Identification and Validation of Immune Markers in Coronary Heart Disease

Conventional risk factors for coronary heart disease (CHD) do not completely account for the observed increase in premature CHD in people from the Indian subcontinent or for Asian Indians who have immigrated to the USA. The objective of this study was to determine the effect of immigration to the USA on plasma levels of lipoprotein [a] (Lp[a]) and other independent risk factors for CHD in Asian Indians. Three subject groups were studied: group 1, 57 subjects living in India and diagnosed with CHD (CHD patients); group 2, 46 subjects living in India and showing no symptoms of CHD (control subjects); group 3, 206 Asian Indians living in the USA. Fasting blood samples were drawn to determine plasma levels of triglyceride (TG), total cholesterol (TC), low density lipoprotein [LDL cholesterol (LDL-Chol)], high density lipoprotein [HDL cholesterol (HDL-Chol)], apolipoprotein B-100 (apoB-100), and Lp[a]. Apolipoprotein [a] (apo[a]) size polymorphism was determined by immunoblotting. Plasma TG, apoB-100, and Lp[a] concentrations were higher in CHD patients than in control and USA groups. CHD patients had higher levels of TC and LDL-Chol and lower HDL-Chol than control subjects. However, the USA population had higher levels of TC, LDL-Chol, and apoB-100 and lower HDL-Chol than control subjects. Plasma Lp[a] levels were inversely correlated with the relative molecular weight of the more abundant of each subject's two apo[a] isoforms (MAI), and CHD patients showed higher frequencies of lower relative molecular weights among MAI. Our observed changes in lipid profiles suggest that immigrating to the USA may place Asian Indians at increased risk for CHD. This study suggests that elevated plasma Lp[a] confers genetic predisposition to CHD in Asian Indians, and nutritional and environmental factors further increase the risk of CHD. This is the first report implicating MAI size as a predictor for development of premature CHD in Asian Indians. Including plasma Lp[a] concentration and apo[a] phenotype in screening procedures may permit early detection and preventive treatment of CHD in this population.

Objective To assess left atrial(LA)function by evaluating changes of LA wall movement and volume detected by real-time three-dimensional speckle tracking imaging(RT3D-STI)in elderly patients with ischemic mitral regurgitation(IMR). Methods Eighty-six elderly patients with coronary heart disease(CHD)were enrolled in this study.According to whether or not to have IMR, the patients were divided into the pure CHD group(n=32)and the CHD-induced ischemic mitral regurgitation(IMR)group(n=54, including 20 cases of mild IMR, 18 cases of moderate IMR and 16 cases of severe IMR). Thirty-two healthy elderly volunteers were considered as control group.RT3D-STI was used to evaluate the global atrial longitudinal strain(GLS), global circumferential strain(GCS), global radial strain(GRS)and LA maximal, minimal and pre-systolic volumes(LAVmax, LAVmin, and LAVp). LA ejection fraction(LAEF), LA passive ejection fraction(LApEF)and LA active ejection fraction(LAaEF)were calculated.The relationship of LA volume changes and myocardial strain with LA function was analyzed. Results The left ventricular ejection fraction(LVEF)and LAEF were reduced in CHD group and IMR group as compared with the control group, and were lower in IMR group than in CHD group(P<0.05). Compared with the control group, the LAVmin was increased, and the LAaEF was decreased in the IMR group(P<0.05). Compared with the control group, the GLS, GCS, GRS were declined in the CHD and IMR groups, and were lower in IMR group than in control group(P<0.05). Along with the increased severity of regurgitation, GLS, GCS, and GRS were decreased in varying degrees.The standard deviations of time to peak longitudinal strains(TLS-SD), of time to peak circumferential strains(TCS-SD), and of time to peak radial strain(TRS-SD)rose in the IMR group as compared with the control group(P<0.05). The myocardial motion indicators(GLS, GCS, GRS)had a quite strong correlation with LAEF in the CHD and IMR groups(CHD group: r=-0.745, -0.718 and 0.627, P=0.006, 0.007 and 0.009; IMR group: r=-0.785, -0.781, 0.643, P=0.006, 0.007 and 0.008). The receiver operating characteristic(ROC)curves analysis showed that the sensitivity and specificity of TLS-SD, TCS-SD and TRS-SD were 89.7% and 81.8%, 78.6% and 84.8%, 85.7% and 72.1%, respectively in the evaluation of LA function changes. Conclusions RT3D-STI can precisely and objectively assess the LA function changes by measuring the volume changes and tracing the myocardial motion in elderly IMR patients. Key words: Coronary disease; Mitral valve insufficiency; Echocardiography, three-dimensional; Atrail function, left

The aim of the present study was to investigate whether acylation stimulating protein (ASP) and complement component 3 (C3) are associated with the occurrence and development of coronary heart disease (CHD). The participants of the study were divided into three groups, including the healthy control (n=42), metabolic syndrome (MS, n=56) and CHD (n=62) groups. An enzyme-linked immunosorbent assay was used to measure the ASP concentrations, while an immunoturbidimetric assay was employed to determine the C3 concentrations. In addition, coronary angiography was performed to determine the severity of coronary artery disease in the CHD group. The CHD group was divided into three subgroups, according to the final Gensini score of coronary artery stenosis for each patient (mild, ≤20 points; moderate, 21–40 points; severe, >40 points). Western blotting and quantitative reverse transcription-polymerase chain reaction (RT-PCR) were performed to analyze the protein and mRNA expression levels of C3 in the CHD subgroups and the healthy control group. The concentrations of ASP and C3 in the CHD group were found to be significantly higher compared with the control and MS groups. In addition, the levels of ASP and C3 in the mild and moderate CHD subgroups were significantly higher compared with the healthy controls or mild CHD patients. Furthermore, the protein expression levels of C3 in the moderate and severe CHD patients were found to be significantly higher compared with the healthy individuals and the mild CHD patients. The quantitative RT-PCR results revealed that the mRNA expression levels of C3 in the moderate and severe CHD patients were significantly higher compared with the healthy control group and the mild CHD patients. Furthermore, the mean levels of C3 transcripts in the severe CHD patients were found to be higher compared with the moderate CHD subgroup (P<0.05). Therefore, ASP and C3 were found to be associated with the occurrence and development of CHD; thus, may be used as novel indexes for CHD.

Objective To investigate the changes of autonomic nerve function of coronary heart disease (CHD) patients with panic disorder(PD). Methods All the subjects who met with the diagnostic code of CHD and PD were divided into CHD group(n=40) ,PD group(n=36) ,comorbid CHD and PD group(n=27) ,and 40physical examinee were recruited as normal control group. They had a 24 hours Holter ECG monitoring by time and frequency domain analysis of heart rate variability. ANOVA analysis was utilized to statistic the collected data. Results Compared with normal controls,the patients of others groups had every indexs of HRV were reduced. The indexs of HRV of comorbid CHD and PD were lower than the patients of CHD or PD group. The score of time domain SDNN(70.40 ± 14.74)ms,SDANN(91.72 ± 24.46)ms,PNN50(2.83 ±2.07)%, RMSSD( 15.66 ±7.45)ms,frequency domain LF(647.54 ± 129.24)ms2, HF(596. 16± 127.66) ms2 in comorbid CHD and PD. There were significant differences with others groups(P ＜ 0.05 ). Conclusion The autonomic nervous functional of the patients with CHD and PD were in disorder. The autonomic nervous functional disorder of the patients with comorbid CHD and PD was more severe. Key words: Coronary heart disease; Panic disorder; Heart rate variability; Autonomic nervous function

To investigate the association between the ApoE and LDLR-R gene loci on coronary heart disease (CHD) and their interaction with alcohol drinking and smoking in Hans of Chinese. A questionnaire survey of the behaviors of smoking and drinking, dietary custom, and anamnesis, was conducted among 146 cases of CHD, aged 64 +/- 11, and 340 controls, aged 63 +/- 12. Peripheral blood samples were collected and the total DNAs were extracted. The levels of triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were examined. The ApoE genotype was identified by the method of multiplex amplification refractory mutation system and AvaII polymorphisms of the LDL-R gene were detected by using the method of polymerase chain reaction-restriction fragment length polymorphism. The interaction between the genes and alcohol drinking and smoking was analyzed by using multivariate logistic regression models. (1) Both the systolic blood pressure and diastolic blood pressure of the CHD patients (132 mm Hg +/- 21 mm Hg, and 81 mm Hg +/- 13 mm Hg, 1 mm Hg = 0.133 kPa) were significantly higher than those of the controls (123 mm Hg +/- 17 mm Hg and 77 mm Hg +/- 11 mm Hg, both P < 0.05). The level of TG was 1.6 +/- 0.9 mmol/L in the CHD group, significantly higher than that in the control group (1.4 +/- 0.8 mmol/L, P < 0.05). However, there was no difference in the levels of TC, LDL-C, and HDL-C between the 2 groups (all P > 0.05). (2) For the ApoE gene, the frequencies of E4/3 genotype and epsilon 4 allele were 24.0% and 13.4% respectively in the CHD group, both significantly higher than those in the control group (12.9% and 7.2% respectively, both P < 0.05). For the LDLR-AvaII locus, no difference was found in different genotypes between the CHD and control groups. However, the proportion of those with epsilon 4 locus and AvaII(+) locus simultaneously was 60% in the CHD group, significantly higher than in the control group (31.8%, P < 0.05). (3) After adjustment of confounding variables, such as age, sex, blood pressure, and body mass index, the binary logistic analysis showed a significant gene-environment interaction (P < 0.05). The OR value were: for epsilon 4-AvaII(+): 2.99 (95% CI: 1.36 approximately 6.66, P < 0.01), for epsilon 3-often drinking: 2.60 (95% CI: 1.35 approximately 5.02, P < 0.01), for epsilon 3-smoking 2.58 (95% CI: 1.16 approximately 5.71, P < 0.05), for epsilon 4-stopped smoking 3.12 (95% CI: 1.23 approximately 8.09, P < 0.05), for epsilon 4-smoking: 5.30 (95% CI: 1.21 approximately 23.22, P < 0.05), and for AvaII(+)-often drinking: 2.49 (95% CI: 1.12 approximately 5.52, P < 0.05) respectively. The carriers of epsilon 3, epsilon 4 or AvaII(+) alleles would have higher risk of suffering from CHD if they are drink alcohol or smoke heavily.

BackgroundNitric oxide (NO) is an endothelium derived relaxing factor (EDRF) which has an important role for regulating the heart-vessel physiology. The objective of this study was to evaluate the effects of the eNOS T-786C polymorphism on lipid parameters and the development of acute coronary syndrome (ACS) and coronary heart disease (CHD) for the first time in a Turkish study group. We have analyzed the genotype frequencies of the T-786C polymorphism of the eNOS gene in 10 ACS patients (5 men, 5 women), 20 CHD patients (14 men, 6 women), and 31 controls (10 men, 21 women), who were angiographically proven to have normal coronaries.ResultsThe demographic, biochemical and left ventricule systolic dysfunction data of the ACS, CHD patients and controls were analyzed as a function of eNOS T-786C genotypes. The eNOS gene T-786C polymorphism frequencies for T/T, C/T and C/C genotypes were respectively 10%, 40%, 50% in subjects with ACS; 75%, 20%, 5% in subjects with CHD and 67.7%, 25.8%, 6.5% in the control group. Significant difference was observed in genotype frequencies between the study groups for T-786C polymorphism (p = 0.001). The CC genotype frequency was found to be the most prevalent in ACS group in comparison to CHD and control groups (p = 0.001). TT was the most frequently observed genotype in both CHD patients and controls (p = 0.001). Left ventricule systolic dysfunction frequency was found to be highest in C/T genotype carriers (66.7%) in patients (ACS+CHD). None of the patients with LVSD were carrying the normal genotype (T/T). The eNOS T-786C polymorphism was not found to be effective over any analyzed lipid variable in patients (ACS+CHD). The HDL-cholesterol levels were found to be lower in CHD group were compared to controls (p < 0.01), whereas glucose and leucocyte levels of the ACS and CHD groups were both higher than controls (p < 0.001).ConclusionThe significantly high frequency of eNOS -786C/C genotype in ACS patients than in those of controls, indicate the genotype association with ACS. The finding of significantly high frequency of T/T genotype in the CHD group, may support the relationship of CC genotype with ACS without CHD. The high frequency of the mutant (C/C) and heterozygous (C/T) genotypes found may be linked to left ventricule remodeling after MI.

Objective To explore the association between plasma resistin levels and acute coronary syndrome. Methods Four hundred patients were divided into coronary heart disease (CHD) group（310）and control group（90）according to the coronary Angiography (CAG). And CHD group was divided into ACS subgroup（n＝217）and SAP subgroup（n＝93）according to the clinical information. 85 cases in CHD group were underwent 64-slice spiral computed tomography coronary artery imaging. The severity and extent of coronary lesions were analyzed by CAG and graded by means of Gensini coronary score system. Resistin level in plasma of all patients was determined by enzyme linked immunosorbent assay. Results Resistin levels in CHD group［(889.1±248.2)pg/ml］ were significant higher compared with the control group［(261.6±111.9)pg/ml］ (P＜0.05), and resistin levels in ACS subgroup［(1260.0±368.0)pg/ml］ were much higher than that in SAP subgroup［(518.3±128.4)pg/ml］ (P＜0.05). Conclusions The resistin levels of patients with acute coronary syndrome increased significantly and might be associated with the vulnerable plaque. Resistin levels and 64 slice spiral computed tomography coronary artery imaging can be used to detect the vulnerable plaque in CHD patients. Key words: Acute coronary syndrome/PA/ME; Resistin/ME; Coronary vessels/PA

Interleukin-6 (IL-6) has been reported to be related to coronary heart disease (CHD). It is proposed that the IL-6 trans-signaling pathway is responsible for the inflammatory effect in diseases, including CHD. In Asian countries, CHD tends to occur in younger age. However, no study has yet been done to assess the relationship between IL-6 trans-signaling pathway and young CHD patients in Indonesia. To assess whether there is a relationship between the levels of some components in the IL-6 trans-signaling pathway, including soluble interleukin-6 receptor (sIL-6R), soluble glycoprotein 130 (sgp130), and intercellular adhesion molecule 1 (ICAM-1) and CHD in young adults. A case-control study was conducted including 33 young CHD patients and 33 non-CHD patients as the control group (age and sex matched with CHD group) at Eka Hospital Pekanbaru, Indonesia, from July to November 2018. CHD was confirmed by coronary angiography, while non-CHD patients were subjects with normal ECG, without history of chest pain and family history of CHD. All participants were checked for sIL-6R, sgp130, and ICAM-1 serum levels using ELISA assays tests. The results were evaluated statistically using Student’s t test. The sIL-6R level tended to be higher in the CHD group compared to the control group (70.19+49.38 ng/ml vs 49.42+38.79 ng/ml) but did not reach statistical significance (p=0.062). The sgp130 level was 428.38+358.79 ng/ml and 474.08+389.43 ng/ml in CHD and control group, respectively (p=0.622). While the ICAM-1 level was 1829.53+1882.37 pg/ml and 2078.16+1595.25 pg/ml in CHD and control group, respectively (p=0.565). The IL-6 trans-signaling pathway, reflected by sIL-6R, sgp130, and ICAM-1 serum levels, was not significantly related with CHD in young adults.

Background and objectiveCarotid artery intima media thickness (CIMT) is a strong predictor of Coronary Heart Disease (CHD) and independent phenotype of early atherosclerosis. The global variation of CIMT and its demographic association is yet unclear. We evaluated regional variations of CIMT based on WHO regions and assessed the differences by age and sex.MethodsA systematic search was conducted on studies published between 1980 January up to December 2020. PubMed, Oxford Medicine Online, EBSCO, Taylor & Francis, Oxford University Press and Embase data bases were used for searching. Supplementary searches were conducted on the Web of Science and Google Scholar. Grey literature was searched in “Open Grey” website. The two major criteria used were “adults” and “carotid intima media”. The search strategy for PubMed was created first and then adapted for the Oxford Medicine Online, EBSCO, Taylor & Francis, Oxford University Press and Embase databases. Covidence software (Veritas Health Innovation, Melbourne, Australia; http://www.covidence.org) was used to manage the study selection process. Meta-analyses were done using the random-effects model. An I2 ≥ 50% or p< 0:05 were considered to indicate significant heterogeneity.ResultsOf 2847 potential articles, 46 eligible articles were included in the review contributing data for 49 381 individuals (mean age: 55.6 years, male: 55.8%). The pooled mean CIMT for the non-CHD group was 0.65mm (95%CI: 0.62–0.69). There was a significant difference in the mean CIMT between regions (p = 0.04). Countries in the African (0.72mm), American (0.71mm) and European (0.71mm) regions had a higher pooled mean CIMT compared to those in the South East Asian (0.62mm), West Pacific (0.60mm) and Eastern Mediterranean (0.60mm) regions. Males had a higher pooled mean CIMT of 0.06mm than females in the non CHD group (p = 0.001); there were also regional differences. The CHD group had a significantly higher mean CIMT than the non-CHD group (difference = 0.23mm, p = 0.001) with regional variations. Carotid artery segment-specific-CIMT variations are present in this population. Older persons and those having CHD group had significantly thicker CIMTs.ConclusionsCIMT varies according to region, age, sex and whether a person having CHD. There are significant regional differences of mean CIMT between CHD and non-CHD groups. Segment specific CIMT variations exist among regions. There is an association between CHD and CIMT values.

Carotid artery intima media thickness (CIMT) is a strong predictor of Coronary Heart Disease (CHD) and independent phenotype of early atherosclerosis. The global variation of CIMT and its demographic association is yet unclear. We evaluated regional variations of CIMT based on WHO regions and assessed the differences by age and sex. A systematic search was conducted on studies published between 1980 January up to December 2020. PubMed, Oxford Medicine Online, EBSCO, Taylor & Francis, Oxford University Press and Embase data bases were used for searching. Supplementary searches were conducted on the Web of Science and Google Scholar. Grey literature was searched in "Open Grey" website. The two major criteria used were "adults" and "carotid intima media". The search strategy for PubMed was created first and then adapted for the Oxford Medicine Online, EBSCO, Taylor & Francis, Oxford University Press and Embase databases. Covidence software (Veritas Health Innovation, Melbourne, Australia; http://www.covidence.org) was used to manage the study selection process. Meta-analyses were done using the random-effects model. An I2 ≥ 50% or p< 0:05 were considered to indicate significant heterogeneity. Of 2847 potential articles, 46 eligible articles were included in the review contributing data for 49 381 individuals (mean age: 55.6 years, male: 55.8%). The pooled mean CIMT for the non-CHD group was 0.65mm (95%CI: 0.62-0.69). There was a significant difference in the mean CIMT between regions (p = 0.04). Countries in the African (0.72mm), American (0.71mm) and European (0.71mm) regions had a higher pooled mean CIMT compared to those in the South East Asian (0.62mm), West Pacific (0.60mm) and Eastern Mediterranean (0.60mm) regions. Males had a higher pooled mean CIMT of 0.06mm than females in the non CHD group (p = 0.001); there were also regional differences. The CHD group had a significantly higher mean CIMT than the non-CHD group (difference = 0.23mm, p = 0.001) with regional variations. Carotid artery segment-specific-CIMT variations are present in this population. Older persons and those having CHD group had significantly thicker CIMTs. CIMT varies according to region, age, sex and whether a person having CHD. There are significant regional differences of mean CIMT between CHD and non-CHD groups. Segment specific CIMT variations exist among regions. There is an association between CHD and CIMT values.

Objective To investigate the significance of blood lipids and pro-inflammatory in chronic obstructive pulmonary disease (COPD) patients in stable and acute exacerbations (AECOPD) with or without coronary heart disease (CAD). Methods One hundred and sixty COPD patients were divided into four groups based on whether COPD was in the acute or stable phase and whether comorbid CAD: AECOPD without CAD group, AECOPD with CAD group, stable COPD without CAD group, and stable COPD with CAD group. Results The levels of ApoA-I and ApoA-II in the AECOPD group and AECOPD with CAD group were significantly lower than in the stable COPD group, stable COPD with CAD group, and control group. The levels of SAA, TNF-α, and IL-6 was significantly higher in AECOPD group with CAD or without CAD compared with control group. SAA levels were significantly increased in stable COPD with CAD group compared with control group. Conclusion The levels of ApoA-I and ApoA-II in the AECOPD without CAD group and AECOPD with CAD group were significantly lower than those in the stable COPD group, stable COPD with CAD group. The change of pro-inflammatory factor TNF-α and IL-6 levels would be an important reason. The SAA level was significantly increased in the AECOPD without CAD group and AECOPD with CAD group, which indicated that the changes in HDL-C components in this group may be an important reason for promoting the progress of CAD.

The aim of this study was to evaluate the relationship between subclinical hypothyroidism and/or autoimmune thyroid disease and coronary heart disease (CHD). Ninety seven patients diagnosed as having CHD by a coronary angiography (CHD group) and 103 healthy subjects matched for age, sex and body mass index (control group) were included in the study. Thyroid function, thyroid autoantibodies and serum lipid concentrations were measured in the CHD and control groups. The CHD group exhibited significantly decreased serum free T3 (FT3) and free T4 (FT4) levels, and significantly increased serum TSH levels as compared with the control group, indicating a significant decrease in thyroid function in the CHD patients. Serum high density lipoprotein cholesterol (HDL-C) levels were significantly decreased in the CHD group. The incidence of subclinical hypothyroidism and thyroid autoantibodies was similar in both two groups. These observations were also true of women even after those who had diabetes mellitus (DM), hypertension (HT) and a smoking habit were excluded. This was not the case, however, in men without DM, HT, or a smoking habit. Patients with CHD had significantly lower serum levels of HDL-C than the control subjects, regardless of gender (P < 0.01). In the group with CHD, there was no difference between the serum lipid levels in patients with subclinical hypothyroidism and those with normal thyroid function. Female patients with CHD had significantly lower serum levels of thyroid hormone and HDL-C, but their subclinical hypothyroidism or thyroid autoimmunity did not seem to be related to the development of CHD.

Statin Underuse and Low Prevalence of LDL-C Control Among U.S. Adults at High Risk of Coronary Heart Disease

ObjectivesTo investigate the distribution of the L/M polymorphism of PON-1 gene in Chinese Han nationality and to analyse the association of PON-1 gene, serum PON-1 activity with coronary hear t...

Objective To examine the features and clinical significance of cardiopulmonary exercise testing(CPET)in elderly patients with coronary heart disease. Methods A retrospective study was conducted at the Fifth Affiliated Hospital of Zhengzhou University from September 2015 to August 2017.Fifty-nine elderly inpatients who had undergone coronary angiography and CPET were enrolled.The mean age was 61.5 years, and there were 48 males and 11 females.Based on the results of coronary angiography, patients were divided into a coronary heart disease(CAD)group(n=40)and a non-CAD group(n=19). Meanwhile, according to the degree of coronary stenosis assessed by angiography, the CAD group was further divided into two subgroups(Group A: coronary stenosis, 50%-70%, n=25; Group B: coronary stenosis, >70%, n=15). All results of CPET were compared between the groups. Results Patients in the CAD group were significantly associated with a lower anaerobic threshold(855.8±207.0)ml/min vs.(976.5±231.8)ml/min, a lower peak VO2(1 371.5±388.8)ml/min vs.(1652.8±435.5)ml/min, a lower percentage of peak VO2(18.3±4.7)ml·min-1·kg-1vs.(22.0±4.4)ml·min-1·kg-1, a lower peak O2-pulse(65.6±14.8)% vs.(85.5±14.9)% and a lower ΔVO2/ΔWR slope to expected value(8.0±1.1)ml·min-1·W-1vs.(9.1±1.5)ml·min-1·W-1, compared with those in the non-CAD group(all P ATand ΔVO2/ΔWRRatio to expected value were lower in Group B(7.5±1.3 vs.8.3±1.0, t=2.317, P=0.026), (6.2±1.9 vs.7.6±1.2, t=2.815, P=0.008)and(0.7±0.2vs.0.9±0.1, t=2.957, P=0.005). There was no difference in ΔVO2/ΔWR 0.05). Conclusions Exercise tolerance is lower in elderly CAD patients than those without CAD, and ΔVO2/ΔWR is decreased during the process of exercise, especially after the AT, which may be associated with low cardiac output due to left ventricular myocardial ischemia.This finding suggests that CPET can provide evidence of ischemia in patients with coronary heart disease and is valuable for the development of diagnostic and therapeutic strategies. Key words: Exercise test; Coronary disease; Myocardial ischemia