Angiographically-defined Coronary Artery Disease Research Articles

P1758The novel small leucin-rich repeat protein podocan is an independent predictor of major adverse cardiac events in patients with angiographically-defined coronary artery disease

Abstract Background Smooth muscle cell (SMC) function determines the clinical course of vascular disease via fibrous cap stability. Podocan is an inhibitor of SMC function and is circulating in peripheral blood rendering it a candidate biomarker to predict MACE in patients with Coronary Artery Disease (CAD). Purpose We designed a prospective cohort study assessing the predictive value of Podocan for cardiovascular outcome (MI, CVA or death) in patients with CAD. Methods 308 patients with angiographic evidence of CAD were enrolled. At index cardiac catheterization Syntax Score was calculated. For patient baseline characteristics see Table. Podocan and CRP-1 were measured using a human Podocan and CRP-1 ELISA. The Kaplan-Meier method was used to construct survival curves, which were compared using the log-rank test. Cox proportional hazard modeling was used for all univariate/multivariate analyses. Statistical analysis was performed using STATA. Results Podocan was detected in 212 patients (69%) with a detection threshold of 0.01 ng/ml. The median Podocan level observed was 1.4±8.2 ng/ml. 96 patients did not have a detectable Podocan level. Mean CRP-1 was 0.117±0.15 mg/ml. Mean Syntax Score was 12±9. Podocan did not correlate with CRP-1. There was also no association between Podocan and Syntax Score, age, BMI, smoking, LDL, and HDL, HgbA1c, LVEF and GFR. At the univariate level, presence of Podocan was associated with an increased rate of MACE (17% Podocan present vs. 7% Podocan absent, p=0.02). Kaplan-Meier survival analysis showed higher event free survival in patients with no detectable Podocan vs. detectable Podocan level (Figure). In a limited multivariate Cox proportional Hazard analysis, Podocan remained an independent predictor of MACE (HR: 2.5; P=0.042) in addition to diabetes, and LV ejection fraction. Baseline Characteristics Total (N=308) Chronic ischemic heart disease (N=273) Acute coronary syndrome (N=35) Age (Year) 66.5±9.5 67±9 61±11 Female (Sex) 106 (33%) 90 (31%) 16 (46%) Hypertension 282 (89%) 244 (89%) 26 (74%) Diabetes 142 (44%) 124 (45%) 11 (31%) Hyperlipidemia 269 (87%) 243 (89%) 26 (74%) CRP (mg/dL) 0.11±0.14 0.10±0.13 0.18±0.19 LVEF (%) 49±10 49±10 48±9.5 CRP, C-reactive protein; LVEF, Left ventricular ejection fraction. Kaplan Meier Survival Curves by Podocan Conclusion Podocan is a novel biomarker independently predicting MACE in secondary prevention of CAD warranting to be further studied in a Multicenter Clinical Trial.

Untargeted Mass Spectrometry Lipidomics identifies correlation between serum sphingomyelins and plasma cholesterol

BackgroundLipoproteins are major players in the development and progression of atherosclerotic plaques leading to coronary stenosis and myocardial infarction. Epidemiological, genetic and experimental observations have implicated the association of sphingolipids and intermediates of sphingolipid synthesis in atherosclerosis. We aimed to investigate relationships between quantitative changes in serum sphingolipids, the regulation of the metabolism of lipoproteins (LDL, HDL), and endophenotypes of coronary artery disease (CAD).MethodsWe carried out untargeted liquid chromatography – mass spectrometry (UPLC-MS) lipidomics of serum samples of subjects belonging to a cross-sectional study and recruited on the basis of absence or presence of angiographically-defined CAD, and extensively characterized for clinical and biochemical phenotypes.ResultsAmong the 2998 spectral features detected in the serum samples, 1328 metabolic features were significantly correlated with at least one of the clinical or biochemical phenotypes measured in the cohort. We found evidence of significant associations between 34 metabolite signals, corresponding to a set of sphingomyelins, and serum HDL cholesterol. Many of these metabolite associations were also observed with serum LDL and total cholesterol levels but not as much with serum triglycerides.ConclusionAmong patients with CAD, sphingolipids in the form of sphingomyelins are directly correlated with serum levels of lipoproteins and total cholesterol. Results from this study support the fundamental role of sphingolipids in modulating lipid serum levels, highlighting the importance to identify novel targets in the sphingolipid metabolic pathway for anti-atherogenic therapies.

A study of difference in serum 25-hydroxyvitamin D concentrations in patients with angiographically-defined coronary disease and healthy subjects

BackgroundCardiovascular disease (CVD) is one of the most important causes of death in developing countries. The current study evaluates the serum 25-hydroxyvitamin D (25OHD), phosphate and calcium levels in patients with angiographically-defined coronary artery disease (CAD) and healthy subjects in a sample population in northeastern Iran. MethodsThere were 566 subjects aged between 20–80 years out of whom283 subjects with CAD were divided into two study groups based on their angiogram results; those with > 50% stenosis of one or more coronary arteries and those with ≤ 50% stenosis. Serum 25OHD levels and anthropometric parameters were measured for all subjects. ResultsThere were approximately 53% (n = 303) males and 47% (n = 269) females in the population sample. We found that crude serum 25OHD concentrations were significantly higher in both the Angio− (21.6 ± 11.8 ng/ml) and Angio+ (21.3 ± 10.2 ng/ml) groups compared to the control subjects (16.4 ± 9.5 ng/ml) (P < 0.001). ConclusionThe findings show that 25OHD state could be a risk factor for CAD, although this would need to be explored further, taking the potential confounding effects of diet into account in future studies.

Abstract 23081: Anti-inflammatory Effect of Whole-Food Plant-Based Vegan Diet vs the American Heart Association - Recommended Diet in Patients With Coronary Artery Disease: The Randomized EVADE CAD Trial

Background: The effect of a whole-food plant-based vegan diet vs an AHA-recommended diet on inflammatory, lipid, and glucometabolic profiles remains uncertain. Methods: This prospective blinded end-point trial randomized 100 patients with invasive angiographically-defined coronary artery disease (CAD) to 8 weeks of a vegan or AHA diet. Participants were provided weekly groceries for their assigned diet strategy, sample 2-week menus, tools to measure portion size, and on-going consultation with the study dietitian. Dietary adherence was measured by two weekly 24-hour dietary recalls and plasma and urine trimethylamine- N -oxide levels. Participants also completed a 4-day food record during the week prior to the baseline, 4-, and 8-week study visits. The primary endpoint was serum hsCRP concentration. A linear mixed effect model was used to model the log-transformed endpoints (to correct for skewness), evaluate the change in endpoint over time within treatment group, and test the interaction between time and treatment. The primary analysis was also covariate-adjusted. Results: Baseline characteristics are shown in Table 1. Two subjects withdrew from the vegan group after randomization, but dietary adherence remained higher in the vegan vs AHA group at the 4-week (96% vs 84%, p=0.09) and 8-week (94% vs 70%, p=0.003) visits. Endpoints are shown in Table 2. Conclusion: A vegan diet significantly reduced systemic inflammation, as evidenced by hsCRP, in patients with CAD on guideline-directed medical therapy, while an AHA diet did not. This is the first rigorous study to comprehensively assess multiple indices of cardiovascular risk between a vegan and AHA diet.

Abstract P029: Factors Associated With Participation of Patients With Coronary Artery Disease in a Randomized Study of a Vegan versus American Heart Association-recommended Diet: Interim Analysis

Introduction: Patients with coronary artery disease (CAD) who make healthy lifestyle changes can greatly impact their disease trajectories. However, the clinical profile of patients more likely to participate in programs aimed at improving lifestyle choices remains uncertain. The objective of this analysis was to examine the baseline clinical profile of patients with CAD motivated to enroll in an eight-week diet study versus those who chose not to enroll. Methods: The study population included patients with angiographically-defined CAD (≥50% lesion in an artery ≥2 mm caliber or prior percutaneous coronary intervention) who provided informed consent to participate in a single-center, prospective, blinded end-point, randomized trial assessing the impact of a vegan versus AHA-recommended diet on inflammatory and glucometabolic profiles. Data collection was obtained by direct interview and exam of patients who chose to enroll in and complete the trial. Electronic medical records were reviewed for patients who provided informed consent but subsequently declined to participate in the study prior to any study intervention, including randomization. Normally distributed and skewed continuous variables were examined by enrollment status with independent samples t-test and Mann-Whitney U test, respectively. Categorical variables were examined by enrollment status by Fisher’s exact test or Chi-square test. Results: Of the 90 patients consented, 60 chose to enroll into the study while 30 chose not to enroll. Compared to those who chose to participate in the study, those who chose not to participate were less likely to be of white race (70% (21/30) vs. 85% (51/60), p=0.002). Other demographic variables including age, sex, ethnicity or BMI did not differ by enrollment. Regarding medical history, patients who chose not to participate were more likely to have diagnoses associated with cardiovascular risk, including hypertension (86.7% (26/30) vs. 56.7% (34/60), p=0.005), hyperlipidemia (96.7% (29/30) vs. 71.7% (43/60), p=0.005), and diabetes mellitus (43.3% (13/30) vs. 21.7% (13/60), p=0.048). Analyses of laboratory parameters revealed that patients who did not participate in the study also had poorer risk factor control, including higher hemoglobin A1c (6.0% (IQR 5.7-7.8%) vs. 5.8% (IQR 5.5-6.3%), p=0.043) as well as lower HDL cholesterol levels (42 g/dL (IQR 34-47) vs. 45 g/dL (IQR 37-55), p=0.046). Conclusion: Among this sample of patients with angiographically-defined CAD, those who chose not to participate in an eight week dietary intervention to lower disease risk were more likely to be of a minority race with a higher proportion of poorly controlled cardiovascular risk factors at baseline. This analysis emphasizes the need for health care teams to consider different strategies of encouraging these high-risk patients to enroll in programs aimed at healthy lifestyle changes.

Abstract P050: Association Between Glycemic Control and Short-term Mortality Varies Across the Spectrum of Coronary Artery Disease

Background: Diabetes is a significant risk factor for cardiovascular disease, but optimal glycemic control strategies remain unclear. In particular, trials of intensive glycemic control have highlighted a tension between increased mortality risk and macrovascular benefits. In this study we aimed to assess whether the burden of coronary artery disease (CAD) modifies the association between glycemic control and short-term mortality. Methods: We studied veterans with diabetes who underwent elective cardiac catheterization between 2005 and 2013 in a retrospective analysis of data from the VA Clinical Assessment, Reporting, and Tracking (CART) Program. Primary exposures were time-varying HbA1c over two years of follow-up after index catheterization, categorized as &lt;6%, 6-6.49%, 6.5-6.99%, 7-7.99%, 8-8.99%, and &gt;=9%, and burden of CAD, categorized as no CAD, non-obstructive CAD, or obstructive CAD. Primary outcome was two-year all-cause mortality. A total of 17394 participants had, on average, five HbA1c measurements over two years of follow-up. We used multivariable Cox proportional hazards regression to estimate the association between HbA1c and mortality, adjusting for demographic and clinical covariates and CAD burden, and including a term for interaction between HbA1c and CAD burden. Results: In adjusted models with 6.5 ≤ HbA1c ≤ 6.99% as the reference category, HbA1c &lt; 6% was associated with increased risk of mortality (HR 1.55 [1.25, 1.92]), whereas HbA1c categories above 7% were not. We observed significant interaction between glycemic control and CAD burden (interaction p=0.0005); the increased risk of short-term mortality at HbA1c &lt; 6% was limited to individuals with non-obstructive and obstructive CAD (Figure 1). Conclusions: HbA1c below 6% was associated with increased risk of short-term mortality, but only in individuals with CAD. CAD burden may thus inform individualized diabetes management strategies, specifically treatment de-escalation in individuals with any angiographically-defined CAD.

Abstract MP076: Angiographic Coronary Artery Disease Severity and Risk of Mental and Conventional Stress Induced Myocardial Ischemia

Background: Mental stress induced myocardial ischemia (MSIMI) is linked to increased risk of adverse cardiovascular outcomes, but its mechanisms are thought to be different from those of conventional stress-induced ischemia (CSIMI). Specifically, whether MSIMI is associated with more severe underlying obstructive coronary artery disease (CAD) is unclear. We investigated the association between angiographically-defined CAD severity and both MSIMI and CSIMI with a hypothesis that, CAD severity will be linked to CSIMI, but not MSIMI. Methods: A total of 273 patients with stable CAD, aged 51±7 years, 49% female, who survived a myocardial infarction (MI) within the past 8 months (median 167±52 days) were enrolled in the Myocardial Infarction and Mental Stress 2 (MIMS-2) study. The coronary angiogram performed during the index MI hospitalization was used to assess CAD severity. Coronary artery obstruction was assessed by counting the number of diseased vessels with 70% stenosis (DV70%) and using the Gensini Score (GS) after correcting for revascularized vessels. Patients underwent 99mTc sestamibi myocardial perfusion imaging during mental stress, using a public speaking task, and during conventional stress test, using exercise or pharmacological stress. MSIMI and CSIMI were defined as a new or worsening impairment in myocardial perfusion using a 17-segment model. Results: A total of 68 (26%) patients developed CSIMI, while 46 (17%) developed MSIMI. Median DV70% and GS were 0 (0-1), and 3 (0-12), respectively. Using logistic regression models, and after adjustment for age, gender, hypertension, hyperlipidemia and diabetes, obstructive CAD was associated with increased risk of CSIMI [OR(95%CI) of 1.54 (1.02 - 2.31) for DV70% and 1.25 (1.03-1.53), for GS], but not MSIMI [OR(95%CI) of 0.93 (0.56 - 1.53) for DV70%, and 0.94 (0.75-1.18) for GS]. Conclusion: Although CSIMI is linked to underlying coronary obstruction, MSIMI is independent of CAD severity among post- MI patients. Other mechanisms are likely responsible for MSIMI post MI.

Zinc and copper levels are not correlated with angiographically-defined coronary artery disease in sudanese patients.

We investigated zinc and copper levels in angiographically defined obstructive coronary artery disease (CAD) in patients undergoing elective coronary angiography in El-Shaab Hospital, Sudan. We performed a cross-sectional study. One hundred forty-two patients were enrolled. Sociodemographic and medical characteristics were collected using a questionnaire. Glucose, lipid, zinc, and copper levels were measured. Out of 142 patients, 102 (71.8%) had CAD and 40 (28.2%) had patent coronary arteries. There were no significant differences in median (interquartile range) zinc [118.5 (97.2–151.0) vs. 130.0 (106.0–174.0) μg/ml, P = 0.120] and copper [150.6 (125.0–183.0) vs. 158 (132.0–180.0) μg/mL, P = 0.478] levels between patients with CAD and those with patent coronary arteries. In linear regression analysis, there were no associations between CAD and zinc and copper levels. The current study failed to show any significant association between CAD and zinc and copper levels.

Relationship between serum cytokine and growth factor concentrations and coronary artery disease

BackgroundWe have assessed the association between serum concentrations of 12 cytokines/growth factors and angiographically-defined coronary artery disease, comparing the concentrations in four groups (one control group and three case groups). MethodsWe studied a total of 426 subjects including; 98 control subjects and 3 case groups. The patient groups consisted of: coronary artery bypass graft (CABG) candidates (n=48) and patients undergoing coronary angiography, with, or without obstructive coronary artery disease. Twelve cytokines (IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, MCP-1, IFN-γ, EGF, and VEGF) were measured using a sandwich chemi-luminescence assays, on the Evidence Investigator® system. ResultsThe four groups were well matched for demographic and clinical characteristics, except waist circumference, fasting blood glucose (FBG), total and LDL cholesterol and diastolic blood pressure that were significantly higher in case groups compared to the control group (P<0.05 for all). There were significant differences between control group and the other three groups regarding the measured cytokines, such as IL-1α, IL-8, MCP-1, and VEGF (P<0.01). Furthermore, IL-4, IL-6 and EGF were also significantly different between the control, obstructive coronary disease and CABG candidate groups (P<0.01). Analysis of the ROC curve showed 92.1% sensitivity, 99.2% specificity and 100% positive predictive value (PPV) for VEGF in its ability to distinguish the CABG group at the cut-off point of 37.18pg/ml. ConclusionThe results of this study suggest that cytokines such as IL-1α, IL-4, IL-8, IL-10 and VEGF may play major roles in pathogenesis of CAD.

Anxiety, depression, coronary artery disease and diabetes mellitus; an association study in ghaem hospital, iran.

Background:There is an increasing trend in the prevalence of coronary artery disease (CAD) in Iran.Objectives:The present study aimed to investigate the relationship of anxiety, depression, diabetes and coronary artery disease among patients undergoing angiography in Ghaem Hospital, Mashhad, Iran.Patients and Methods:This case-control study was conducted between September 2011 and August 2012 among 200 patients undergoing coronary angiography for symptoms of coronary disease at Ghaem Hospital, Mashhad, Iran. The control group consisted of 697 healthy adults recruited from the individuals who attended the clinic for routine medical checkups or pre-employment examinations. The Beck anxiety and depression inventory scores and fasting blood glucose results were assessed in all the subjects. Data were analyzed using SPSS version 16. P < 0.05 was regarded as statistically significant.Results:The mean age of patients was 57.52 ± 9.33 years old and for the control group it was 55.35 ± 8.45 years; there was no significant difference between the subjects (P = 0.647) regarding age. There was also no significant difference in gender distribution between the patients and control groups (P = 0.205). There was however a significant difference in anxiety and depression scores between the patients and healthy controls (P < 0.001). There was a significant positive correlation between anxiety score and depression score in both groups when data were analyzed by Pearson test. (P < 0.001, r = 0.604 and r = 0.521). Moreover, there was a significant positive linear correlation between the depression/anxiety scores and fasting blood glucose concentrations in the patients group (r = 0.3, P < 0.001) and a weak negative correlation in the healthy controls (r = -0.096, P < 0.05).Conclusions:Depression and anxiety are potentially important factors among patients with angiographically-defined CAD. There appear to be significant associations between glucose tolerance and anxiety and depression in these patients.

Anjiyografik Olarak Koroner Arter Hastalığı Tanısı Konulmuş Türk Hastalarda Pon L/M55 ve Q/R192 Genotiplerinin Dağılımı: Serum Lipitlerine Etkileri

Objective: Paraoxonase 1 (PON1) was suggested to lower the risk of coronary artery disease (CAD) by preventing high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C) oxidation during atherosclerotic process. The relation between PON1 activity and CAD has been attributed to polymorphisms in the gene coding for this enzyme. The PON1 gene has two common polymorphisms, which lead to a leucine→ methionine substitution at position 55 (PON55) and a glutamine→ arginine substitution at position 192 (PON192), have been defined as the molecular basis of interindividual variability in PON activity. The aim of this study was to investigate the frequency of PON55 and PON192 polymorphisms in Turkish patients with CAD and to determine whether this polymorphism was effective on plasma lipid levels. Material and Methods: One hundred and thirty-five angiographically-defined CAD patients and 110 healthy controls were screened for the PON55 and PON192 genotypes and plasma lipids. Results: The frequency of PON55 MM genotype was significantly higher in the CAD patients than in the controls. The frequencies of PON192 genotypes were similar among CAD patients and controls. Both for PON55 and PON192 genotypes the HDL-C levels of CAD patients were significantly lower than in the corresponding controls. The severity of CAD was not associated with either the PON55 or the PON192 genotype. Conclusion: PON55 and PON192 genotypes are not useful markers for the estimation of either cardiovascular risk or the severity of coronary artery disease in the Turkish population.

A cross-sectional study of the association between heat shock protein 27 antibody titers, pro-oxidant–antioxidant balance and metabolic syndrome in patients with angiographically-defined coronary artery disease

Objective To investigate the association between serum antibody titers to Hsp27 (anti-Hsp27) and pro-oxidant–antioxidant balance (PAB) in patients with angiographically-defined coronary artery disease (CAD) with or without the metabolic syndrome (MS). Design Subjects ( n = 243) were classified into MS+ ( n = 161) and MS− ( n = 82) subgroups, based on the AHA/NHBLI criteria. Results Serum anti-Hsp27 titers were found to be significantly higher in the MS+ vs. MS− group. However, no significant difference was observed in serum PAB values. When assessed for individual components of MS, increased serum anti-Hsp27 was found to be higher in subgroups with elevated triglycerides, elevated blood pressure and reduced high-density lipoprotein cholesterol (HDL-C). Subgroups of patients with elevated triglycerides had higher PAB values. HDL-C was the only significant predictor of anti-Hsp27 in the population as a whole. Conclusion The evidence from this investigation indicates the presence of elevated anti-Hsp27 in patients with concurrent CAD and MS compared to those with CAD alone.

Relation of Increased Prebeta-1 High-Density Lipoprotein Levels to Risk of Coronary Heart Disease

Preβ-1 high-density lipoprotein (HDL) plays a key role in reverse cholesterol transport by promoting cholesterol efflux. Our aims were (1) to test previous associations between preβ-1 HDL and coronary heart disease (CHD) and (2) to investigate whether preβ-1 HDL levels also are associated with risk of myocardial infarction (MI). Plasma preβ-1 HDL was measured by an ultrafiltration-isotope dilution technique in 1,255 subjects recruited from the University of California-San Francisco Lipid and Cardiovascular Clinics and collaborating cardiologists. Preβ-1 HDL was significantly and positively associated with CHD and MI even after adjustment for established risk factors. Inclusion of preβ-1 HDL in a multivariable model for CHD led to a modest improvement in reclassification of subjects (net reclassification index 0.15, p = 0.01; integrated discrimination improvement 0.003, p = 0.2). In contrast, incorporation of preβ-1 HDL into a risk model of MI alone significantly improved reclassification of subjects (net reclassification index 0.21, p = 0.008; integrated discrimination improvement 0.01, p = 0.02), suggesting that preβ-1 HDL has more discriminatory power for MI than for CHD in our study population. In conclusion, these results confirm previous associations between preβ-1 HDL and CHD in a large well-characterized clinical cohort. Also, this is the first study in which preβ-1 HDL was identified as a novel and independent predictor of MI above and beyond traditional CHD risk factors.

Apolipoprotein E polymorphism and the characteristics of diseased vessels in male Chinese patients with angiographic coronary artery disease: a case-case study.

Variations in the apolipoprotein E (apo E) gene may predict the incidence of coronary artery disease (CAD). However, the correlation between apo E polymorphism and the severity of CAD is still unclear. Apolipoprotein E polymorphism can predict CAD. Used a case-case study of 213 Chinese angiographically-defined CAD patients who were screened for apo E genotypes. The characteristics of their diseased vessels were recorded. Apolipoprotein E4 carriers had > 75% stenosis, more wide-ranging and longer vessel disease, a greater number of diseased vessels, and a higher Gensini score than apo E2 carriers or individuals with the apo E3/3 genotype. Apolipoprotein E2 carriers had < or =75% stenosis and a shorter length of vessel disease than individuals with the apo E3/3 genotype or apo E4 carriers. The severity of stenosis, length of vessel disease, and number of diseased vessels were affected by the interaction between genotype and body mass index, family history of CAD, total plasma cholesterol level, smoking history, and hypertension history. The apo E4 allele may serve as an independent genetic marker predicting severity of CAD. Other CAD risk factors may accelerate the process of pathogenesis. The apo E2 allele may play a protective role.

Association between angiotensin II type-1 receptor A1166C polymorphism and the presence of angiographically-defined coronary artery disease in an Iranian population

Abstract Background: There are reported associations between a polymorphism of the angiotensin II type 1 receptor (AT1R/A1166C) gene and coronary artery disease (CAD), hypertension, and myocardial infarction in some populations. Objective: Investigate the association between A1166C polymorphism and CAD in an Iranian population. Methods: Four hundred and thirteen patients with suspected CAD were recruited. Based on coronary angiography, the patients were classified into CAD+ (n=315) and CAD- (n=98) groups defined as &gt;50% and &lt;50% stenosis of any major coronary artery, respectively. One hundred and thirty-five healthy subjects were also recruited as the control group. The AT1R polymorphism was assessed using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) based method. Results: A higher frequency of the AC and CC genotypes and lower frequency of the AA genotype was observed in both CAD+ and CAD- groups, compared with the control group (p &lt;0.05). CAD+ and CAD- groups also had a higher frequency of the C allele than controls (p &lt;0.01). There was no significant difference in genotype and allele frequencies between hypertensive and non-hypertensive patients (p &gt; 0.05). In addition, the AT1R genotype frequencies did not differ significantly among different subgroups of CAD+ patients, based on the number of affected coronary vessels (p &gt;0.05). Conclusion: The frequency AT1R/A1166C polymorphism was higher among patients with some degrees of coronary stenosis who are candidates of coronary angiography.

Hyperuricemia and the Presence and Severity of Coronary Artery Disease

Background: Few studies have assessed the relation of hyperuricemia with the severity of coronary artery disease (CAD). This study investigated the association between high uric acid levels with the presence and severity of CAD. Methods: Three hundred and seventy patients having angiographic evidence of atherosclerosis (CAD + case group) compared to 170 patients with no luminal stenosis (n=110) or with <50% luminal stenosis (n=60) at coronary angiography (CAD − control group). Results: The mean age of the patients was 60 ± 10 years (317 men, 58.7%). Hyperuricemia was more likely associated with a trend toward higher vessel scores, indicating a more severe CAD (adjusted OR=1.51, 95% CI=1.09-2.09; P =0.005) in the whole population. A comparison of sex-specific values showed a significant association existed only in men. Conclusions: Asymptomatic hyperuricemia may be associated with the presence and severity of angiographically-defined CAD in patients with suspicious symptoms for CAD.

Plasma Levels of HDL Subpopulations and Remnant Lipoproteins Predict the Extent of Angiographically-Defined Coronary Artery Disease in Postmenopausal Women

The association of coronary heart disease (CHD) with subpopulations of triglyceride (TG)-rich lipoproteins and high-density lipoproteins (HDL) is established in men, but has not been well characterized in women. Plasma HDL subpopulation concentrations, quantified by 2-dimensional gel electrophoresis, and plasma remnant-like particle cholesterol (RLP-C) concentrations were measured in 256 postmenopausal women with established CHD and in 126 CHD-free postmenopausal women. Coronary artery disease was assessed in women with CHD by quantitative coronary angiography. Plasma RLP-C and prebeta1 HDL concentrations were higher and alpha1 and alpha2 HDL concentrations were lower in CHD than in CHD-free women. After adjustment for conventional CHD-risk factors, plasma levels of RLP-C were positively associated with the degree of coronary artery disease. In similar analyses, plasma prebeta1 HDL particle concentrations were positively associated and alpha2 HDL particle concentrations were inversely associated with the extent of coronary atherosclerosis. Plasma TG, low density lipoprotein cholesterol, and HDL cholesterol levels were not associated with the degree of coronary atherosclerosis. The degree of coronary atherosclerosis in postmenopausal women is linked to a dysregulation of the TG/HDL metabolism. Subpopulations of TG-rich and HDL lipoproteins are better predictors of disease than TG and HDL cholesterol concentrations.

Delayed intravascular catabolism of chylomicron-like emulsions is an independent predictor of coronary artery disease

The atherogenic role of a delayed intravascular catabolism of chylomicrons has been suggested by univariate analysis of case-control studies. However, it is not established whether this association is caused by a direct atherogenic effect of these lipoproteins or results from the presence of concurrent and metabolically-related coronary artery disease (CAD) risk factors. In this study, the plasma kinetics of a chylomicron-like emulsion doubly labeled with 14 C -cholesteryl oleate (CE) and 3 H -triolein (TG) was determined in 93 subjects with or without angiographically-defined CAD. As compared with controls and even after adjustment for body mass index (BMI), LDL- and HDL-cholesterol, and the presence of traditional risk factors, CAD patients had 45% smaller fractional clearance rate (FCR) of TG, 41% smaller FCR-CE and 19% smaller dilapidation index (DI; P < 0.05). Among CAD patients, those with highest angiographic score had 66% smaller FCR-TG ( P = 0.007), 50% smaller FCR-CE ( P = 0.01) and 27% smaller DI ( P = 0.004). In a multivariate logistic regression analysis, FCR-CE ( P < 0.0001) and DI ( P = 0.001) were the only independent predictors for the presence of CAD. In conclusion, we presently show that the rate of lipolysis and removal from the circulation of chylomicron-like emulsions constitutes an independent predictor of CAD and a marker of CAD severity.

Less affluent area of residence and lesser-insured status predict an increased risk of death or myocardial infarction after angiographic diagnosis of coronary disease.

Low socioeconomic status (SES) predicts coronary artery disease (CAD) onset, but its value among patients with CAD is uncertain. Geographic measures (e.g., residential neighborhood) may predict risk, but this requires further evaluation. A cohort of 3410 patients with significant, angiographically-defined CAD (> or =1 lesion of > or =70% stenosis) joined a registry during the period between 1993 and 2000 and was followed for 6.7 years (median 3.7 years). A geographic SES measure-residential economic status (RES)-and insurance type were examined for association with mortality or myocardial infarction (MI). In Cox regression adjusting for 17 covariates, lower RES quartile was associated with increased death/MI (p-trend<0.001), death (p-trend=0.001), and MI (p-trend=0.07). First RES quartile (vs. fourth) predicted death/MI (hazard ratio [HR]=1.32, 95% confidence interval [CI]=1.07-1.62, p=0.01) and death (HR=1.46, CI=1.12-1.91, p=0.006), but not MI (HR=1.18, p=0.31). Compared with private insurance, self-pay (HR=1.88, p=0.053), charity care (HR=1.71, p<0.001), and Medicaid (HR=1.43, p=0.24), but not Medicare (HR=0.95, p=0.68), were associated with death/MI. Both geographic (RES) and economic (insurance) measures of SES independently predicted risk of death/MI in a large population with angiographically-defined CAD. This suggests that SES remains a significant predictor of health outcomes after CAD has developed, and that geographic measures of SES deserve further evaluation.

Investigation of the association between angiographically defined coronary artery disease and periodontal disease.

The association between periodontal disease and coronary artery disease (CAD) has been investigated in numerous studies with inconsistent results. Resolving these differences is complicated by the use of varying definitions of CAD. The aim of this study was to investigate the association between angiographically-defined CAD and periodontal disease. Non-smoking, non-diabetic patients, over 40 years of age, with no history of a myocardial infarction in the previous 6 months and who had undergone cardiac catheterization within the previous 12 months were enrolled in this study. Subjects were classified as having CAD (CAD+) if they had 50% stenosis in at least one major epicardial artery and classified as CAD negative (CAD-) if they had <50% stenosis in all identified arteries. Periodontal disease severity was measured through bleeding on probing, probing depth, clinical attachment level (CAL), gingival recession, number of missing teeth, and radiographic bone loss. One hundred (53 = CAD+; 47 = CAD-) patients were examined. CAD+ patients were more likely to be male (CAD+ 83.0% male; CAD- 40.4% male; P= 0.001), and were older (CAD+ 65.3 years; CAD- 60.8 years; P= 0.0138). Although all patients reported they were currently non-smokers and had not smoked for at least 5 years, the fraction who were former smokers was greater for CAD+ patients (66% versus 24.4%; P = 0.0001) and mean pack/year history of smoking was higher for CAD+ patients (15.8 versus 4.5; P = 0.0003). Mean CAL (3.13 mm versus 2.78 mm; P 0.0227), number of sites with CAL > or = 6 mm (6.85 versus 3.32; P = 0.0242), radiographic bone loss (3.60 mm versus 3.18 mm; P = 0.0142) were greater for CAD+ patients than for CAD- patients. However, after adjustment for age and previous smoking history, factors common to both diseases, the associations of CAD and periodontal disease were reduced and were not statistically significant (odds ratio [OR]: mean CAL OR = 1.06; number of sites with CAL > or = 6 mm OR = 1.03; mean radiographic bone loss OR = 1.31; P > or = 0.2055). After accounting for factors common to both periodontal disease and CAD, there was no significant association between periodontal disease and chronic CAD as assessed angiographically. Further investigations into the relationship between periodontal disease and CAD should clearly separate chronic CAD and acute coronary events.