Wrist Circumference as a Novel Predictor of Coronary Artery Disease and Metabolic Syndrome

Apolipoprotein C-III (apoC-III) is a marker of triglyceride (TG)-rich lipoproteins, which are often increased in metabolic syndrome (MS). The T-455C polymorphism in the insulin-responsive element of the APOC3 gene influences TG and apoC-III levels. To evaluate the contribution of apoC-III levels and T-455C polymorphisms in the coronary artery disease (CAD) risk of MS patients, we studied 873 patients, 549 with CAD and 251 with normal coronary arteries. Patients were classified also as having or not having MS (MS, n = 270; MS-free, n = 603). Lipids, insulin, apolipoprotein levels, and APOC3 T-455C genotypes were evaluated. ApoC-III levels were significantly increased in MS patients, and the probability of having MS was correlated with increasing quartiles of apoC-III levels. MS patients with CAD had significantly higher apoC-III levels than did CAD-free MS patients. The carriership for the -455C variant multiplied the probability of CAD in MS in an allele-specific way and was associated with increased apoC-III and TG levels. Obesity was less frequent in MS carriers of the -455C allele than in MS noncarriers (21.6% vs. 34.8%, P < 0.05). In conclusion, apoC-III-rich lipoprotein metabolism and the APOC3 polymorphism have relevant impacts on the CAD risk of MS patents.

The value of wrist circumference for predicting the presence of coronary artery disease and metabolic syndrome

Copresence of abdominal aortic aneurysm in symptomatic coronary artery disease patients

Background: Reactive oxygen species (ROS) and inflammation play the role in the pathogenesis and the development of coronary artery disease (CAD), and high-sensitivity C-reactive protein (hs-CRP), a marker for low-grade inflammation, is one of the most studied biomarkers for the evaluation of CAD risk. In contrast, there is little biomarker of ROS, which is easy to assay and is widely accepted as marker of CAD. Hence, in this study, we compared associations of hs-CRP and derivatives of reactive oxygen metabolites (d-ROM), a newly and easier-to-assay marker of ROS, with the severity of CAD. Methods: We examined the presence of CAD by coronary angiography (coronary stenosis ≥ 50% luminal diameter narrowing) and CAD patients were divided to single-vessel disease (SVD) or multiple-vessel disease (MVD) according to the number of vessels. In consecutive CAD patients, we assessed d-ROM by simpler method for detecting hydroperoxide as a marker of ROS, and compared association between hs-CRP and severity of CAD. Results: In preliminary study, d-ROM values were significantly increased in CAD patients compared to control patients. In consecutive 261 CAD patients, d-ROM values were significantly higher in CAD patients with MVD (n=172) than CAD patients with SVD (n=89) (d-ROM: CAD+SVD; 332.2 ± 70.9 U.CARR versus CAD+MVD; 353.2 ± 70.5 U.CARR, p&lt;0.05). In receiver-operating characteristic analysis, d-ROM values was a significant determinant for the severity of CAD (area under the curve; 0.60, 95% confidence interval; 0.52-0.67, p&lt;0.01). In contrast, hs-CRP of CAD patients with MVD were not changed compared to those of CAD patients with SVD (ln[hs-CRP]: CAD+SVD; -2.79 ± 1.12 mg/dL versus CAD+MVD; -2.65 ± 1.09 mg/dL, p=0.32). By multivariate backward logistic regression analysis among various risk factors, d-ROM values, but not hs-CRP independently associated with the severity of CAD (p&lt;0.05). Conclusion: d-ROM values reflecting ROS levels significantly increased in CAD patients and significantly correlated with the severity of CAD. d-ROM assay might be a more important biomarker than hs-CRP to evaluate the severity of CAD and screen for CAD in high-risk patients. Identifying the high-risk CAD patients by d-ROM may provide clinical benefits for risk stratification.

Relationship between inflammatory markers with the presence and severity of coronary artery disease

Introduction Metabolic Syndrome (MS) is a bundle of cardiometabolic risk factors leading to metabolic, clinical and hemodynamic disorders. It begins as insulin resistance and is followed by systemic disorders, such as abdominal obesity, Diabetes Mellitus (DM), dyslipidemia, hypertension and Coronary Artery Disease (CAD). Mean platelet volume (MPV) is an indicator of thrombotic risk and a predictor of CAD. The study aims to correlate MS with MPV and the extent and severity of CAD. Material and Methods We studied 151 patients (124 males – 27 females, mean age 63.56±11.28 years) who underwent coronary angiography. The existence of MS was defined according to the criteria set by the respective scientific societies. According to these, the patients were classified into Group A (46 patients with MS – 35 males, 11 females – mean age 62.07±11.35 years) and Group B (105 patients without MS – 89 males, 16 females – mean age 65.06±12.54 years). Obstructive coronary artery stenosis was considered at the existence of &amp;gt;50% stenosis in at least one vessel, and severe CAD when there was an obstructive session at the left main coronary artery or disease of all three coronary vessels. Several biochemical and hematological parameters were assessed. Results Group A patients had a higher incidence of multivascular disease (20 patients – 43.48% vs. 16 patients – 16.8%, p=0.02), reduced Ejection Fraction (42.4±9.6 vs. 53, 5±6.54 - p=0.01) and higher Syntax Score (19.52±7.68 vs. 9.64±5.32 - p=0.01). They also showed abnormalities in lipid values (total cholesterol, triglycerides, LDL, HDL - p=0.01), higher blood glucose and HbA1c values, and higher values of fibrinogen and MPV (11.91±1.93 vs. 9.84±1.06), which is considered a significant prognostic factor in patients with Acute Coronary Syndrome and congestive Heart Failure. In addition, a significant correlation was observed between MPV and Syntax Score (r=0.64 – p&amp;lt;0.001). Conclusion MS and MPV are associated with more severe CAD clinically and angiographically. Addressing and regulating MS factors is essential for the proper management of CAD.

In hypertensive patients with indication of renal arteriography to investigate renal artery stenosis (RAS) there are no recommendations regarding when to investigate coronary artery disease (CAD). Moreover, the predictors of CAD in patients with RAS are not clear. We aimed to evaluate the frequency and the determinants of CAD in hypertensive patients referred to renal angiography. Eighty-two consecutive patients with high clinical risk suggesting the presence of RAS systematically underwent renal angiography and coronary angiography during the same procedure. Significant arterial stenosis was defined by an obstruction≥70% to both renal and coronary territories. Significant CAD was present in 32/82 (39%) and significant RAS in 32/82 (39%) patients. Both CAD and RAS were present in 25.6% from the 82 patients. Patients with severe CAD were older (63±12 vs. 56±13 years; p = 0.03) and had more angina (41 vs. 16%; p = 0.013) compared to patients without severe CAD. Significant RAS was associated with an increased frequency of severe CAD compared to patients without significant RAS (66% vs. 22%, respectively; p<0.001). Myocardial scintigraphy showed ischemia in 21.8% of the patients with CAD. Binary logistic regression analysis showed that RAS≥70% was independently associated with CAD≥70% (OR: 11.48; 95% CI 3.2–40.2; p<0.001), even in patients without angina (OR: 13.48; 95%CI 2.6–12.1; p<0.001). Even considering a small number of patients with significant RAS, we conclude that in hypertensive patients referred to renal angiography, RAS≥70% may be a strong predictor of severe CAD, independently of angina, and dual investigation should be considered.

Predictors for coronary artery disease in patients with paradoxical systolic blood pressure elevation during recovery after graded exercise

ObjectiveThe impact of serum uric acid (sUA) levels on the clinical prognosis and severity of coronary artery disease in patients with acute coronary syndrome (ACS) and hypertension after percutaneous coronary...

Background: Hypertension, dyslipidemia, and disturbed glucose metabolism associated with central obesity are often referred to as Metabolic Syndrome (MetS) and patients of MetS have a two- to three-fold increased risk for the development of cardiovascular diseases. Objective: Objectives were to determine the frequency of MetS in patients presenting with acute coronary syndromes and to compare the frequencies of severe coronary artery disease in patients with and without MetS. Methods: This descriptive cross-sectional study included 200 patients with acute coronary syndromes over a period of six months. Frequency of MetS was calculated. The frequencies of severe coronary artery disease were compared between patients having MetS and not having MetS using chi-square chart. Results: Total 200 patients with the mean age of 54.24 ± 9.41 years were included. 131 (65.5%) patients with acute coronary syndrome had MetS. Total 112 patients (56%) had severe coronary artery disease. 63.35% with MetS and 42.03% without MetS had severe coronary artery disease (p=0.003). Conclusion: The frequency of metabolic syndrome was high (65.5%) in patients with acute coronary syndromes and severe coronary artery disease was found to be associated with the presence of metabolic syndrome in these patients

Background: Hypertension, dyslipidemia, and disturbed glucose metabolism associated with central obesity are often referred to as Metabolic Syndrome (MetS) and patients of MetS have a two- to three-fold increased risk for the development of cardiovascular diseases. Objective: Objectives were to determine the frequency of MetS in patients presenting with acute coronary syndromes and to compare the frequencies of severe coronary artery disease in patients with and without MetS. Methods: This descriptive cross-sectional study included 200 patients with acute coronary syndromes over a period of six months. Frequency of MetS was calculated. The frequencies of severe coronary artery disease were compared between patients having MetS and not having MetS using chi-square chart. Results: Total 200 patients with the mean age of 54.24 ± 9.41 years were included. 131 (65.5%) patients with acute coronary syndrome had MetS. Total 112 patients (56%) had severe coronary artery disease. 63.35% with MetS and 42.03% without MetS had severe coronary artery disease (p=0.003). Conclusion: The frequency of metabolic syndrome was high (65.5%) in patients with acute coronary syndromes and severe coronary artery disease was found to be associated with the presence of metabolic syndrome in these patients.

Co-Existence of Carotid Artery Disease, Renal Artery Stenosis, and Lower Extremity Peripheral Arterial Disease in Patients With Coronary Artery Disease

People with either end-stage renal disease or metabolic syndrome (MS) are at increased risk for developing coronary artery disease. The impact of MS on coronary artery disease in end-stage renal disease patients, however, remained unclear. We therefore evaluated whether the presence of MS is associated with more coronary lesions and a worse cardiac outcome in end-stage renal disease patients with acute coronary syndrome. We retrospectively examined 76 consecutive end-stage renal disease patients who experienced acute coronary syndrome and underwent cardiac catheterization. Cardiovascular events were compared between the MS and non-MS group. MS was found in 58 patients and coronary artery disease was found in 63 patients [52 with MS (accounting for 90% of the MS group); 11 without MS (61% of the non-MS); MS vs. non-MS, P=0.01]. Patients with MS had more multi-vessel coronary artery disease (P<0.001) than those without MS. Sixty-nine (MS, 51; non-MS, 18) patients survived the acute coronary syndrome. During the follow-up period (MS, 17.6+/-13.8; non-MS, 19.9+/-11.7 months), 12 patients with MS (24%) and none without MS died owing to cardiovascular events (MS vs. non-MS, P=0.028). Regarding major cardiac events, including cardiac death, repeat non-fatal myocardial infarction, and repeat revascularization, the non-MS group had a higher probability of event-free survival (P<0.0001). In patients with end-stage renal disease complicated by acute coronary syndrome, MS is frequently seen and associated with a higher probability of coronary artery disease involving multiple coronary branches and a higher probability of cardiac death and major cardiac events. Therefore, detection of MS in such patients is useful for risk stratification.

Coronary artery disease (CAD), the leading cause of morbidity and mortality, has imposed huge health and economic burdens globally. Zinc-α2-glycoprotein (ZAG) is a novel adipokine. Increasing evidence suggests the close relationship between serum ZAG levels and various cardiometabolic risk factors. However, the relationship between serum ZAG levels and CAD is still not fully clarified. We conducted this study to evaluate serum ZAG levels and its association with cardiovascular risk factors. A total of 129 patients with CAD, 99 patients with noncoronary artery disease (NCAD), and 121 controls were recruited in this retrospective study. CAD (coronary artery stenosis ≥50%) or NCAD (coronary artery stenosis <50%) patients who underwent coronary angiography were diagnosed according to the American Heart Association criteria. Serum ZAG levels were determined via commercial enzyme-linked immunosorbent assay (ELISA) kits. The results showed that serum ZAG levels in CAD and NCAD groups were significantly decreased when compared with those in the control group. Multiple stepwise regression analysis revealed that the grouping variable (control, NCAD, and CAD) was an independent determinant of serum ZAG levels (β = −0.328, P < 0.001) after controlling other confounding factors. Further multivariate ordinary logistic regression analysis demonstrated that the risk of grouping at one level higher in subjects with the lowest tertile of ZAG levels was 2.28-fold higher than those with the highest tertile levels (OR = 3.281, 95% CI 1.782–6.038, P < 0.001). The receiver-operating characteristic (ROC) curve analysis showed that serum ZAG could distinguish CAD patients (AUC = 0.706, 95% CI, 0.643–0.770, P < 0.05), NCAD patients (AUC = 0.673, 95% CI, 0.602–0.743, P < 0.05), and NCAD and CAD patients (AUC = 0.692, 95% CI, 0.633–0.750, P < 0.05) from controls. In conclusion, serum ZAG levels were significantly decreased in NCAD/CAD patients. The decreased serum ZAG levels were independently associated with the presence of NCAD/CAD. ZAG might serve as a candidate diagnostic biomarker for NCAD/CAD.

Association between neck and wrist circumferences and cardiometabolic risk in children and adolescents: The CASPIAN-V study.