Skip to main content
Top
Published in: Cardiovascular Ultrasound 1/2011

Open Access 01-12-2011 | Research

Comparison of intima-media thickness and ophthalmic artery resistance index for assessing subclinical atherosclerosis in HIV-1-infected patients

Authors: Pierfrancesco Grima, Marcello Guido, Roberto Chiavaroli, Antonella De Donno, Mariangela Tana, Antonella Zizza

Published in: Cardiovascular Ultrasound | Issue 1/2011

Login to get access

Abstract

Background

Human immunodeficiency virus (HIV) infection and antiretroviral treatment are associated with metabolic and cardiovascular complications that potentially increase the risk of atherosclerosis and cardiovascular disease in this population. Measurement of arterial wall thickness has been used as a surrogate of extent, severity and progression of atherosclerosis. A cross-sectional cohort study was performed to compare the validity of two non-invasive arterial measures: carotid intima-media thickness (IMT), a parameter of atherosclerosis, and ophthalmic artery resistance index (OARI), an index of occlusive carotid artery disease.

Methods

A total of 95 patients receiving highly active antiretroviral therapy (HAART) for more than 12 months were consecutively enrolled. IMT and OARI were measured by 7.5 MHz linear probe.

Results

There was a significant linear increase in IMT and OARI values as the grade of cardiovascular risk (0.70 and 0.69 for very low risk, 0.86 and 0.72 for low risk and 0.98 and 0.74 for medium/high risk, p < 0.001). A IMT > 0.83 and an OARI > 0.72 were the most discriminatory values for predicting a cardiovascular risk ≥ 10% (sensibility 89.6% and 75.8%; sensitivity 70.5% and 68.4%; p < 0.001).

Conclusions

Our data indicate that OARI may have a potential as a new precocious marker of subclinical atherosclerosis in HIV-1-infected patients.
Appendix
Available only for authorised users
Literature
1.
go back to reference Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD: Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV outpatient Study Investigators. N Engl J Med. 1998, 338: 853-860. 10.1056/NEJM199803263381301CrossRefPubMed Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD: Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV outpatient Study Investigators. N Engl J Med. 1998, 338: 853-860. 10.1056/NEJM199803263381301CrossRefPubMed
2.
go back to reference Martínez E, Milinkovic A, Buira E, de Lazzari E, León A, Larrousse M, Loncá M, Laguno M, Blanco JL, Mallolas J, García F, Miró JM, Gatell JM: Incidence and causes of death in HIV-infected persons receiving highly active antiretroviral therapy compared with estimates for the general population of similar age and from the same geographical area. HIV Med. 2007, 8: 251-258.CrossRefPubMed Martínez E, Milinkovic A, Buira E, de Lazzari E, León A, Larrousse M, Loncá M, Laguno M, Blanco JL, Mallolas J, García F, Miró JM, Gatell JM: Incidence and causes of death in HIV-infected persons receiving highly active antiretroviral therapy compared with estimates for the general population of similar age and from the same geographical area. HIV Med. 2007, 8: 251-258.CrossRefPubMed
3.
go back to reference Lewden C, May T, Rosenthal E, Burty C, Bonnet F, Costagliola D, Jougla E, Semaille C, Morlat P, Salmon D, Cacoub P, Chêne G, ANRS EN19 Mortalité Study Group and Mortavic1: Changes in causes of death among adults infected by HIV between 2000 and 2005: The "Mortalité 2000 and 2005" surveys (ANRS EN19 and Mortavic). J Acquir Immune Defic Syndr. 2008, 48 (5): 590-598. 10.1097/QAI.0b013e31817efb54CrossRefPubMed Lewden C, May T, Rosenthal E, Burty C, Bonnet F, Costagliola D, Jougla E, Semaille C, Morlat P, Salmon D, Cacoub P, Chêne G, ANRS EN19 Mortalité Study Group and Mortavic1: Changes in causes of death among adults infected by HIV between 2000 and 2005: The "Mortalité 2000 and 2005" surveys (ANRS EN19 and Mortavic). J Acquir Immune Defic Syndr. 2008, 48 (5): 590-598. 10.1097/QAI.0b013e31817efb54CrossRefPubMed
4.
go back to reference Burger-Kentischer A, Göbel H, Kleemann R, Zernecke A, Bucala R, Leng L, Finkelmeier D, Geiger G, Schaefer HE, Schober A, Weber C, Brunner H, Rütten H, Ihling C, Bernhagen J: Reduction of the aortic inflammatory response in spontaneous atherosclerosis by blockade of macrophage migration inhibitory factor (MIF). Atherosclerosis. 2006, 184 (1): 28-38. 10.1016/j.atherosclerosis.2005.03.028CrossRefPubMed Burger-Kentischer A, Göbel H, Kleemann R, Zernecke A, Bucala R, Leng L, Finkelmeier D, Geiger G, Schaefer HE, Schober A, Weber C, Brunner H, Rütten H, Ihling C, Bernhagen J: Reduction of the aortic inflammatory response in spontaneous atherosclerosis by blockade of macrophage migration inhibitory factor (MIF). Atherosclerosis. 2006, 184 (1): 28-38. 10.1016/j.atherosclerosis.2005.03.028CrossRefPubMed
5.
go back to reference Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, Najjar SS, Rembold CM, Post WS, American Society of Echocardiography Carotid Intima-Media Thickness Task Force: Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008, 21 (2): 93-111. 10.1016/j.echo.2007.11.011CrossRefPubMed Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, Najjar SS, Rembold CM, Post WS, American Society of Echocardiography Carotid Intima-Media Thickness Task Force: Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008, 21 (2): 93-111. 10.1016/j.echo.2007.11.011CrossRefPubMed
6.
go back to reference Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M: Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation. 2007, 115 (4): 459-467. 10.1161/CIRCULATIONAHA.106.628875CrossRefPubMed Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M: Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation. 2007, 115 (4): 459-467. 10.1161/CIRCULATIONAHA.106.628875CrossRefPubMed
7.
go back to reference Hsue PY, Lo JC, Franklin A, Bolger AF, Martin JN, Deeks SG, Waters DD: Progression of atherosclerosis as assessed by carotid intima-media thickness in patients with HIV infection. Circulation. 2004, 109 (13): 1603-1608. 10.1161/01.CIR.0000124480.32233.8ACrossRefPubMed Hsue PY, Lo JC, Franklin A, Bolger AF, Martin JN, Deeks SG, Waters DD: Progression of atherosclerosis as assessed by carotid intima-media thickness in patients with HIV infection. Circulation. 2004, 109 (13): 1603-1608. 10.1161/01.CIR.0000124480.32233.8ACrossRefPubMed
8.
go back to reference Salonen JT, Salonen R: Ultrasound B-mode imaging in observational studies of atherosclerotic progression. Circulation. 1993, 87 (3 Suppl): II56-II65.PubMed Salonen JT, Salonen R: Ultrasound B-mode imaging in observational studies of atherosclerotic progression. Circulation. 1993, 87 (3 Suppl): II56-II65.PubMed
9.
go back to reference O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK: Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999, 340 (1): 14-22.CrossRefPubMed O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK: Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999, 340 (1): 14-22.CrossRefPubMed
10.
go back to reference Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, Clegg LX: Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-1993. Am J Epidemiol. 1997, 146 (6): 483-494.CrossRefPubMed Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, Clegg LX: Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-1993. Am J Epidemiol. 1997, 146 (6): 483-494.CrossRefPubMed
11.
go back to reference Zielinski T, Dzielinska Z, Januszewicz A, Rynkun D, Makowiecka Ciesla M, Tyczynski P, Prejbisz A, Demkow M, Kadziela J, Naruszewicz M, Januszewicz M, Juraszynski Z, Korewicki J, Ruzyllo W: Carotid intima-media thickness as a marker of cardiovascular risk in hypertensive patients with coronary artery disease. Am J Hypertens. 2007, 20 (10): 1058-1064. 10.1016/j.amjhyper.2007.05.011CrossRefPubMed Zielinski T, Dzielinska Z, Januszewicz A, Rynkun D, Makowiecka Ciesla M, Tyczynski P, Prejbisz A, Demkow M, Kadziela J, Naruszewicz M, Januszewicz M, Juraszynski Z, Korewicki J, Ruzyllo W: Carotid intima-media thickness as a marker of cardiovascular risk in hypertensive patients with coronary artery disease. Am J Hypertens. 2007, 20 (10): 1058-1064. 10.1016/j.amjhyper.2007.05.011CrossRefPubMed
12.
go back to reference Li C, Engstrom G, Berglund G, Janzon L, Hedblad B: Incidence of ischemic stroke in relation to asymptomatic carotid artery atherosclerosis in subjects with normal blood pressure. A prospective cohort study. Cerebrovasc Dis. 2008, 26 (3): 297-303. 10.1159/000149577CrossRefPubMed Li C, Engstrom G, Berglund G, Janzon L, Hedblad B: Incidence of ischemic stroke in relation to asymptomatic carotid artery atherosclerosis in subjects with normal blood pressure. A prospective cohort study. Cerebrovasc Dis. 2008, 26 (3): 297-303. 10.1159/000149577CrossRefPubMed
13.
go back to reference Tranquart F, Bergès O, Koskas P, Arsene S, Rossazza C, Pisella PJ, Pourcelot L: Color Doppler imaging of orbital vessels: personal experience and literature review. J Clin Ultrasound. 2003, 31 (5): 258-273. 10.1002/jcu.10169CrossRefPubMed Tranquart F, Bergès O, Koskas P, Arsene S, Rossazza C, Pisella PJ, Pourcelot L: Color Doppler imaging of orbital vessels: personal experience and literature review. J Clin Ultrasound. 2003, 31 (5): 258-273. 10.1002/jcu.10169CrossRefPubMed
14.
go back to reference Michelson EL, Morganroth J, Nichols CW, MacVaugh H: Retinal arteriolar changes as an indicator of coronary artery disease. Arch Intern Med. 1979, 139 (10): 1139-1141. 10.1001/archinte.139.10.1139CrossRefPubMed Michelson EL, Morganroth J, Nichols CW, MacVaugh H: Retinal arteriolar changes as an indicator of coronary artery disease. Arch Intern Med. 1979, 139 (10): 1139-1141. 10.1001/archinte.139.10.1139CrossRefPubMed
15.
go back to reference Tedeschi-Reiner E, Strozzi M, Skoric B, Reiner Z: Relation of atherosclerotic changes in retinal arteries to the extent of coronary artery disease. Am J Cardiol. 2005, 96 (8): 1107-1109. 10.1016/j.amjcard.2005.05.070CrossRefPubMed Tedeschi-Reiner E, Strozzi M, Skoric B, Reiner Z: Relation of atherosclerotic changes in retinal arteries to the extent of coronary artery disease. Am J Cardiol. 2005, 96 (8): 1107-1109. 10.1016/j.amjcard.2005.05.070CrossRefPubMed
16.
go back to reference Grima P, Guido M, Chiavaroli R, Zizza A: Ultrasound-assessed perirenal fat is related to increased ophthalmic artery resistance index in HIV-1 patients. Cardiovasc Ultrasound. 2010, 8: 24- 10.1186/1476-7120-8-24CrossRefPubMedPubMedCentral Grima P, Guido M, Chiavaroli R, Zizza A: Ultrasound-assessed perirenal fat is related to increased ophthalmic artery resistance index in HIV-1 patients. Cardiovasc Ultrasound. 2010, 8: 24- 10.1186/1476-7120-8-24CrossRefPubMedPubMedCentral
17.
go back to reference Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB: Prediction of coronary heart disease using risk factor categories. Circulation. 1998, 97 (18): 1837-1847.CrossRefPubMed Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB: Prediction of coronary heart disease using risk factor categories. Circulation. 1998, 97 (18): 1837-1847.CrossRefPubMed
18.
go back to reference de Saint Martin L, Vandhuick O, Guillo P, Bellein V, Bressollette L, Roudaut N, Amaral A, Pasquier E: Premature atherosclerosis in HIV positive patients and cumulated time of exposure to antiretroviral therapy (SHIVA study). Atherosclerosis. 2006, 185 (2): 361-367. 10.1016/j.atherosclerosis.2005.06.049CrossRefPubMed de Saint Martin L, Vandhuick O, Guillo P, Bellein V, Bressollette L, Roudaut N, Amaral A, Pasquier E: Premature atherosclerosis in HIV positive patients and cumulated time of exposure to antiretroviral therapy (SHIVA study). Atherosclerosis. 2006, 185 (2): 361-367. 10.1016/j.atherosclerosis.2005.06.049CrossRefPubMed
19.
go back to reference Mercié P, Thiébaut R, Aurillac-Lavignolle V, Pellegrin JL, Yvorra-Vives MC, Cipriano C, Neau D, Morlat P, Ragnaud JM, Dupon M, Bonnet F, Lawson-Ayayi S, Malvy D, Roudaut R, Dabis F, Groupe d'Epidemiologie Clinique du Sida en Aquitaine (GECSA): Carotid intima-media thickness is slightly increased over time in HIV-1-infected patients. HIV Med. 2005, 6 (6): 380-387.CrossRefPubMed Mercié P, Thiébaut R, Aurillac-Lavignolle V, Pellegrin JL, Yvorra-Vives MC, Cipriano C, Neau D, Morlat P, Ragnaud JM, Dupon M, Bonnet F, Lawson-Ayayi S, Malvy D, Roudaut R, Dabis F, Groupe d'Epidemiologie Clinique du Sida en Aquitaine (GECSA): Carotid intima-media thickness is slightly increased over time in HIV-1-infected patients. HIV Med. 2005, 6 (6): 380-387.CrossRefPubMed
20.
go back to reference Smith SC, Greenland P, Grundy SM: AHA Conference Proceedings. Prevention conference V: Beyond secondary prevention: Identifying the high-risk patient for primary prevention: executive summary. American Heart Association. Circulation. 2000, 101 (1): 111-116.CrossRefPubMed Smith SC, Greenland P, Grundy SM: AHA Conference Proceedings. Prevention conference V: Beyond secondary prevention: Identifying the high-risk patient for primary prevention: executive summary. American Heart Association. Circulation. 2000, 101 (1): 111-116.CrossRefPubMed
21.
go back to reference Wendelhag I, Wiklund O, Wikstrand J: Atherosclerotic changes in the femoral and carotid arteries in familial hypercholesterolemia. Ultrasonographic assessment of intima-media thickness and plaque occurrence. Arterioscler Thromb. 1993, 13 (10): 1404-1411.CrossRefPubMed Wendelhag I, Wiklund O, Wikstrand J: Atherosclerotic changes in the femoral and carotid arteries in familial hypercholesterolemia. Ultrasonographic assessment of intima-media thickness and plaque occurrence. Arterioscler Thromb. 1993, 13 (10): 1404-1411.CrossRefPubMed
22.
go back to reference Kanters SD, Algra A, van Leeuwen MS, Banga JD: Reproducibility of in vivo carotid intima-media thickness measurements: a review. Stroke. 1997, 28 (3): 665-671.CrossRefPubMed Kanters SD, Algra A, van Leeuwen MS, Banga JD: Reproducibility of in vivo carotid intima-media thickness measurements: a review. Stroke. 1997, 28 (3): 665-671.CrossRefPubMed
23.
go back to reference Freire CM, Ribeiro AL, Barbosa FB, Nogueira AI, de Almeida MC, Barbosa MM, Lana AM, e Silva AC, Ribeiro-Oliveira A: Comparison between automated and manual measurements of carotid intima-media thickness in clinical practice. Vasc Health Risk Manag. 2009, 5: 811-817.PubMedPubMedCentral Freire CM, Ribeiro AL, Barbosa FB, Nogueira AI, de Almeida MC, Barbosa MM, Lana AM, e Silva AC, Ribeiro-Oliveira A: Comparison between automated and manual measurements of carotid intima-media thickness in clinical practice. Vasc Health Risk Manag. 2009, 5: 811-817.PubMedPubMedCentral
24.
go back to reference Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, Najjar SS, Rembold CM, Post WS, American Society of Echocardiography Carotid Intima-Media Thickness Task Force: Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008, 21 (2): 93-111. 10.1016/j.echo.2007.11.011CrossRefPubMed Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, Najjar SS, Rembold CM, Post WS, American Society of Echocardiography Carotid Intima-Media Thickness Task Force: Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008, 21 (2): 93-111. 10.1016/j.echo.2007.11.011CrossRefPubMed
25.
go back to reference Hu HH, Sheng WY, Yen MY, Lai ST, Teng MM: Color Doppler imaging of orbital arteries for detection of carotid occlusive disease. Stroke. 1993, 24 (8): 1196-1203.CrossRefPubMed Hu HH, Sheng WY, Yen MY, Lai ST, Teng MM: Color Doppler imaging of orbital arteries for detection of carotid occlusive disease. Stroke. 1993, 24 (8): 1196-1203.CrossRefPubMed
26.
go back to reference Ho AC, Lieb WE, Flaharty PM, Sergott RC, Brown GC, Bosley TM, Savino PJ: Color Doppler imaging of the ocular ischemic syndrome. Ophthalmology. 1992, 99 (9): 1453-1462.CrossRefPubMed Ho AC, Lieb WE, Flaharty PM, Sergott RC, Brown GC, Bosley TM, Savino PJ: Color Doppler imaging of the ocular ischemic syndrome. Ophthalmology. 1992, 99 (9): 1453-1462.CrossRefPubMed
27.
go back to reference Mawn LA, Hedges TR, Rand W, Heggerick PA: Orbital color Doppler imaging in carotid occlusive disease. Arch Ophthalmol. 1997, 115 (4): 492-496.CrossRefPubMed Mawn LA, Hedges TR, Rand W, Heggerick PA: Orbital color Doppler imaging in carotid occlusive disease. Arch Ophthalmol. 1997, 115 (4): 492-496.CrossRefPubMed
28.
go back to reference Päivänsalo M, Riiheläinen K, Rissanen T, Suramo I, Laatikainen L: Effect of an internal carotid stenosis on orbital blood velocity. Acta Radiol. 1999, 40 (3): 270-275.CrossRefPubMed Päivänsalo M, Riiheläinen K, Rissanen T, Suramo I, Laatikainen L: Effect of an internal carotid stenosis on orbital blood velocity. Acta Radiol. 1999, 40 (3): 270-275.CrossRefPubMed
29.
go back to reference Maruyoshi H, Kojima S, Kojima S, Nagayoshi Y, Horibata Y, Kaikita K, Sugiyama S, Ogawa H: Waveform of ophthalmic artery Doppler flow predicts the severity of systemic atherosclerosis. Circ J. 2010, 74 (6): 1251-1256. 10.1253/circj.CJ-09-0866CrossRefPubMed Maruyoshi H, Kojima S, Kojima S, Nagayoshi Y, Horibata Y, Kaikita K, Sugiyama S, Ogawa H: Waveform of ophthalmic artery Doppler flow predicts the severity of systemic atherosclerosis. Circ J. 2010, 74 (6): 1251-1256. 10.1253/circj.CJ-09-0866CrossRefPubMed
30.
go back to reference Grima P, Guido M, Zizza A, Chiavaroli R: Sonographically measured perirenal fat thickness: an early predictor of atherosclerosis in HIV-1-infected patients receiving highly active antiretroviral therapy?. J Clin Ultrasound. 2010, 38 (4): 190-195.PubMed Grima P, Guido M, Zizza A, Chiavaroli R: Sonographically measured perirenal fat thickness: an early predictor of atherosclerosis in HIV-1-infected patients receiving highly active antiretroviral therapy?. J Clin Ultrasound. 2010, 38 (4): 190-195.PubMed
31.
go back to reference Hiatt WR: Medical treatment of peripheral arterial disease and claudication. N Engl J Med. 2001, 344 (21): 1608-1621. 10.1056/NEJM200105243442108CrossRefPubMed Hiatt WR: Medical treatment of peripheral arterial disease and claudication. N Engl J Med. 2001, 344 (21): 1608-1621. 10.1056/NEJM200105243442108CrossRefPubMed
32.
go back to reference Triposkiadis F, Kallikazaros I, Trikas A, Stefanadis C, Stratos C, Tsekoura D, Toutouzas P: A comparative study of the effect of coronary artery disease on ascending and abdominal aorta distensibility and pulse wave velocity. Acta Cardiol. 1993, 48 (2): 221-233.PubMed Triposkiadis F, Kallikazaros I, Trikas A, Stefanadis C, Stratos C, Tsekoura D, Toutouzas P: A comparative study of the effect of coronary artery disease on ascending and abdominal aorta distensibility and pulse wave velocity. Acta Cardiol. 1993, 48 (2): 221-233.PubMed
Metadata
Title
Comparison of intima-media thickness and ophthalmic artery resistance index for assessing subclinical atherosclerosis in HIV-1-infected patients
Authors
Pierfrancesco Grima
Marcello Guido
Roberto Chiavaroli
Antonella De Donno
Mariangela Tana
Antonella Zizza
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Cardiovascular Ultrasound / Issue 1/2011
Electronic ISSN: 1476-7120
DOI
https://doi.org/10.1186/1476-7120-9-9

Other articles of this Issue 1/2011

Cardiovascular Ultrasound 1/2011 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.