7 results on '"Choi, Harry"'
Search Results
2. Impaired Coronary Blood Flow in Patients with Psoriasis: Findings from an Observational Cohort Study.
- Author
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Uceda DE, Dey AK, Lateef SS, Abdelrahman K, Aksentijevich M, Reddy AS, Choi H, Rodante JA, Playford MP, Bluemke DA, Zhou W, Chen MY, Gelfand JM, and Mehta NN
- Subjects
- Adult, Computed Tomography Angiography, Coronary Angiography, Coronary Artery Disease diagnosis, Coronary Artery Disease etiology, Cross-Sectional Studies, Female, Heart Disease Risk Factors, Humans, Longitudinal Studies, Male, Middle Aged, Prevalence, Prospective Studies, Psoriasis diagnosis, Severity of Illness Index, Coronary Artery Disease epidemiology, Psoriasis complications
- Published
- 2021
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3. Application of machine learning to determine top predictors of noncalcified coronary burden in psoriasis: An observational cohort study.
- Author
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Munger E, Choi H, Dey AK, Elnabawi YA, Groenendyk JW, Rodante J, Keel A, Aksentijevich M, Reddy AS, Khalil N, Argueta-Amaya J, Playford MP, Erb-Alvarez J, Tian X, Wu C, Gudjonsson JE, Tsoi LC, Jafri MS, Sandfort V, Chen MY, Shah SJ, Bluemke DA, Lockshin B, Hasan A, Gelfand JM, and Mehta NN
- Subjects
- Adult, Comorbidity, Coronary Artery Disease blood, Coronary Artery Disease diagnosis, Coronary Artery Disease immunology, Coronary Vessels diagnostic imaging, Dyslipidemias blood, Dyslipidemias epidemiology, Dyslipidemias immunology, Female, Humans, Inflammation blood, Inflammation epidemiology, Inflammation immunology, Male, Middle Aged, Obesity blood, Obesity epidemiology, Obesity immunology, Prospective Studies, Psoriasis blood, Psoriasis epidemiology, Psoriasis immunology, Risk Assessment methods, Risk Factors, Tomography, X-Ray Computed, Coronary Artery Disease epidemiology, Machine Learning, Psoriasis complications
- Abstract
Background: Psoriasis is associated with elevated risk of heart attack and increased accumulation of subclinical noncalcified coronary burden by coronary computed tomography angiography (CCTA). Machine learning algorithms have been shown to effectively analyze well-characterized data sets., Objective: In this study, we used machine learning algorithms to determine the top predictors of noncalcified coronary burden by CCTA in psoriasis., Methods: The analysis included 263 consecutive patients with 63 available variables from the Psoriasis Atherosclerosis Cardiometabolic Initiative. The random forest algorithm was used to determine the top predictors of noncalcified coronary burden by CCTA. We evaluated our results using linear regression models., Results: Using the random forest algorithm, we found that the top 10 predictors of noncalcified coronary burden were body mass index, visceral adiposity, total adiposity, apolipoprotein A1, high-density lipoprotein, erythrocyte sedimentation rate, subcutaneous adiposity, small low-density lipoprotein particle, cholesterol efflux capacity and the absolute granulocyte count. Linear regression of noncalcified coronary burden yielded results consistent with our machine learning output., Limitation: We were unable to provide external validation and did not study cardiovascular events., Conclusion: Machine learning methods identified the top predictors of noncalcified coronary burden in psoriasis. These factors were related to obesity, dyslipidemia, and inflammation, showing that these are important targets when treating comorbidities in psoriasis., (Published by Elsevier Inc.)
- Published
- 2020
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4. Treatment of Psoriasis With Biologic Therapy Is Associated With Improvement of Coronary Artery Plaque Lipid-Rich Necrotic Core: Results From a Prospective, Observational Study.
- Author
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Choi H, Uceda DE, Dey AK, Abdelrahman KM, Aksentijevich M, Rodante JA, Elnabawi YA, Reddy A, Keel A, Erb-Alvarez J, Teague H, Playford MP, Zhou W, Chen MY, Gelfand JM, Bluemke DA, Buckler A, and Mehta NN
- Subjects
- Adult, Cardiometabolic Risk Factors, Computed Tomography Angiography, Coronary Angiography, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease pathology, Female, Humans, Lipids analysis, Male, Middle Aged, Necrosis, Prospective Studies, Psoriasis complications, Psoriasis diagnosis, Severity of Illness Index, Time Factors, Treatment Outcome, Biological Products therapeutic use, Coronary Artery Disease complications, Plaque, Atherosclerotic, Psoriasis drug therapy
- Abstract
Background: Lipid-rich necrotic core (LRNC), a high-risk coronary plaque feature assessed by coronary computed tomography angiography, is associated with increased risk of future cardiovascular events in patients with subclinical, nonobstructive coronary artery disease. Psoriasis is a chronic inflammatory condition that is associated with increased prevalence of high-risk coronary plaque and risk of cardiovascular events. This study characterized LRNC in psoriasis and how LRNC modulates in response to biologic therapy., Methods: Consecutive biologic naïve psoriasis patients (n=209) underwent coronary computed tomography angiography at baseline and 1-year to assess changes in LRNC using a novel histopathologically validated software (vascuCAP Elucid Bioimaging, Boston, MA) before and after biologic therapy over 1 year., Results: Study participants were middle-aged, predominantly male with similar cardiometabolic and psoriasis status between treatment groups. In all participants at baseline, LRNC was associated with Framingham risk score (β [standardized β]=0.12 [95% CI, 0.00-0.15]; P =0.045), and psoriasis severity (β=0.13 [95% CI, 0.01-0.26]; P =0.029). At 1-year, participants receiving biologic therapy had a reduction in LRNC (mm
2 ; 3.12 [1.99-4.66] versus 2.97 [1.84-4.35]; P =0.028), while those who did not receive biologic therapy over 1 year demonstrated no significant change with nominally higher LRNC (3.12 [1.82-4.60] versus 3.34 [2.04-4.74]; P =0.06). The change in LRNC was significant compared with that of the nonbiologic treated group (ΔLRNC, -0.22 mm2 versus 0.14 mm2 , P =0.004) and remained significant after adjusting for cardiovascular risk factors and psoriasis severity (β=-0.09 [95% CI, -0.01 to -0.18]; P =0.033)., Conclusions: LRNC was associated with psoriasis severity and cardiovascular risk factors in psoriasis. Additionally, there was favorable modification of LRNC in those on biologic therapy. This study provides evidence of potential reduction in LRNC with treatment of systemic inflammation. Larger, longer follow-up prospective studies should be conducted to understand how changes in LRNC may translate into a reduction in future cardiovascular events in psoriasis.- Published
- 2020
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5. Association Between Soluble Lectinlike Oxidized Low-Density Lipoprotein Receptor-1 and Coronary Artery Disease in Psoriasis.
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Dey AK, Gaddipati R, Elnabawi YA, Ongstad E, Goyal A, Chung JH, Teague HL, Rodante JA, Sajja AA, Sorokin AV, Lateef SS, Aksentijevich M, Choi H, Reddy AS, Varghese NJ, Groenendyk J, Belur AD, Genovese L, Rivers JP, Lerman J, Kabbany MT, Harrington C, Ortiz J, Khalil N, Keel A, Baumer Y, Chen MY, Bluemke DA, Joshi AA, Kaplan MJ, Remaley AT, Playford MP, Karathanasis SK, Gelfand JM, Gupta R, and Mehta NN
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- Adult, Cohort Studies, Coronary Artery Disease blood, Female, Humans, Longitudinal Studies, Male, Middle Aged, Psoriasis pathology, Severity of Illness Index, Time Factors, Computed Tomography Angiography, Coronary Artery Disease diagnostic imaging, Psoriasis complications, Scavenger Receptors, Class E blood
- Abstract
Importance: Psoriasis, a chronic inflammatory skin disease associated with accelerated noncalcified coronary burden (NCB) by coronary computed tomography angiography (CCTA), accelerates lipoprotein oxidation in the form of oxidized modified lipoproteins. A transmembrane scavenger receptor for these oxidized modified lipoproteins is lectinlike oxidized low-density lipoprotein receptor-1 (LOX-1), which has been reported to be associated with coronary artery disease. It is unknown whether this receptor is associated with coronary artery disease in psoriasis., Objective: To assess the association between soluble LOX-1 (sLOX-1) and NCB in psoriasis over time., Design, Setting, and Participants: In a cohort study at the National Institutes of Health, 175 consecutive patients with psoriasis were referred from outpatient dermatology practices between January 1, 2013, and October 1, 2017. A total of 138 consecutively recruited patients with psoriasis were followed up at 1 year., Exposures: Circulating soluble lectinlike oxidized low-density lipoprotein receptor-1 levels were measured blindly by field scientists running undiluted serum using an enzyme-linked immunosorbent assay., Main Outcomes and Measures: Coronary computed tomography angiography scans were performed to quantify NCB in all 3 major epicardial coronary arteries by a reader blinded to patient demographics, visit, and treatment status., Results: Among the 175 patients with psoriasis, the mean (SD) age was 49.7 (12.6) years and 91 were men (55%). The cohort had relatively low median cardiovascular risk by Framingham risk score (median, 2.0 [interquartile range (IQR), 1.0-6.0]) and had a mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) suggestive of overweight profiles (29.6 [6.0]). Elevated sLOX-1 levels were found in patients with psoriasis compared with age- and sex-matched controls (median, 210.3 [IQR, 110.9-336.2] vs 83.7 [IQR, 40.1-151.0]; P < .001), and were associated with Psoriasis Area Severity Index (PASI) score (β = 0.23; 95% CI, 0.082-0.374; P = .003). Moreover, sLOX-1 was associated with NCB independent of hyperlipidemia status (β = 0.11; 95% CI, 0.016-0.200; P = .023), an association which persisted after adjusting for traditional cardiovascular risk factors, statin use, and biologic psoriasis treatment (β = 0.10; 95% CI, 0.014-0.193; P = .03). At 1 year, in those who had clinical improvement in PASI (eg, >50% improvement), a reduction in sLOX-1 (median, 311.1 [IQR, 160.0-648.8] vs median, 224.2 [IQR, 149.1 - 427.4]; P = .01) was associated with a reduction in NCB (β = 0.14; 95% CI, 0.028-0.246; P = .02)., Conclusions and Relevance: Soluble lectinlike oxidized low-density lipoprotein receptor-1 levels were elevated in patients with psoriasis and were associated with severity of skin disease. Moreover, sLOX-1 associated with NCB independent of hyperlipidemia status, suggesting that inflammatory sLOX-1 induction may modulate lipid-rich NCB in psoriasis. Improvement of skin disease was associated with a reduction of sLOX-1 at 1 year, demonstrating the potential role of sLOX-1 in inflammatory atherogenesis in psoriasis.
- Published
- 2020
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6. Application of Non-invasive Imaging in Inflammatory Disease Conditions to Evaluate Subclinical Coronary Artery Disease.
- Author
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Choi H, Uceda DE, Dey AK, and Mehta NN
- Subjects
- Arthritis, Rheumatoid diagnosis, Arthritis, Rheumatoid epidemiology, Asymptomatic Diseases epidemiology, Cardiac Imaging Techniques, Chronic Disease, Computed Tomography Angiography methods, Coronary Angiography methods, Coronary Artery Disease pathology, Female, Humans, Incidence, Inflammation diagnostic imaging, Inflammation physiopathology, Lupus Erythematosus, Systemic diagnosis, Lupus Erythematosus, Systemic epidemiology, Male, Prognosis, Psoriasis diagnosis, Psoriasis epidemiology, Risk Assessment, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease epidemiology, Inflammation epidemiology, Multimodal Imaging methods
- Abstract
Purpose of Review: Traditional risk models, such as the Framingham risk score, fail to capture the increased cardiovascular disease risk seen in patients with chronic inflammatory diseases. This review will cover imaging modalities and their emerging applications in assessing subclinical cardiovascular disease for both research and clinical care in patients with chronic inflammatory diseases., Recent Findings: Multiple imaging modalities have been studied to assess for subclinical cardiovascular disease via functional/physiologic, inflammatory, and anatomic assessment in patients with chronic inflammatory diseases. The use of imaging to evaluate subclinical cardiovascular disease in patients with chronic inflammatory diseases has the potential to capture early sub-clinical atherosclerosis, to improve risk stratification of future cardiovascular events, and to guide effective disease management.
- Published
- 2019
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7. Association of Biologic Therapy With Coronary Inflammation in Patients With Psoriasis as Assessed by Perivascular Fat Attenuation Index.
- Author
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Elnabawi YA, Oikonomou EK, Dey AK, Mancio J, Rodante JA, Aksentijevich M, Choi H, Keel A, Erb-Alvarez J, Teague HL, Joshi AA, Playford MP, Lockshin B, Choi AD, Gelfand JM, Chen MY, Bluemke DA, Shirodaria C, Antoniades C, and Mehta NN
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- Computed Tomography Angiography methods, Coronary Angiography methods, Coronary Artery Disease diagnosis, Coronary Vessels drug effects, Female, Follow-Up Studies, Humans, Inflammation complications, Inflammation diagnosis, Male, Middle Aged, Prognosis, Prospective Studies, Psoriasis complications, Psoriasis diagnosis, Severity of Illness Index, Time Factors, Adipose Tissue diagnostic imaging, Biological Factors therapeutic use, Biological Therapy methods, Coronary Artery Disease complications, Coronary Vessels diagnostic imaging, Inflammation therapy, Psoriasis therapy
- Abstract
Importance: Psoriasis is a chronic inflammatory skin disease associated with increased coronary plaque burden and cardiovascular events. Biologic therapy for psoriasis has been found to be favorably associated with luminal coronary plaque, but it is unclear whether these associations are attributable to direct anti-inflammatory effects on the coronary arteries., Objective: To investigate the association of biologic therapy with coronary inflammation in patients with psoriasis using the perivascular fat attenuation index (FAI), a novel imaging biomarker that assesses coronary inflammation by mapping spatial changes of perivascular fat composition via coronary computed tomography angiography (CCTA)., Design, Setting, and Participants: This prospective cohort study performed from January 1, 2013, through March 31, 2019, analyzed changes in FAI in patients with moderate to severe psoriasis who underwent CCTA at baseline and at 1 year and were not receiving biologic psoriasis therapy at baseline., Exposures: Biologic therapy for psoriasis., Main Outcomes and Measures: Perivascular FAI mapping was performed based on an established method by a reader blinded to patient demographics, visit, and treatment status., Results: Of the 134 patients (mean [SD] age, 51.1 [12.1] years; 84 [62.5%] male), most had low cardiovascular risk by traditional risk scores (median 10-year Framingham Risk Score, 3% [interquartile range, 1%-7%]) and moderate to severe skin disease. Of these patients, 82 received biologic psoriasis therapy (anti-tumor necrosis factor α, anti-interleukin [IL] 12/23, or anti-IL-17) for 1 year, and 52 did not receive any biologic therapy and were given topical or light therapy (control group). At baseline, 46 patients (27 in the treated group and 19 in the untreated group) had a focal coronary atherosclerotic plaque. Biologic therapy was associated with a significant decrease in FAI at 1 year (median FAI -71.22 HU [interquartile range (IQR), -75.85 to -68.11 HU] at baseline vs -76.09 HU [IQR, -80.08 to -70.37 HU] at 1 year; P < .001) concurrent with skin disease improvement (median PASI, 7.7 [IQR, 3.2-12.5] at baseline vs 3.2 [IQR, 1.8-5.7] at 1 year; P < .001), whereas no change in FAI was noted in those not receiving biologic therapy (median FAI, -71.98 [IQR, -77.36 to -65.64] at baseline vs -72.66 [IQR, -78.21 to -67.44] at 1 year; P = .39). The associations with FAI were independent of the presence of coronary plaque and were consistent among patients receiving different biologic agents, including anti-tumor necrosis factor α (median FAI, -71.25 [IQR, -75.86 to -66.89] at baseline vs -75.49 [IQR, -79.12 to -68.58] at 1 year; P < .001) and anti-IL-12/23 or anti-IL-17 therapy (median FAI, -71.18 [IQR, -75.85 to -68.80] at baseline vs -76.92 [IQR, -81.16 to -71.67] at 1 year; P < .001)., Conclusions and Relevance: In this study, biologic therapy for moderate to severe psoriasis was associated with reduced coronary inflammation assessed by perivascular FAI. This finding suggests that perivascular FAI measured by CCTA may be used to track response to interventions for coronary artery disease.
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- 2019
- Full Text
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