAs) from fish are thought to reduce risk of sudden death, possibly by reducing susceptibility to cardiac arrhythmia. Objective: To study the effect o...Context: Very-long-chain n-3 polyunsaturated fatty acids(omega-3 PUFAs) from fish are thought to reduce risk of sudden death, possibly by reducing susceptibility to cardiac arrhythmia. Objective: To study the effect of supplemental fish oil vs placebo on ventricular tachyarrhythmia or death. Design, Setting, and Patients: The Study on Omega-3 Fatty acids and ventricular Arrhythmia(SOFA) was a randomized, parallel, placebo-controlled, double-blind trial conducted at 26 cardiology clinics across Europe. A total of 546 patients with implantable cardioverter-defibrillators(ICDs) and prior documented malignant ventricular tachycardia(VT) or ventricular fibrillation(VF) were enrolled between October 2001 and August 2004. Patients were randomly assigned to receive 2 g/d of fish oil(n=273) or placebo(n=273) for a median period of 356 days(range, 14-379 days). Main Outcome Measure: Appropriate ICD intervention for VT or VF, or all-cause death. Results: The primary end point occurred in 81(30%) patients taking fish oil vs 90(33%) patients taking placebo(hazard ratio[HR], 0.86; 95%confidence interval[CI], 0.64-1.16; P=.33). In prespecified subgroup analyses, the HR was 0.91(95%CI, 0.66-1.26) for fish oil vs placebo in the 411 patients who had experienced VT in the year before the study, and 0.76(95%CI, 0.52-1.11) for 332 patients with prior myocardial infarctions. Conclusion: Our findings do not indicate evidence of a strong protective effect of intake of omega-3 PUFAs from fish oil against ventricular arrhythmia in patients with ICDs.展开更多
Background: Adults with diabetes are thought to have a high risk of cardiovascular disease(CVD), irrespective of their age. The main aim of this study was to find out the age at which people with diabetes develop a hi...Background: Adults with diabetes are thought to have a high risk of cardiovascular disease(CVD), irrespective of their age. The main aim of this study was to find out the age at which people with diabetes develop a high risk of CVD, as defined by: an event rate equivalent to a 10-year risk of 20%or more; or an event rate equivalent to that associated with previous myocardial infarction. Methods: We did a population-based retrospective cohort study using provincial health claims to identify all adults with(n=379 003) and(n=9 018 082) without diabetes mellitus living in Ontario, Canada, on April 1, 1994. Individuals were followed up to record CVD events until March 31, 2000. Findings: The transition to a high-risk category occurred at a younger age for men and women with diabetes than for those without diabetes(mean difference 14.6 years). For the outcome of acute myocardial infarction(AMI), stroke, or death from any cause, diabetic men and women entered the high-risk category at ages 47.9 and 54.3 years respectively. When we used a broader definition of CVD that also included coronary or carotid revascularisation, the ages were 41.3 and 47.7 years for men and women with diabetes respectively. Interpretation: Diabetes confers an equivalent risk to ageing 15 years. However, in general, younger people with diabetes(age 40 or younger) do not seem to be at high risk of CVD. Age should be taken into account in targeting of risk reduction in people with diabetes.展开更多
Background and Purpose -Perioperative risk and long-term benefit of carot id endarterectomy (CE) are not detailed in women with symptomatic internal carot id artery (ICA) stenosis. Our aim was to compare the efficacy ...Background and Purpose -Perioperative risk and long-term benefit of carot id endarterectomy (CE) are not detailed in women with symptomatic internal carot id artery (ICA) stenosis. Our aim was to compare the efficacy of CE versus medic al therapy in women and men with symptomatic ICA stenosis. Methods -Data were taken from the North Amercan Symptomatic Carotid Endarterectomy Trial (873 wome n, 2012 men) and the ASA and Carotid Endarterectomy trial (335 women, 813 men). Results -The 30-day perioperative risk of death was higher in women than in men (2.3% versus 0.8% , P=0.002). Higher perioperative risk of stroke and dea th was also observed (7.6% versus 5.9% ) but not statistically significant. W ith ≥ 70% stenosis, the 5-year absolute risk reduction (ARR)-in stroke fr om CE was similar between women (15.1% ) and men (17.3% ). With 50% to 69% stenosis, CE was not beneficial in women (ARR=3.0% , P=0.94), contrary to men (ARR=10.0% , P=0.02). Medically treated women had low risk for stroke. A stroke prognosis instrument (SPI-II) assigned points to 7 factors that identified hi gher risk for medically treated women: 3 points for hemispheric (not retinal) ev ent, history of diabetes, previous stroke; 2 for age older than 70 years, stroke (not transient ischemic attack); 1 for severe hypertension, history of myocardi al infarction. CE was beneficial only for 29.0% of women with 50% to 69% s tenosis who had the highest total score of 8 to 15 (ARR=8.9% ). Conclusions - Women and men with ≥ 70% symptomatic stenosis had similar long-term benefit from CE,although the perioperative risks were higher for women. CE was not bene ficial for women with 50% to 69% stenosis without other risk factors for str oke.展开更多
Background-Atrial fibrillation(AF) is a frequently encountered arrhythmia aft er cardiac surgery, but its underlying mechanisms are still unclear. We hypothes ize that autoimmune and inflammatory responses against hea...Background-Atrial fibrillation(AF) is a frequently encountered arrhythmia aft er cardiac surgery, but its underlying mechanisms are still unclear. We hypothes ize that autoimmune and inflammatory responses against heat shock protein 65(HSP 65) may be involved and hence examined the relationship between HSP65 autoantibo dies and occurrence of postoperative AF. Methods and Results-A prospective stud y of 329 patients undergoing elective primary CABG was undertaken. Cardiovascula r risk factors, ECG characteristics, medications, and intraoperative and postope rative features were documented. Anti-HSP65 antibodies and Creactive protein le vels were measured in all preoperative blood samples with ELISA. Postoperative A F was defined as the characteristic arrhythmia, lasting for at least 15 minutes and confirmed on 12-lead ECG and occurring within the first postoperative week. This occurred in 62 patients(19%). In univariate analysis, HSP65 antibodies we re significantly higher in patients with postoperative AF(P=0.02). History of pr evious myocardial infarction, duration of bypass, number of distal anastomosis, and duration of ventilation were also associated with AF (P< 0.05), but C-react ive protein levels were not(P=0.13). Multivariate analysis confirmed the positiv e association of HSP65 antibodies with postoperative AF(OR, 1.41; P=0.04) indepe ndent of age, sex, other cardiovascular risk factors, severity of coronary arter y disease, duration of ventilation, duration of bypass, and left ventricular fun ction. Conclusions-We report a novel association between anti-HSP65 antibodies and occurrence of postoperative AF, indicating a possible role for antibody-me diated immune response in its pathogenesis.展开更多
Objectives: We evaluated the feasibility of using late gadolinium- enhanced(LGE) cardiovascular magnetic resonance(CMR) to distinguish left ventricular(LV) systolic dysfunction related or not to coronary artery diseas...Objectives: We evaluated the feasibility of using late gadolinium- enhanced(LGE) cardiovascular magnetic resonance(CMR) to distinguish left ventricular(LV) systolic dysfunction related or not to coronary artery disease(CAD) in patients with heart failure(HF) but without clinical suspicion of CAD as the underlying cause. Background: In patients with known CAD, LGE- CMR is capable of distinguishing LV systolic dysfunction related to CAD from dilated cardiomyopathy. Methods: Seventy- one patients with HF and LV systolic dysfunction,without a previous history of myocardial infarction, with neither Q waves nor clinical data suggesting CAD, underwent both LGE- CMR and coronary angiography. Results: Twenty- six patients(37% ) had angiographically proven CAD(< 70% stenosis of a major epicardial vessel)(angio[+ ] group), and 45(63% ) had unobstructed coronary arteries(angio[- ] group). Twenty- one patients in the angio(+ ) group(21 of 26, 81% ) showed subendocardial and/or transmural enhancement, whereas only 4(9% ) of 45 in the angio(- ) group showed it(p< 0.001). In 7 patients(7 of 71, 10% ),we found a different pattern of mid- wall enhancement- namely, 3 of 26 patients in the angio(+ ) group and 4 of 45 in the angio(- ) group(11% vs. 9% , p=0.7). Mid- wall enhancement in the angio(+ ) group was distributed in segments other than those which had subendocardial enhancement. Conclusions: In patients with HF and LV systolic dysfunction without clinical suspicion of CAD, LGE- CMR is an excellent tool for classifying patients in relation to the presence or absence of underlying CAD. Thus, CMR might offer a valid alternative to coronary angiography for the detection of CAD in these patients.展开更多
Objectives: To determine predictors of outcome after percutaneous coronary intervention(PCI) in patients with cardiogenic shock complicating acute myocardial infarction. Methods: Retrospective analysis of a cohort of ...Objectives: To determine predictors of outcome after percutaneous coronary intervention(PCI) in patients with cardiogenic shock complicating acute myocardial infarction. Methods: Retrospective analysis of a cohort of 113 patients undergoing emergency coronary angiography and attempted PCI for cardiogenic shock complicating acute myocardial infarction in a regional cardiothoracic unit. Results: In-hospital mortality was 51%(58 patients). Adverse outcome was associated with previous myocardial infarction, age over 70 years, cardiogenic shock complicating failure to respond to thrombolytic treatment(failed thrombolysis), and multivessel coronary artery disease. Multivariate logistic regression analysis showed that the first three factors were independent predictors of in-hospital death with odds ratios of 5.21(95%confidence interval(CI) 1.85 to 14.69), 4.02(95%CI 1.14 to 14.12), and 3.78(95%CI 1.43 to 9.96), respectively. Conclusion: About 50%of patients with cardiogenic shock undergoing a strategy of urgent coronary angiography and PCI survive to hospital discharge. Survivors do well in the subsequent six months. Emergency PCI for cardiogenic shock reduces mortality from an expected 80%to about 50%. Clinical features can help determine which patients are most likely to gain from urgent coronary angiography and attempted PCI. Alternative strategies are needed to improve the outcome of patients who fare badly.展开更多
This study was designed to evaluate the relationship between plasma leptin and prognosis in patients with angiographically confirmed coronary atherosclerosis. Experimental studies suggest that leptin, an adipose tissu...This study was designed to evaluate the relationship between plasma leptin and prognosis in patients with angiographically confirmed coronary atherosclerosis. Experimental studies suggest that leptin, an adipose tissue-derived hormone, exerts important cardiovascular effects. Study subjects were recruited prospectively from a cohort of patients undergoing clinically indicated coronary angiography (n=382). The median duration of follow-up was four years. Follow-up information was available for 361 patients. The combined end point of cardiac death, myocardial infarction(MI), cerebrovascular accident, or re-vascularization occurred in 44 subjects. In the simple Cox model, leptin had a significant(p< 0.001) non-linear/cubic univariate relationship with the combined end point. Other variables associated with prognosis in the univariate analysis were body mass index (BMI), prior MI, insulin resistance, Creactive protein(CRP), fibrinogen, and number of coronary vessels with >50%stenosis. A positive relationship between leptin and prognosis was also seen when leptin levels were split by quintiles, with a hazard ratio of 6.46 for the highest quintile. The only two variables significantly associated with the combined end point in the multivariate Cox model were leptin(p= 0.004) and number of coronary vessels with >50%stenosis(p< 0.001). A similar relationship between leptin and prognosis was observedwhen leptinwas adjusted forBMI. In patientswith angiographically confirmed coronary atherosclerosis, leptin is a novel predictor of future cardiovascular events independent of other risk factors, including lipid status and CRP.展开更多
Objectives: The goal of this study was to determine the relationship between established cardiovascular risk factors and the extent of coronary atherosclerotic plaque. Background: Few data exist correlating cardiovasc...Objectives: The goal of this study was to determine the relationship between established cardiovascular risk factors and the extent of coronary atherosclerotic plaque. Background: Few data exist correlating cardiovascular risk factors with volumetric measurements of coronary atheroma burden in patients with coronary artery disease. Methods: Clinical characteristics, quantitative coronary angiography,and intravascular ultrasound(IVUS) were evaluated in subjects enrolled in a study comparing atorvastatin and pravastatin. Plaque areas were measured at 1-mm intervals to compute atheroma volume. The percent of cross sections with an abnormal intimal thickness( >0.5 mm) was determined. Data on cardiovascular risk factors were collected. Results: In 654 subjects, atheroma volume averaged 174.5 mm3 and percent atheroma volume 38.9%. Atherosclerosis was present in 81.2%of 25,897 cross sections. In univariate analysis, there was a strong association between diabetes, male gender, and a history of either prior revascularization or stroke with percent atheroma volume. Hypertension or prior myocardial infarction was also predictive of more severe disease. Low-density lipoprotein and C-reactive protein were not significant predictors of greater disease burden. In multivariate analysis, diabetes, male gender, and a history of a prior interventional procedure remained strong predictors of increased atheroma volume. History of stroke, non-Caucasian race, and smoking status remained significant. Although multiple measures of IVUS disease burden were worse in subjects with diabetes, angiographic stenosis severity was not different. Conclusions: Male gender, diabetes, and a history of prior revascularization are strong independent predictors of atherosclerotic burden in coronary disease patients. Many risk factors did not predict angiographic disease severity, suggesting different mechanisms drive stenosis development and atheroma accumulation.展开更多
文摘Context: Very-long-chain n-3 polyunsaturated fatty acids(omega-3 PUFAs) from fish are thought to reduce risk of sudden death, possibly by reducing susceptibility to cardiac arrhythmia. Objective: To study the effect of supplemental fish oil vs placebo on ventricular tachyarrhythmia or death. Design, Setting, and Patients: The Study on Omega-3 Fatty acids and ventricular Arrhythmia(SOFA) was a randomized, parallel, placebo-controlled, double-blind trial conducted at 26 cardiology clinics across Europe. A total of 546 patients with implantable cardioverter-defibrillators(ICDs) and prior documented malignant ventricular tachycardia(VT) or ventricular fibrillation(VF) were enrolled between October 2001 and August 2004. Patients were randomly assigned to receive 2 g/d of fish oil(n=273) or placebo(n=273) for a median period of 356 days(range, 14-379 days). Main Outcome Measure: Appropriate ICD intervention for VT or VF, or all-cause death. Results: The primary end point occurred in 81(30%) patients taking fish oil vs 90(33%) patients taking placebo(hazard ratio[HR], 0.86; 95%confidence interval[CI], 0.64-1.16; P=.33). In prespecified subgroup analyses, the HR was 0.91(95%CI, 0.66-1.26) for fish oil vs placebo in the 411 patients who had experienced VT in the year before the study, and 0.76(95%CI, 0.52-1.11) for 332 patients with prior myocardial infarctions. Conclusion: Our findings do not indicate evidence of a strong protective effect of intake of omega-3 PUFAs from fish oil against ventricular arrhythmia in patients with ICDs.
文摘Background: Adults with diabetes are thought to have a high risk of cardiovascular disease(CVD), irrespective of their age. The main aim of this study was to find out the age at which people with diabetes develop a high risk of CVD, as defined by: an event rate equivalent to a 10-year risk of 20%or more; or an event rate equivalent to that associated with previous myocardial infarction. Methods: We did a population-based retrospective cohort study using provincial health claims to identify all adults with(n=379 003) and(n=9 018 082) without diabetes mellitus living in Ontario, Canada, on April 1, 1994. Individuals were followed up to record CVD events until March 31, 2000. Findings: The transition to a high-risk category occurred at a younger age for men and women with diabetes than for those without diabetes(mean difference 14.6 years). For the outcome of acute myocardial infarction(AMI), stroke, or death from any cause, diabetic men and women entered the high-risk category at ages 47.9 and 54.3 years respectively. When we used a broader definition of CVD that also included coronary or carotid revascularisation, the ages were 41.3 and 47.7 years for men and women with diabetes respectively. Interpretation: Diabetes confers an equivalent risk to ageing 15 years. However, in general, younger people with diabetes(age 40 or younger) do not seem to be at high risk of CVD. Age should be taken into account in targeting of risk reduction in people with diabetes.
文摘Background and Purpose -Perioperative risk and long-term benefit of carot id endarterectomy (CE) are not detailed in women with symptomatic internal carot id artery (ICA) stenosis. Our aim was to compare the efficacy of CE versus medic al therapy in women and men with symptomatic ICA stenosis. Methods -Data were taken from the North Amercan Symptomatic Carotid Endarterectomy Trial (873 wome n, 2012 men) and the ASA and Carotid Endarterectomy trial (335 women, 813 men). Results -The 30-day perioperative risk of death was higher in women than in men (2.3% versus 0.8% , P=0.002). Higher perioperative risk of stroke and dea th was also observed (7.6% versus 5.9% ) but not statistically significant. W ith ≥ 70% stenosis, the 5-year absolute risk reduction (ARR)-in stroke fr om CE was similar between women (15.1% ) and men (17.3% ). With 50% to 69% stenosis, CE was not beneficial in women (ARR=3.0% , P=0.94), contrary to men (ARR=10.0% , P=0.02). Medically treated women had low risk for stroke. A stroke prognosis instrument (SPI-II) assigned points to 7 factors that identified hi gher risk for medically treated women: 3 points for hemispheric (not retinal) ev ent, history of diabetes, previous stroke; 2 for age older than 70 years, stroke (not transient ischemic attack); 1 for severe hypertension, history of myocardi al infarction. CE was beneficial only for 29.0% of women with 50% to 69% s tenosis who had the highest total score of 8 to 15 (ARR=8.9% ). Conclusions - Women and men with ≥ 70% symptomatic stenosis had similar long-term benefit from CE,although the perioperative risks were higher for women. CE was not bene ficial for women with 50% to 69% stenosis without other risk factors for str oke.
文摘Background-Atrial fibrillation(AF) is a frequently encountered arrhythmia aft er cardiac surgery, but its underlying mechanisms are still unclear. We hypothes ize that autoimmune and inflammatory responses against heat shock protein 65(HSP 65) may be involved and hence examined the relationship between HSP65 autoantibo dies and occurrence of postoperative AF. Methods and Results-A prospective stud y of 329 patients undergoing elective primary CABG was undertaken. Cardiovascula r risk factors, ECG characteristics, medications, and intraoperative and postope rative features were documented. Anti-HSP65 antibodies and Creactive protein le vels were measured in all preoperative blood samples with ELISA. Postoperative A F was defined as the characteristic arrhythmia, lasting for at least 15 minutes and confirmed on 12-lead ECG and occurring within the first postoperative week. This occurred in 62 patients(19%). In univariate analysis, HSP65 antibodies we re significantly higher in patients with postoperative AF(P=0.02). History of pr evious myocardial infarction, duration of bypass, number of distal anastomosis, and duration of ventilation were also associated with AF (P< 0.05), but C-react ive protein levels were not(P=0.13). Multivariate analysis confirmed the positiv e association of HSP65 antibodies with postoperative AF(OR, 1.41; P=0.04) indepe ndent of age, sex, other cardiovascular risk factors, severity of coronary arter y disease, duration of ventilation, duration of bypass, and left ventricular fun ction. Conclusions-We report a novel association between anti-HSP65 antibodies and occurrence of postoperative AF, indicating a possible role for antibody-me diated immune response in its pathogenesis.
文摘Objectives: We evaluated the feasibility of using late gadolinium- enhanced(LGE) cardiovascular magnetic resonance(CMR) to distinguish left ventricular(LV) systolic dysfunction related or not to coronary artery disease(CAD) in patients with heart failure(HF) but without clinical suspicion of CAD as the underlying cause. Background: In patients with known CAD, LGE- CMR is capable of distinguishing LV systolic dysfunction related to CAD from dilated cardiomyopathy. Methods: Seventy- one patients with HF and LV systolic dysfunction,without a previous history of myocardial infarction, with neither Q waves nor clinical data suggesting CAD, underwent both LGE- CMR and coronary angiography. Results: Twenty- six patients(37% ) had angiographically proven CAD(< 70% stenosis of a major epicardial vessel)(angio[+ ] group), and 45(63% ) had unobstructed coronary arteries(angio[- ] group). Twenty- one patients in the angio(+ ) group(21 of 26, 81% ) showed subendocardial and/or transmural enhancement, whereas only 4(9% ) of 45 in the angio(- ) group showed it(p< 0.001). In 7 patients(7 of 71, 10% ),we found a different pattern of mid- wall enhancement- namely, 3 of 26 patients in the angio(+ ) group and 4 of 45 in the angio(- ) group(11% vs. 9% , p=0.7). Mid- wall enhancement in the angio(+ ) group was distributed in segments other than those which had subendocardial enhancement. Conclusions: In patients with HF and LV systolic dysfunction without clinical suspicion of CAD, LGE- CMR is an excellent tool for classifying patients in relation to the presence or absence of underlying CAD. Thus, CMR might offer a valid alternative to coronary angiography for the detection of CAD in these patients.
文摘Objectives: To determine predictors of outcome after percutaneous coronary intervention(PCI) in patients with cardiogenic shock complicating acute myocardial infarction. Methods: Retrospective analysis of a cohort of 113 patients undergoing emergency coronary angiography and attempted PCI for cardiogenic shock complicating acute myocardial infarction in a regional cardiothoracic unit. Results: In-hospital mortality was 51%(58 patients). Adverse outcome was associated with previous myocardial infarction, age over 70 years, cardiogenic shock complicating failure to respond to thrombolytic treatment(failed thrombolysis), and multivessel coronary artery disease. Multivariate logistic regression analysis showed that the first three factors were independent predictors of in-hospital death with odds ratios of 5.21(95%confidence interval(CI) 1.85 to 14.69), 4.02(95%CI 1.14 to 14.12), and 3.78(95%CI 1.43 to 9.96), respectively. Conclusion: About 50%of patients with cardiogenic shock undergoing a strategy of urgent coronary angiography and PCI survive to hospital discharge. Survivors do well in the subsequent six months. Emergency PCI for cardiogenic shock reduces mortality from an expected 80%to about 50%. Clinical features can help determine which patients are most likely to gain from urgent coronary angiography and attempted PCI. Alternative strategies are needed to improve the outcome of patients who fare badly.
文摘This study was designed to evaluate the relationship between plasma leptin and prognosis in patients with angiographically confirmed coronary atherosclerosis. Experimental studies suggest that leptin, an adipose tissue-derived hormone, exerts important cardiovascular effects. Study subjects were recruited prospectively from a cohort of patients undergoing clinically indicated coronary angiography (n=382). The median duration of follow-up was four years. Follow-up information was available for 361 patients. The combined end point of cardiac death, myocardial infarction(MI), cerebrovascular accident, or re-vascularization occurred in 44 subjects. In the simple Cox model, leptin had a significant(p< 0.001) non-linear/cubic univariate relationship with the combined end point. Other variables associated with prognosis in the univariate analysis were body mass index (BMI), prior MI, insulin resistance, Creactive protein(CRP), fibrinogen, and number of coronary vessels with >50%stenosis. A positive relationship between leptin and prognosis was also seen when leptin levels were split by quintiles, with a hazard ratio of 6.46 for the highest quintile. The only two variables significantly associated with the combined end point in the multivariate Cox model were leptin(p= 0.004) and number of coronary vessels with >50%stenosis(p< 0.001). A similar relationship between leptin and prognosis was observedwhen leptinwas adjusted forBMI. In patientswith angiographically confirmed coronary atherosclerosis, leptin is a novel predictor of future cardiovascular events independent of other risk factors, including lipid status and CRP.
文摘Objectives: The goal of this study was to determine the relationship between established cardiovascular risk factors and the extent of coronary atherosclerotic plaque. Background: Few data exist correlating cardiovascular risk factors with volumetric measurements of coronary atheroma burden in patients with coronary artery disease. Methods: Clinical characteristics, quantitative coronary angiography,and intravascular ultrasound(IVUS) were evaluated in subjects enrolled in a study comparing atorvastatin and pravastatin. Plaque areas were measured at 1-mm intervals to compute atheroma volume. The percent of cross sections with an abnormal intimal thickness( >0.5 mm) was determined. Data on cardiovascular risk factors were collected. Results: In 654 subjects, atheroma volume averaged 174.5 mm3 and percent atheroma volume 38.9%. Atherosclerosis was present in 81.2%of 25,897 cross sections. In univariate analysis, there was a strong association between diabetes, male gender, and a history of either prior revascularization or stroke with percent atheroma volume. Hypertension or prior myocardial infarction was also predictive of more severe disease. Low-density lipoprotein and C-reactive protein were not significant predictors of greater disease burden. In multivariate analysis, diabetes, male gender, and a history of a prior interventional procedure remained strong predictors of increased atheroma volume. History of stroke, non-Caucasian race, and smoking status remained significant. Although multiple measures of IVUS disease burden were worse in subjects with diabetes, angiographic stenosis severity was not different. Conclusions: Male gender, diabetes, and a history of prior revascularization are strong independent predictors of atherosclerotic burden in coronary disease patients. Many risk factors did not predict angiographic disease severity, suggesting different mechanisms drive stenosis development and atheroma accumulation.
