What We Have Learned from the Recent Meta-analyses on Diagnostic Methods for Atherosclerotic Plaque Regression.

PURPOSE OF REVIEW: Atherosclerosis has major morbidity and mortality implications globally. While it has often been considered an irreversible degenerative process, recent evidence provides compelling proof that atherosclerosis can be reversed. Plaque regression is however difficult to appraise and quantify, with competing diagnostic methods available. Given the potential of evidence synthesis to provide clinical guidance, we aimed to review recent meta-analyses on diagnostic methods for atherosclerotic plaque regression. RECENT FINDINGS: We identified 8 meta-analyses published between 2015 and 2017, including 79 studies and 14,442 patients, followed for a median of 12 months. They reported on atherosclerotic plaque regression appraised with carotid duplex ultrasound, coronary computed tomography, carotid magnetic resonance, coronary intravascular ultrasound, and coronary optical coherence tomography. Overall, all meta-analyses showed significant atherosclerotic plaque regression with lipid-lowering therapy, with the most notable effects on echogenicity, lipid-rich necrotic core volume, wall/plaque volume, dense calcium volume, and fibrous cap thickness. Significant interactions were found with concomitant changes in low density lipoprotein cholesterol, high density lipoprotein cholesterol, and C-reactive protein levels, and with ethnicity. Atherosclerotic plaque regression and conversion to a stable phenotype is possible with intensive medical therapy and can be demonstrated in patients using a variety of non-invasive and invasive imaging modalities.

Predictors of oxidative stress and vascular function in an experimental study of tobacco versus electronic cigarettes: A post hoc analysis of the SUR-VAPES 1 Study.

INTRODUCTION: Use of a conventional cigarette (CC) or electronic cigarette (EC) leads to oxidative stress and endothelial dysfunction, but the impact of other features and their interplay with CCs and ECs have been incompletely appraised. We explored moderators of CC and EC effects on oxidative stress and endothelial dysfunction. METHODS: We have conducted an experimental study on CCs and ECs in which repeated indicators of oxidative stress (serum levels of soluble NOX2-derived peptide, nitric oxide bioavailability, 8-iso-prostaglandin F2α-III, and vitamin E) and endothelial dysfunction (flow-mediated dilation) were collected in 40 subjects (20 smokers, 20 non-smokers). Several moderating features were appraised, adjusting for smoking status and cigarette type. RESULTS: Absolute changes in oxidative stress and vascular features after smoking a CC or vaping an EC were significantly correlated (all p<0.05), with the notable exception of 8-iso-prostaglandin F2α-III levels (p=0.030). Inferential analysis based on generalized estimating equations highlighted that the only variable significantly associated with oxidative stress and vascular features was smoking status (all p<0.05). Specifically, we found that smokers had a less pronounced untoward oxidative and vascular response after vaping an EC in comparison to non-smokers, who had oxidative and vascular reactions to an EC that resembled more those seen after smoking a CC. Intriguingly, women taking oral contraceptives appeared to have more unfavorable changes in vitamin E (p=0.002) and FMD (p=0.008). CONCLUSIONS: This study suggests that the comparative oxidative and vascular effects of an EC versus a CC may be influenced by smoking status, with a potential interaction in women taking oral contraceptives. These findings need further confirmation but could have important clinical and policy implications. ABBREVIATIONS: SUR-VAPES: Sapienza University of Rome-Vascular Assessment of Proatherosclerotic Effects of Smoking.