Prediction of Subclinical Coronary Atherosclerosis in Patients with High and Very High Cardiovascular Risk

Objective To develop a diagnostic rule for detection of patients (pts) with high probability of subclinical atherosclerosis among those with high or very high cardiovascular (CV) risk. Materials and Methods This cross-sectional study enrolled 52 pts (32 men [62 %]), aged 40 to 65 years [mean age 54.6±8.0]) with high or very high CV risk (5-9 and =10 % by The Systematic Coronary Risk Estimation Scale [SCORE], respectively). All participants underwent cardiac computed tomography (CT) angiography and calcium scoring. Traditional risk factors (RFs) (family history of premature CVD, smoking, overweight/obesity and abdominal obesity, hypertension, type 2 diabetes mellitus, lipids parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides) and lipids-related markers (apolipoprotein A1, apolipoprotein B, ApoB/ApoA1 ratio), biomarkers of inflammation (high-sensitivity C-reactive protein [hs CRP], fibrinogen), indicator carbohydrate metabolism (glucose), ankle-brachial index, stress-test, carotid plaques according to ultrasound were evaluated in all pts. Psychological RFs were evaluated using Hospital Anxiety and Depression Scale and DS-14 for type D personality. Results All pts were divided into 2 groups according to the CT angiography results: Pts in the main group (n=21) had any non-obstructive lesions or calcium score >0, pts in the control group (n=31) had intact coronary arteries. The groups did not differ in age or gender. 26 multiple linear logistic models for any subclinical atherosclerosis were developed based on obtained diagnostic features. Taking into account R-square = 0.344 (p=0.0008), the best fitting model was follows: Subclinical coronary atherosclerosis=-1.576 + 0.234 x SCORE =5 % + 0.541 x hs CRP >2 g/l +0.015 x heart rate (bpm) +0.311 family history of premature CVD. The developed algorithm had sensitivity of 63 % and specificity of 80 %. Conclusion The created diagnostic model diagnostic model suggests the presence of subclinical coronary atherosclerosis in patients with high/very high CV risk with a high degree of probability. This easyto-use method can be used in routine clinical practice to improve risk stratification and management choices in high-risk pts. © 2020 Rockefeller University Press. All rights reserved

An exploration of potential approaches to improve the diagnosis of subclinical atherosclerosis in patients with high cardiovascular risk

PURPOSE: The search for optimal approaches to the diagnosis of subclinical atherosclerosis using a wide range of traditional and psychosocial risk factors (RFs), as well as clinical and instrumental diagnostic methods in patients (pts) with high or very high cardiovascular (CV) risk. METHODS: This cross-sectional study enrolled52 pts, aged 40 to 65 years with high or very high CV risk (5-9 and ≥10% by the Systematic Coronary Risk Estimation Scale [SCORE], respectively). All participants underwent cardiac computed tomography (CT)angiography and calcium scoring. Traditional RFs (family history of premature CVD, smoking, overweight/obesity and abdominal obesity, hypertension, type 2 diabetes mellitus, lipids parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides) and lipids-related markers (apolipoprotein A1, apolipoprotein B, ApoB/ApoA1 ratio), biomarkers of inflammation (high-sensitivity C-reactive protein [hs CRP], fibrinogen), indicator carbohydrate metabolism (glucose), ankle-brachial index, stress-test, carotid plaques according to ultrasound, arterial stiffness were evaluated in all pts. Psychological RFs were evaluated using Hospital Anxiety and Depression Scale and DS-14 for type D personality. RESULTS: All pts were divided into 2 groups according to the CT angiography results: pts in the main group (n=21) had any non-obstructive lesions or calcium score >0, pts in the control group (n=31) had intact coronary arteries. The groups did not differ in age or gender. It was found that patients with subclinical atherosclerosis significantly more often have a very high (≥10%) CV risk (42.9% vs.16.3%, p<0.05), a long (≥5 years) history of arterial hypertension (47.6% vs. 12.9% , p<0.01) and longer duration of antihypertensive therapy (61.9% vs. 29.0%, p<0.05), higher heart rate in rest (87. ± 14 vs. 77 ± 10 beats/min, p<0.01), increased arterial stiffness according to aortic pulse wave velocity (85.7% vs. 61.3%, p<0.05) and high level of hs-CRP (100% vs. 90.3%, p<0.05). CONCLUSION: Using in routine clinical practice of additional anamnestic (hypertension lasting ≥ 5 years and the intake of any antihypertensive drugs) and clinical-instrumental parameters (high heart rate in rest, hs CRP and arterial stiffness in pts with high and very high CV risk increases effectiveness of early detection of subclinical atherosclerosis

Russian citizens' perceptions of corruption and trust of the police

Since 1991, Russian citizens\u27 perception of the police has been consistently overwhelmingly negative. Both direct and vicarious citizen experiences with the police were examined to identify potential factors that may explain the pervasive and persistent negative perceptions. An original survey of citizens (N=509) was analysed with structural equation modelling techniques to determine how various forms of corruption (including bribery, unfair treatment and abuse of power), and social class standing influenced perceptions. Experiences with corruption had significant negative correlations with police trust. Trust was found to be independent of social class position. Bribery and abuse of power had significant co-variations with unfair treatment. Citizens actively avoid any police contact; therefore, their perceptions appear to be predominately influenced by a lack of institutional trust. The findings are consistent with the extant research. © 2013 © 2013 Taylor & Francis