Henrik Sillesen
University of Copenhagen, Vascular Surgery, Department Member
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Introduction: Intermittent claudication (IC) caused by Peripheral Artery Disease (PAD) is a common cardiovascular disease. Patients with IC have reduced walking capacity, restricted activity levels and mobility, and reduced health-related... more
Introduction: Intermittent claudication (IC) caused by Peripheral Artery Disease (PAD) is a common cardiovascular disease. Patients with IC have reduced walking capacity, restricted activity levels and mobility, and reduced health-related quality of life. The disease leads to social isolation, the risk of cardiovascular morbidity, and mortality. Non-operative management of IC requires exercise therapy and studies show that supervised exercise training is more effective than unsupervised training, yet many patients with IC lack motivation for changes in health behavior. No studies investigating the effects of existing cardiac rehabilitation targeted patients with IC have been published. The aim of this paper is to present the rationale and design of the CIPIC Rehab Study, which examines the effect of a cross-sectoral rehabilitation programme versus usual care for patients in non-operative management for IC. Methods and analysis: A randomised clinical trial aims to investigate whether...
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Background and Purpose— The relative contributions of on-treatment low- and high-density lipoprotein cholesterol (LDL-C, HDL-C), triglycerides, and blood pressure (BP) control on the risk of recurrent stroke or major cardiovascular events... more
Background and Purpose— The relative contributions of on-treatment low- and high-density lipoprotein cholesterol (LDL-C, HDL-C), triglycerides, and blood pressure (BP) control on the risk of recurrent stroke or major cardiovascular events in patients with stroke is not well defined. Methods— We randomized 4731 patients with recent stroke or transient ischemic attack and no known coronary heart disease to atorvastatin 80 mg per day or placebo. Results— After 4.9 years, at each level of LDL-C reduction, subjects with HDL-C value above the median or systolic BP below the median had greater reductions in stroke and major cardiovascular events and those with a reduction in triglycerides above the median or diastolic BP below the median showed similar trends. There were no statistical interactions between on-treatment LDL-C, HDL-C, triglycerides, and BP values. In a further exploratory analysis, optimal control was defined as LDL-C <70 mg per deciliter, HDL-C >50 mg per deciliter, t...
Research Interests: Medicine, Humans, Blood Pressure, Cholesterol, Female, and 15 moreMale, Hypercholesterolemia, Clinical Sciences, Aged, Middle Aged, Adult, Coronary heart disease, Blood Pressure Control, Exploratory Analysis, Neurosciences, Confidence Interval, Cumulant, Arterial pressure, Cardiovascular Events, and Cardiovascular medicine and haematology
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Research Interests: Evidence Based Medicine, Risk assessment, Health Policy, Medicine, Stents, and 15 morePolicy making, Stroke, Humans, United States, Risk factors, Medicaid, Clinical Sciences, Angioplasty, Carotid Endarterectomy, Risk Factors, Risk Assessment, Angiology, Carotid Stenosis, Patient selection, and Cardiovascular medicine and haematology
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Research Interests: Cardiology, Medicine, Fibrinogen, Humans, Internal Medicine, and 15 moreFemale, Male, Brain Ischemia, Aged, Middle Aged, C reactive protein, Adult, Carotid Artery, Ischaemic Stroke, Carotid Stenosis, Carotid Artery Stenosis, Cohort Studies, high sensitivity C reactive protein, Cardiovascular Events, and Cardiovascular medicine and haematology
Patients with familial hypercholesterolemia (FH) are at markedly increased risk of developing premature coronary artery disease. The objective of the present study was to evaluate the role of carotid ultrasonography as a measure of... more
Patients with familial hypercholesterolemia (FH) are at markedly increased risk of developing premature coronary artery disease. The objective of the present study was to evaluate the role of carotid ultrasonography as a measure of subclinical coronary artery disease in patients with FH. The present prospective study compared the presence of subclinical carotid and coronary artery disease in 67 patients with FH (mean age 55 ± 8 years, 52% men) to that in 30 controls with nonanginal chest pain (mean age 56 ± 9 years, 57% men). The carotid intima-media thickness and carotid plaque burden were assessed using B-mode ultrasonography, according to the Mannheim consensus. Coronary artery disease was assessed using computed tomographic coronary angiography. A lumen reduction &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50% was considered indicative of obstructive coronary artery disease. The patients with FH and the controls had a comparable carotid intima-media thickness (0.64 vs 0.66 mm, p = 0.490), prevalence of carotid plaque (93% vs 83%, p = 0.361), and median carotid plaque score (3 vs 2, p = 0.216). Patients with FH had a significantly greater median coronary calcium score than did the controls (62 vs 5, p = 0.015). However, the prevalence of obstructive coronary artery disease was comparable (27% vs 31%, p = 0.677). No association was found between the carotid intima-media thickness and coronary artery disease. An association was found between the presence of carotid plaque and coronary artery disease in the patients with FH and the controls. The absence of carotid plaque, observed in 5 patients (7%) with FH, excluded the presence of obstructive coronary artery disease. In conclusion, the patients with FH had a high prevalence of carotid plaque and a significantly greater median coronary calcium score than did the controls. A correlation was found between carotid plaque and coronary artery disease in patients with FH; however, the presence of carotid plaque and carotid plaque burden are not reliable indicators of obstructive coronary artery disease.
Research Interests: Risk assessment, Prospective studies, Humans, Female, Male, and 13 moreFollow-up studies, Netherlands, Incidence, Risk factors, Middle Aged, Coronary Angiography, Risk Factors, Risk Assessment, The Carotid Artery Intima Media Thickness, Coronary Artery Disease, Carotid Arteries, Asymptomatic Diseases., and Cardiovascular medicine and haematology
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Carotid artery stenosis (CAS) and vertebral artery stenosis (VAS) are associated with cerebral infarction after coronary artery bypass graft surgery (CABG). It remains unclear whether this association is causal. We investigated the... more
Carotid artery stenosis (CAS) and vertebral artery stenosis (VAS) are associated with cerebral infarction after coronary artery bypass graft surgery (CABG). It remains unclear whether this association is causal. We investigated the associations between neurologically asymptomatic CAS and VAS and the occurrence of subclinical cerebral lesions after CABG verified by magnetic resonance imaging. CABG patients were included and CAS and VAS were identified by magnetic resonance angiography. Cerebral magnetic resonance imaging was performed to identify new post-operative subclinical cerebral lesions. The associations between CAS/VAS post-operative cerebral lesions were investigated. Forty-six patients were included in the study. 13% had significant CAS and 11% had significant VAS. Thirty-five percent had new cerebral infarction postoperatively. We found a significant association between the presence of cerebral vessel stenosis and acute cerebral infarction (67% vs. 27%, p = 0.047). However...
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When looking at tissue sections of ex vivo samples, autofluorescence can be a major cause of artifacts and misinterpretations. We here reiterate evidence that autofluorescing granules, often hemosiderin but also ceroid or mucinogen... more
When looking at tissue sections of ex vivo samples, autofluorescence can be a major cause of artifacts and misinterpretations. We here reiterate evidence that autofluorescing granules, often hemosiderin but also ceroid or mucinogen granules, are severe obstacles when imaging and diagnosing biofilm infections through fluorescent imaging techniques. We used confocal laser scanning microscopy with spectral analysis for autofluorescence detection as well as standard histological stains in order to identify the culprit and show that these granules might very well be mistaken for bacterial biofilms. Furthermore, we hypothesize that the increased amount of autofluorescing granules may be a consequence of prolonged inflammation as a consequence of chronic biofilm infections.
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Although recent studies suggest that measuring coronary artery calcification (CAC) may be superior to indirect atherosclerotic markers in predicting cardiac risk, there are limited data evaluating imaging-based biomarkers that directly... more
Although recent studies suggest that measuring coronary artery calcification (CAC) may be superior to indirect atherosclerotic markers in predicting cardiac risk, there are limited data evaluating imaging-based biomarkers that directly quantify atherosclerosis in different vascular beds performed in a single cohort. The BioImage Study (A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population) sought to identify imaging biomarkers that predict near-term (3-year) atherothrombotic events. The BioImage Study enrolled 5,808 asymptomatic U.S. adults (mean age: 69 years, 56.5% female) in a prospective cohort evaluating the role of vascular imaging on cardiovascular risk prediction. All patients were evaluated by CAC and novel 3-dimensional carotid ultrasound. Plaque areas from both carotid arteries were summed as the carotid plaque burden (cPB). The primary endpoint was the composite of major adverse cardiac events (MACE) (cardiovascular death, myocardial infarction, ...
Research Interests: Risk assessment, Prospective studies, Humans, Female, Male, and 15 moreCt, Three Dimensional Imaging, Follow-up studies, CVD, Aged, Prevalence, Middle Aged, CAC, Risk Assessment, The Carotid Artery Intima Media Thickness, Coronary Artery Disease, Vascular Calcification, Predictive value of tests, Asymptomatic Diseases., and Cardiovascular medicine and haematology
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The online version of this article, along with updated information and services, is located on the
Research Interests: Risk, Treatment Outcome, Stroke, Humans, Female, and 15 moreMale, Hypercholesterolemia, Brain Ischemia, LDL-cholesterol, Recurrence, Clinical Sciences, Aged, Middle Aged, Coronary heart disease, Cerebral Hemorrhage, Neurosciences, Carotid Stenosis, Randomized Controlled Trials as Topic, Cardiovascular Events, and Cardiovascular medicine and haematology
Research Interests: Evidence Based Medicine, Risk assessment, Health Policy, Stents, Policy making, and 12 moreStroke, Humans, United States, Risk factors, Clinical Sciences, Angioplasty, Carotid Endarterectomy, Risk Factors, Risk Assessment, Carotid Stenosis, Patient selection, and Cardiovascular medicine and haematology
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Established risk factors do not fully identify patients at risk for recurrent stroke. The SPARCL trial (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) evaluated the effect of atorvastatin on stroke risk in patients with... more
Established risk factors do not fully identify patients at risk for recurrent stroke. The SPARCL trial (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) evaluated the effect of atorvastatin on stroke risk in patients with a recent stroke or transient ischemic attack and no known coronary heart disease. This analysis explored the relationships between 13 plasma biomarkers assessed at trial enrollment and the occurrence of outcome strokes. We conducted a case-cohort study of 2176 participants; 562 had outcome strokes and 1614 were selected randomly from those without outcome strokes. Time to stroke was evaluated by Cox proportional hazards models. There was no association between time to stroke and lipoprotein-associated phospholipase A2, monocyte chemoattractant protein-1, resistin, matrix metalloproteinase-9, N-terminal fragment of pro-B-type natriuretic peptide, soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1, or soluble CD40 lig...
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Prediction of cardiovascular events improves using imaging, i.e. coronary calcium score and ultrasound assessment of carotid plaque. This study analysed the predictive value of two ultrasound measures of carotid plaque size: carotid... more
Prediction of cardiovascular events improves using imaging, i.e. coronary calcium score and ultrasound assessment of carotid plaque. This study analysed the predictive value of two ultrasound measures of carotid plaque size: carotid plaque thickness and carotid and intima-media thickness (IMT). A total of 6102 asymptomatic persons underwent assessment of conventional risk factors and imaging by carotid ultrasound. Carotid plaque burden (cPB) and maximum carotid plaque thickness (cPTmax) were measured from 'cross-sectional sweep' video acquisition of the carotid artery. IMT was measured from distal common carotid artery images. All participants were followed up for ∼3 years, and major cardiovascular events (MACE) were collected and adjudicated. All data were available for 5808 participants, in whom 216 first MACE events were observed. Increasing both cPB and cPTmax were associated with increasing the risk of future MACE when compared with participants without carotid atherosc...
Objective Quality improvement in surgery has mainly been based on clinical database outcomes. This study compared variables from the patient-reported Aberdeen Varicose Vein Questionnaire with the Danish Clinical Vein Database, in order to... more
Objective Quality improvement in surgery has mainly been based on clinical database outcomes. This study compared variables from the patient-reported Aberdeen Varicose Vein Questionnaire with the Danish Clinical Vein Database, in order to reveal agreements and differences in symptoms and clinical findings. Methods In the period January-March 2011, 379 legs in 287 patients treated for varicose veins were registered in the Danish Clinical Vein Database and compared to the Aberdeen Varicose Vein Questionnaire. Results Patients and physicians agreed in reduction of symptoms after intervention with one or more complaints still present in 128 (93%) patients according to Aberdeen Varicose Vein Questionnaire compared to the Danish Clinical Vein Database with only 64 (47%) patients. Patients reported cosmetic complaints and teleangiectasies both before and after treatment (p < 0.001) more often than doctors. Conclusion The Aberdeen Varicose Vein Questionnaire has added valuable informatio...
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Disruption of the endothelial lining may be one of the events linking intraluminal thrombus and abdominal aortic aneurysm growth. In the present study, we examined whether von Willebrand factor activity in plasma, contact proteins of... more
Disruption of the endothelial lining may be one of the events linking intraluminal thrombus and abdominal aortic aneurysm growth. In the present study, we examined whether von Willebrand factor activity in plasma, contact proteins of blood coagulation, and inflammatory biomarkers may be associated with intraluminal thrombus volume in search of a biochemical marker of endothelial damage and thrombus size. Prospective study, correlating potential endothelial biomarkers and intraluminal thrombus volume acquired by computed tomography angiography. Plasma was consecutively obtained from 38 patients with asymptomatic infrarenal abdominal aortic aneurysm. von Willebrand factor activity, thrombin generation time, factor XII, and prekallikrein concentration were measured in plasma on automated and in-house platforms. In total, 8 patients were excluded due to ongoing anticoagulant therapy, renal impairment, or nonappearance, thus leaving 30 patients for further analysis. All patients had comp...
Research Interests: Biomarkers, Prospective studies, Humans, von Willebrand factor, Female, and 11 moreMale, Blood Coagulation, Aged, Prognosis, Thrombosis, Predictive value of tests, Multidetector Computed Tomography, Vascular and Endovascular Surgery, Prekallikrein, Asymptomatic Diseases., and Computed tomography angiography
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The aim of this study was to examine the use of quantitative fluorescein angiographic analysis as a means of estimating rates of perfusion of the retina in eyes with a circulatory deficit secondary to carotid artery stenosis. The study... more
The aim of this study was to examine the use of quantitative fluorescein angiographic analysis as a means of estimating rates of perfusion of the retina in eyes with a circulatory deficit secondary to carotid artery stenosis. The study included 21 eyes with ocular ischaemic syndrome (OIS) and 20 control eyes from subjects with carotid artery stenosis but without signs of ocular ischaemia. Analyses of video fluorescein angiograms extracting time intervals for the time delay between specific phases of the angiogram were performed. Time delay was compared between groups and in relation to degree of carotid artery stenosis and ocular systolic blood pressure. Among the three flow indices of retinal perfusion (arteriovenous passage time 1 (AVP1), arteriovenous passage time 2 (AVP2) and venous filling time (VP)), those including the venous filling phase were significantly prolonged in the OIS group. Furthermore, AVP2 was delayed by 3 sec. in OIS eyes (16.6 sec. versus 13.6 sec. in controls). VP was 2.4 sec. longer in OIS eyes (11.5 sec. versus 9.1 sec.). We found a significant correlation between AVP2 and ocular perfusion pressure, but no correlation between the degree of carotid artery stenosis and any of the flow indices. In a patient population spanning a wide ocular systolic blood pressure range, angiography-based quantitative flowmetry demonstrated a difference between carotid artery stenosis patients with and without OIS and a correlation between flow and ocular perfusion pressure. While angiographic flowmetry proved effective in discriminating between groups of individuals, it can only be used to support the diagnosis of the ocular ischaemic syndrome in patients with extreme flow reduction.