#NADIA KULLO PLUS#

Hence, detection of LMD during the initial evaluation of patients with myocardial ischemia is important as revascularization remains the guideline-recommended management strategy in these patients.

#NADIA KULLO PLUS#

The ISCHEMIA trial, which randomized patients with moderate or severe ischemia to guideline-directed medical therapy vs guideline-directed medical therapy plus optimal revascularization, showed no statistical difference between the groups for the primary composite outcome or the secondary outcome of cardiovascular death or myocardial infarction.( 3) However, patients with LMD ≥50% on computed coronary tomographic angiography (CCTA) were excluded from randomization.

Kullo's laboratory is to improve the ability to predict adverse cardiovascular events in asymptomatic individuals using genetic susceptibility markers, circulating biomarkers and measurements of arterial function.Detection of significant (≥50%) left main disease (LMD) has major prognostic and therapeutic implications.( 1) While the detection of obstructive coronary artery disease (CAD) is important, this is especially true of LMD because current guidelines recommend revascularization to improve survival when LMD is present.( 2) Currently available risk-prediction algorithms are suboptimal when it comes to predicting such adverse outcomes in asymptomatic individuals. Often, the first manifestation is myocardial infarction, ischemic stroke or sudden death. Kullo's lab is creating a vascular diseases biorepository containing DNA, serum, plasma and cell line samples from volunteers with common vascular diseases - including carotid artery stenosis, aortic aneurysm and peripheral arterial disease - and rare vascular traits, including fibromuscular dysplasia.Ītherosclerotic vascular disease is the leading cause of mortality and morbidity in the U.S. The laboratory is engaged in clinical investigation related to PAD, including epidemiology of symptomatic PAD, the genetic bases of PAD and alterations in arterial function in patients with PAD. The research team is also studying the association of arterial stiffness on measures of left ventricular function including longitudinal strain and diastolic function. The laboratory is investigating the clinical utility of measures of arterial stiffness such as aortic pulse wave velocity and characteristic impedance.

Arterial stiffness and ventricular arterial interactions.

Kullo's team studies the connections between novel protein markers and measurable traits of vascular disease, such as coronary artery calcium, cerebral leukoaraiosis, albuminuria and ankle-brachial index, with the goal of identifying new proteomic markers for vascular disease.

Proteomic markers for vascular disease.

Kullo and collaborators are working with the Electronic Medical Records and Genomics (eMERGE) Network to develop better ways to use EHR-linked biorepositories for large-scale genomic research. Another project is investigating the clinical utility of a genetic risk score composed of susceptibility variants for abdominal aortic aneurysm. Kullo's laboratory conducts clinical trials in genomic medicine, such as the recently concluded Myocardioal Infarction Genes (MI-GENES) study, which assessed the effect on LDL cholesterol of disclosing a genetic risk score for coronary heart disease based on 28 susceptibility variants.

Implementing genomic medicine in the EHR.

Kullo's laboratory is engaged in several projects related to FH, including the use of electronic phenotyping for rapid ascertainment of FH from electronic health records (EHRs), use of EHR-based strategies to improve outcomes in patients with FH, assigning pathogenicity to variants identified from sequencing of FH-related genes and investigating the pleiotropic effects of FH-related genes. Kullo's lab uses family history studies, linkage studies, candidate gene association studies, genome-wide association studies and genome sequencing to study the genetic basis of atherosclerosis.

Genetics of arterial plaques (atherosclerosis).

These include genetic markers, circulating biomarkers, and noninvasive tests of arterial function and structure. Kullo is investigating the use of new methodologies in refining cardiovascular risk stratification. Through his Atherosclerosis and Lipid Genomics Laboratory, Dr. Kullo, M.D., is in biomarkers of cardiovascular risk.

The main research interest of Iftikhar J.

Nadia kullo