Burden Of Atherosclerosis In Patients Research Articles

Does Increased Fructose Consumption Increase Atherosclerosis Burden in Patients with NSTEMI?

Does Increased Fructose Consumption Increase Atherosclerosis Burden in Patients with NSTEMI?

Coronary Inflammation Assessed by Perivascular Fat Attenuation Index in Patients with Psoriasis: A Propensity Score-Matched Study

Objectives: This study aimed to evaluate coronary inflammation by measuring the perivascular fat attenuation index (FAI) and quantify the atherosclerosis burden in patients with psoriasis and control individuals without psoriasis based on coronary computed tomography angiography (CCTA) images. Methods: A total of 98 consecutive patients with psoriasis (76 male [77.6%], aged 56.5 years, range 45.5–65.0) were recruited, and 196 patients (157 male [80.1%]; aged 54.6 ± 14.1 years) without established cardiovascular disease (CVD) who underwent CCTA within the same period were enrolled in the control group. Coronary plaque burden was quantified using the computed tomography-adapted Leaman score (CT-LeSc), and the FAI surrounding the proximal of three main epicardial vessels was measured to represent coronary inflammation. Results: Patients with psoriasis and the control subjects were well matched in CVD risk factors (all p > 0.05). Psoriasis patients had a greater overall CT-LeSc (5.86 vs. 4.69, p = 0.030) and lower perivascular FAI (−80.19 ± 7.48 vs. −78.14 ± 7.81 HU, p < 0.001). A similar result was found upon comparing psoriasis patients without biological or statin therapy with non-psoriasis individuals without statin treatments. Furthermore, the psoriasis group had a higher prevalence of non-calcified plaques (30.3% in the psoriasis group vs. 20.1% in the control subjects, p = 0.001). No difference in perivascular FAI on either calcified and mixed plaques or non-calcified plaques between the two groups was found. Conclusion: Patients with psoriasis have a higher atherosclerotic burden as quantified by CT-LeSc and less coronary inflammation as detected by perivascular FAI around the most proximal of the three major epicardial vessels. The usefulness of perivascular FAI for evaluating coronary inflammation in patients with chronic low-grade inflammatory disease such as psoriasis should be verified.

Correlations of the burden of lacunar infarcts with ischemic stroke recurrence and intracranial atherosclerosis burden in patients under anti-coagulation for non-valvular atrial fibrillation after acute ischemic stroke (2694)

Correlations of the burden of lacunar infarcts with ischemic stroke recurrence and intracranial atherosclerosis burden in patients under anti-coagulation for non-valvular atrial fibrillation after acute ischemic stroke (2694)

Bidirectional link between diabetes mellitus and coronavirus disease 2019 leading to cardiovascular disease: A narrative review.

Coronavirus disease 2019 (COVID-19) is a global pandemic where several comorbidities have been shown to have a significant effect on mortality. Patients with diabetes mellitus (DM) have a higher mortality rate than non-DM patients if they get COVID-19. Recent studies have indicated that patients with a history of diabetes can increase the risk of severe acute respiratory syndrome coronavirus 2 infection. Additionally, patients without any history of diabetes can acquire new-onset DM when infected with COVID-19. Thus, there is a need to explore the bidirectional link between these two conditions, confirming the vicious loop between “DM/COVID-19”. This narrative review presents (1) the bidirectional association between the DM and COVID-19, (2) the manifestations of the DM/COVID-19 loop leading to cardiovascular disease, (3) an understanding of primary and secondary factors that influence mortality due to the DM/COVID-19 loop, (4) the role of vitamin-D in DM patients during COVID-19, and finally, (5) the monitoring tools for tracking atherosclerosis burden in DM patients during COVID-19 and “COVID-triggered DM” patients. We conclude that the bidirectional nature of DM/COVID-19 causes acceleration towards cardiovascular events. Due to this alarming condition, early monitoring of atherosclerotic burden is required in “Diabetes patients during COVID-19” or “new-onset Diabetes triggered by COVID-19 in Non-Diabetes patients”.

Pericardial adiposity versus body adiposity measured by BMI in the assessment of coronary atherosclerosis burden in patients with hypertension

ABSTRACT Objectives The link between obesity and hypertension with coronary atherosclerosis is complex. We aimed to assess the association of cardiac fat deposition measured by pericardial fat volume(PFV) using by multi-detector CT(MDCT) and general obesity measured by BMI with subclinical coronary atherosclerotic markers (coronary artery calcium score (CAC), coronary plaque and stenosis) in patients with hypertension and suspected coronary artery disease. Methods Among 496 patients presenting with chest pain who underwent 64-slice MDCT angiography to exclude occlusive coronary disease, 261 patients with hypertension (age: 57 ± 8 years, 45% males) enrolled in the present study. Results PFV showed a significant association with CAC(r = 0.2,P = .001),coronary stenosis severity(PFV median(IQR) 88(63–161) in patients with coronary stenosis<50% compared to PFV median(IQR) 125(85–140) in patients with coronary stenosis ≥ 50%, P = .001) and coronary plaque presence (PFV median (IQR) 89(65–128) in patients without plaque compared to PFV median (IQR) 115(74–150) in patients with plaque presence = 0.03).the significant association of PFV with CAC[odds ratio(95% confidence interval = 0.5(0.19–0.97),P = .001] and coronary stenosis severity [odds ratio(95% confidence interval = 1.1(1.00–1.01),P = .01]persisted after adjustment for conventional cardiac risk. BMI showed a significant association with significant coronary stenosis presence (P = .02).The association of BMI with significant coronary stenosis presence after adjustment for conventional cardiac risk factors (P = .03).BMI showed no significant association with CAC and coronary plaque presence (P > .05). Conclusion PFV showed a significant independent association with coronary calcification and significant coronary stenosis in patients with hypertension rather than BMI.

Interaction of smoking, hyperhomocysteinemia, and metabolic syndrome with carotid atherosclerosis: A cross-sectional study in 972 non-diabetic patients.

Little is known about the interactions between hyperhomocysteinemia and metabolic syndrome (MetS) in individuals at risk for atherosclerosis. The aim of this study was to assess the burden of atherosclerosis in patients with MetS and hyperhomocysteinemia. We assessed the interaction of MetS with other risk factors including hyperhomocysteinemia in 972 patients with a history of stroke, transient ischemic attack, or carotid stenosis. MetS was defined as by the International Diabetes Federation as body mass index ≥30 kg/m² and two or more of the following: hypertension, high triacylglycerides, and low high-density lipoprotein. We defined hyperhomocysteinemia as plasma total homocysteine ≥14 µmol/L. Patients with diabetes were excluded. Carotid total plaque area (TPA), a strong predictor of cardiovascular risk, was measured by carotid ultrasound. The association of TPA with MetS, and interaction with related risk factors, was assessed by multiple linear regression. Complete data were available on 972 non-diabetic patients. Of these, 179 (18.4%) had MetS. Patients with MetS and hyperhomocysteinemia (P < 0.001) or smoking (P=0.02) had a higher TPA compared with those with MetS and normal plasma total homocysteine levels. In linear regression, there was a significant association of MetS (P=0.004), hyperhomocysteinemia (P=0.01), and smoking (P=0.004) with increased TPA. Patients with MetS and smoking or hyperhomocysteinemia are at particularly high cardiovascular risk. Targeted atherosclerosis prevention should include identification and treatment of MetS, smoking, and hyperhomocysteinemia (including that due to unrecognized metabolic vitamin B12 deficiency).

Plasma RANTES level is correlated with cardio-cerebral atherosclerosis burden in patients with ischemic cerebrovascular disease

BackgroundRegulated upon activation, normal T-cell expressed, and secreted (RANTES) is a chemokine actively involved in the initiation and progression of atherosclerosis (AS), which is the major cause of ischemic cerebrovascular disease (ICVD). This study aimed to determine the associations between circulating RANTES level and overall AS conditions of cardiac and cerebral vessel beds in patients with ICVD. MethodsPatients with ICVD admitted to the department of neurology of Xuanwu Hospital from April 1, 2019 to June 30, 2019 were prospectively enrolled in the study. Plasma RANTES level was measured by enzyme-linked immunosorbent assay to represent the circulating RANTES level. The integrated AS burden of the cervicocephalic and coronary arteries was examined using computed tomography angiography and reflected by “cardio-cerebral AS burden (CCAB)” as a continuous variable. Then, the relationship of plasma RANTES level and CCAB in patients with ICVD was analyzed by correlation analyses and general linear models. ResultsA total of 40 patients with ICVD were included in the study. There was a significant positive correlation between CCAB and plasma RANTES level in ICVD (r = 0.786, P < 0.001), independent of age, sex, acute or chronic phase of ICVD, and mono or dual antiplatelet therapy (adjusted B for ln RANTES, 12.063; 95% confidence interval, 7.572–16.533). The association of plasma RANTES level with AS conditions (burden, severity, and extent) in single cardiac or cerebral vessel bed was similar to that with CCAB, but the correlation coefficient for CCAB was higher (increment ranged from 0.126 to 0.397). ConclusionsPlasma RANTES level was an independent indicator for the integrated AS burden of the cervicocephalic and coronary arteries in ICVD. Comprehensive evaluation of AS conditions using the novel continuous index CCAB might be important in revealing the systematic relationship between circulating RANTES and AS in patients with ICVD.

P4492Peripheral blood mononuclear cell expression of the stabilizing RNA-binding protein HuR is associated with incidence and extent of human atherosclerotic cardiovascular disease

Abstract Background Human Antigen R (HuR) is a stabilizing RNA-binding protein that regulates the expression of several pro-inflammatory molecules. However, its regulation in human atherosclerotic cardiovascular disease remains unknown. Purpose To determine the association of peripheral blood mononuclear cell HuR expression with established markers of increased cardiovascular risk and atherosclerosis burden in patients with subclinical or clinically overt coronary artery disease (CAD). Methods HuR mRNA expression was measured in peripheral blood mononuclear cells derived from 289 patients with stable CAD or acute myocardial infarction (AMI) and 373 individuals without clinically overt cardiovascular disease (CVD). Structural and functional vascular measurements including intima-media thickness (IMT) and number of atheromatous plaques by carotid and femoral artery ultrasonophaphy, markers of arterial wave reflections by pulse wave analysis and pulse wave velocity were used as surrogate markers of subclinical CVD. The number of angiographically confirmed diseased coronary arteries (&gt;50% stenosis) was used to assess the extent of CAD. Results HuR mRNA expression was significantly increased in patients with CAD (both stable and AMI) compared to controls (p=0.039). Subgroup analysis revealed that STEMI patients (n=107) had increased levels of HuR expression compared to NSTEMI (n=49, p=0.03). Among patients with stable CAD (n=133), high HuR expression was independently associated with the number of diseased coronary arteries (OR=1.35 for 1-SD increase in HuR, 95% CI 1.07–1.72, p=0.012), as well as with reduced ejection fraction (EF&lt;45%, OR=1.32 per 1-SD increase, 95% CI 1.05–1.85, p=0.024). Among individuals without CVD, high HuR was associated with lower HDL levels (adjusted beta=-5.2 mg/dl for highest versus lowest quartile, p=0.03) and higher diastolic blood pressure (adjusted beta=3.6 mmHg, p=0.007), while, after adjustment for traditional cardiovascular risk factors, HuR levels in individuals without CVD were independently associated with increased IMT in the common carotid artery (mean increase 6.2% for highest versus lowest quartile, p=0.019). Conclusion HuR expression is associated with early subclinical arterial disease in individuals without clinically overt CVD and with the presence and severity of cardiac and vascular dysfunction in patients with clinically overt CAD. These findings imply a clinical role of the HuR pathway in cardiovascular disease and warrant further investigation.

Association of Prediabetes With Higher Coronary Atherosclerotic Burden Among Patients With First Diagnosed Acute Coronary Syndrome.

Diabetes mellitus (DM) is associated with more extensive coronary atherosclerosis and more vulnerable plaque phenotypes. However, DM should not be considered a homogeneous and purely binary entity in terms of risk assessment. We evaluated the impact of prediabetic status on coronary atherosclerosis burden in patients with first-time acute coronary syndrome (ACS) who underwent urgent coronary angiography. The patients were divided into DM, prediabetes, and control groups. The 3-vessel disease (TVD) rates and SYNTAX and Gensini scoring systems for defining atherosclerotic burden were compared. The study was conducted in 469 consecutive patients admitted with a diagnosis of ACS. Of these, 250 patients were admitted at the first occurrence of ACS undergoing diagnostic coronary angiography. SYNTAX and Gensini scores and TVD rates were higher in prediabetic patients than in nondiabetic patients ( P = .004, P = .008, and P = .014, respectively), but similar in prediabetic and diabetic patients ( P = .912, P = .773, and P = 1.000, respectively). Coronary atherosclerosis burden is more advanced in prediabetic patients than in nondiabetic patients and is comparable between prediabetic and diabetic patients at first presentation of ACS. Cardiologists should not miss the opportunity to diagnose prediabetes and DM when patients present with an ACS.

Gamma Glutamyl Transferase Levels in Patients with Acute Coronary Syndrome: A Cross-Sectional Study

Background & Objectives: Oxidative stress is thought to play a key role in the progression of atherosclerosis. Many studies have identified Gamma glutamyl transferase (GGT) as a marker of oxidative stress and its relationship with coronary artery disease (CAD). There is limited data exploring the changes of GGT levels in acute coronary syndrome (ACS). The objective of present study was to assess the prevalence of raised GGT and its correlates in ACS patients. Methods: A cross-sectional study was performed in Intensive cardiac coronary unit of Medicine Department in tertiary care teaching hospital. All consecutive patients of ACS more than 18 years of age were included in this study. ACS was diagnosed on the basis of history, electrocardiogram and biochemical markers. All subjects underwent test for GGT by enzymatic calorimetric method. Magnitude of raised GGT in ACS was expressed in percentage. Unadjusted odds ratio (ORs) and multivariate logistic regression analysis were computed to assess the strength of association between independent variables and dependent variables. P value ≤0.05 was considered as significant. Results: We included 323 study subjects from November 2012 to October 2014. The magnitude of raised GGT among ACS was 41.80%. The magnitude of raised GGT in non ST elevated myocardial infarction (NSTEMI), ST elevated myocardial infarction (STEMI) and unstable angina (UA) was 57.32%, 37.85% and 32.81% respectively. The significant correlate of raised GGT were male sex [OR: 3.58 (95%CI: 1.88- 6.79) P=0.000] and NSTEMI as diagnosis of ACS [OR: 3.32 (95%CI: 1.51-7.30) P=0.003] in the study subjects. Interpretation & Conclusion: Gamma glutamyl transferase activity is increased in subjects with ACS. High levels of serum GGT on admission were associated with the burden of atherosclerosis in patients with ACS.

Assessment of the relationship between serum uric acid level and atherosclerosis burden in patients undergoing coronary angiography in Ekbatan (Farshchian) hospital, Hamadan 2015

BackgroundNowadays, cardiac disease is the most widespread reason of death in most countries such as Iran. Some studies have correlated serum uric acid level with risk of death in the patients of acute coronary syndrome. The study aimed to determine if there is any correlation between serum uric level and atherosclerosis burden. Material and methodsIn this cross-sectional study, all the patients underwent coronary angiography in Hamadan's Ekbatan Hospital in 2015 and were studied in terms of demographic, serum lipid profile, blood glucose and uric acid. Data were obtained from patients' medical records, registered in data sheet and analyzed by spss16 statistical software. Results140 patients participated in this study of whom 60% were male and 40% female with age mean of 62.92 ± 11.21 years old. Blood uric acid's mean was 6.39 ± 2.16 mg/dl and based on coronary artery involvement range was single vessel disease (6.17 ± 1.91), two vessel disease (6.56 ± 2.17), three vessel disease (6.32 ± 2.01), mild or minimal or patent (6.78 ± 3.16) and in ectatic or slow flow (7.30 ± 0.86) mg/dl, respectively. According to the results of Kruskal–Wallis test, no significant relation was observed between uric acid level and the range of coronary artery involvement (P = 0.60). But, the mean of serum uric acid level in severe Ischemic heart disease was significantly more than acute coronary syndrome (P = 0.04). ConclusionBlood uric acid is not a dependent predictive risk factor of atherosclerosis but through effects on other risk factors it may increase the risk of heart disease.

High Resting Heart Rate and High BMI Predicted Severe Coronary Atherosclerosis Burden in Patients With Stable Angina Pectoris by SYNTAX Score

We investigated the independent and combined association of resting heart rate (RHR expressed as beats/min, bpm) and body mass index (BMI) with SYNTAX score (SS) in patients with stable angina. We divided 312 patients into 4 groups according to RHR quartiles: Q1 (<65 bpm), Q2 (65-69 bpm), Q3 (70-79 bpm), and Q4 (≥80 bpm). The SS (12.0 ± 9.0, 16.0 ± 15.5, 18.0 ± 16.5, and 20.0 ± 27.5; P < .001) was significantly higher for those in Q4 than for those in Q1, Q2, and Q3. Multivariate logistic regression analysis indicated that each 10-bpm increment in RHR was significantly associated with SS (odds ratio [OR] 1.62, 95% confidence interval [CI] 1.27-2.06). Patients with high RHR and high BMI had significantly greater odds ratio (OR) of high SS (4.03, 95% CI 2.00-8.14), compared to participants with low RHR and low BMI. Both RHR and BMI were independent predictors of coronary atherosclerosis as assessed by SS. RHR in combination with BMI and multivariate logistic regression analysis emphasized the importance of the correlation between RHR and SS in patients with stable angina pectoris.

The Association of HLA-class I Genes and the Extent of Atherosclerotic Plaques in Patients with Psoriatic Disease.

To investigate the association between HLA susceptibility and disease severity markers and the extent of atherosclerosis in patients with psoriatic disease. White patients with psoriatic arthritis (PsA) and psoriasis without PsA (PsC) were recruited. An ultrasound of the carotid arteries was performed and the size of each atherosclerotic plaque was measured. The resulting score, the total plaque area (TPA), represented the extent of atherosclerosis. HLA genotyping was performed using sequence-specific oligonucleotide probes. The association between 10 HLA susceptibility and severity markers of PsC and PsA and the severity of atherosclerosis was assessed by ordinal logistic regression models adjusted for age, sex, and cardiovascular (CV) risk factors. The study involved 411 patients (273 PsA, 138 PsC). Of them, 61.8% had at least 1 atherosclerotic plaque. HLA-B*13:02 and HLA-C*06:02 were associated with more severe atherosclerosis (age- and sex-adjusted OR 2.31, 95% CI 1.23-4.32 and OR 1.68, 95% CI 1.12-2.52, respectively). HLA-B*38:01 was associated with less severe atherosclerosis (OR 0.49, 95% CI 0.28-0.86). These associations remained statistically significant after adjusting for CV risk factors. Higher levels of erythrocyte sedimentation rate (ESR) were associated with more severe atherosclerosis (age- and sex-adjusted OR 1.33, p = 0.02). HLA-B*13:02-positive (p = 0.01) as well as HLA-C*06:02-positive (p = 0.008) patients had higher levels of ESR over time. HLA-C*06:02 and B*13:02 alleles are associated with a higher burden of atherosclerosis in patients with psoriatic disease. This association may be mediated by a higher level of systemic inflammation.

HLA-Class I genes are associated with a higher burden of atherosclerosis in patients with psoriatic disease

s / Atherosclerosis 241 (2015) e32ee71 e53 Inflammation and atherosclerosis EAS-0065. HLA-CLASS I GENES ARE ASSOCIATED WITH A HIGHER BURDEN OF ATHEROSCLEROSIS IN PATIENTS WITH PSORIATIC DISEASE L. Eder , F. Abji , C.F. Rosen , V. Chandran , D.D. Gladman . Rheumtology, Toronto Western Hospital, Toronto, Canada; Dermatology, Toronto Western Hospital, Toronto, Canada Aim: Psoriasis is a chronic inflammatory skin disease. The extent of inflammation is linked with cardiovascular risk in these patients. We aimed to investigate the association between Human-Leukocyte Antigen (HLA) markers of severe phenotype of psoriatic disease (PsD) and the extent of atherosclerosis in these patients. Methods: 411 Caucasian patients with PsD were analyzed. An ultrasound of the carotid arteries was performed and the presence of atherosclerotic plaques was recorded. The size of each plaque was measured and the resulting score, total plaque area (TPA), represented the extent of atherosclerosis. TPA was classified to 4 categories (No plaques, mild, moderate and severe atherosclerosis). HLA genotyping was performed by sequencespecific oligonucleotide probes. The association between each HLA allele and the severity of atherosclerosis was assessed by ordinal logistic regression models adjusted for age, sex and traditional cardiovascular risk factors. Results: 62% of patients had at least one atherosclerotic plaque. HLAB*1302 and HLA-C*0602 were associated with more severe atherosclerosis (ageand sex-adjusted OR 2.3 (95% Confidence Interval (CI) 1.2, 4.3) and OR 1.7 (95% CI 1.1, 2.5), respectively), while HLA-B*3801 was associated with a lower extent of atherosclerosis (ageand sex-adjusted OR 0.49, 95% CI 0.28, 0.86). These associations remained statistically significant after adjusting for traditional cardiovascular risk factors. Higher levels of erythrocyte sedimentation rate over time were associated with HLA-B*1302 (p1⁄40.01) and HLA-C*0602 (p1⁄40.001). No association was found between these alleles and traditional cardiovascular risk factors. Conclusion: HLA-C*0602 and B*1302 are markers of more severe atherosclerosis in patients with PsD. EAS-0089. MODULATION OF TLR2-MEDIATED INFLAMMATION BY AZAPEPTIDES AS SELECTIVE LIGANDS OF CD36 IN ATHEROSCLEROSIS K. Mellal , K. Zoccal , M. Mulumba , G.Y. Ramos , D.W. Lubell , J.F. Cailhier , S. Marleau , H. Ong . 1 Faculty of Pharmacy, University of Montreal, Montreal, Canada; 2 Faculty of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil; Department of Chemistry, University of Montreal, Montreal, Canada; CHUM, University of Montreal,

N-Terminal Pro-Brain Natriuretic Peptide Level is Associated With Severity and Complexity of Coronary Atherosclerosis in Patients With Acute Coronary Syndrome.

N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are associated with short- and long-term mortality in acute coronary syndrome (ACS). We investigated whether baseline NT-proBNP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). We enrolled 509 patients with ACS who underwent coronary angiography. The patients were divided into tertiles according to the SXScore: low SXScore (≤ 22), intermediate SXScore (23-32), and high SXScore (≥ 33). The NT-proBNP levels demonstrated an increase from low SXScore tertile to high SXScore tertile. The NT-proBNP levels according to the SXScore tertiles are as follows: low and intermediate (median 635 vs 1635, P = .014), low and high (median 635 vs 4568, P < .001), and intermediate and high (median 1635 vs 4568, P < .001). In multivariate analysis, NT-proBNP remained an independent predictor of high SXScore (odds ratio: 2.688, 95% confidence interval: 1.315-5.494, P = .007) together with age (P = .002), neutrophil-lymphocyte ratio (P = .017), and presence of non-ST-segment elevation ACS (P = .002). The NT-proBNP was independently associated with burden of coronary atherosclerosis in patients with ACS.

Atherosclerosis Burden in Patients with Acute Chest Pain: Obesity Paradox

Obesity paradox has been described in various populations of coronary artery disease, mainly asymptomatic subjects. However, relationship between obesity and coronary artery calcification detected by cardiac CT in symptomatic patients has rarely been demonstrated. This study seeks to investigate whether the paradoxical relationship between obesity and coronary artery calcification exists in patients with acute chest pain. A final cohort of 1030 chest pain patients presenting at our emergency department who underwent coronary evaluation by multidetector cardiac CT were examined. With absent-to-mild coronary calcification (CAC score < 100) as a referent, multivariable analysis showed that presence of obesity (OR 0.564; 95% CI 0.395, 0.806; P 0.002), body mass index (OR 0.945; 95% CI 0.920, 0.971; P < 0.001), body weight (OR 0.987; 95% CI 0.979, 0.995; P 0.001), and body surface area (OR 0.582; 95% CI 0.369, 0.920; P 0.020) were inversely associated with moderate-to-severe coronary calcification (CAC score ≥ 100). This study extends the concept of obesity paradox to symptomatic patients undergoing coronary artery calcium score assessment. However, biological explanation(s) of this paradox remains unanswered.

Glomerular Filtration Rate is Associated With Burden of Coronary Atherosclerosis in Patients With Acute Coronary Syndrome

We aimed to elucidate the relationship between mild to moderate renal impairements and burden of atherosclerosis in patients with acute coronary syndrome (ACS). A total of 380 patients with ACS were included in the study. Gensini and SYNTAX scores were also calculated. Kidney function was classified based on estimated glomerular filtration rate (eGFR) into stage 1: eGFR >90, stage 2: 60 to 89, and stage 3: 30 to 60 mL/min per 1.73 m(2). Gensini and SYNTAX scores were higher in stages 2 and 3 than in stage 1. Also, the number of diseased vessels, number of critical lesions (>50 and 70%), left main disease, and number of total occlusion vessels were higher in stages 2 and 3 than in stage 1. Multivariate linear regression analysis demonstrated that a decreased eGFR was an independent risk factor for SYNTAX and Gensini scores together with age and male gender.

Serum gamma-glutamyltransferase and the burden of atherosclerosis in patients with acute coronary syndrome

We evaluated the relationship between serum gamma-glutamyltransferase (GGT) levels and the burden of atherosclerosis in patients with acute coronary syndrome (ACS). This study involved 180 patients (139 male, 41 female; mean age 63±11 years) with the diagnosis of ACS (non-ST elevation myocardial infarction and unstable angina) who underwent coronary angiography on the first day after hospital admission. The burden of atherosclerosis was assessed by the number of involved vessels, and the Gensini and Syntax scores. Serum GGT levels were measured by enzymatic caloric test. Patients with high Syntax scores (>=33) were more frequently diabetic, hypertensive, and had higher GGT and creatinine levels compared to the patients with low Syntax scores (<=23). Similarly, patients with >=3 diseased vessels were more frequently diabetic, hypertensive, and smokers. In addition, these patients were older and had higher serum glucose, urea and GGT levels. Correlation analysis revealed that the level of GGT was significantly associated with Gensini and Syntax scores, number of diseased vessels, and the number of critical lesions (r=0.378 p<0.001, r=0.301 p<0.001, r=0.159 p=0.036, r=0.355 p<0.001, respectively). Multivariate linear regression analysis demonstrated that increased GGT level was an independent risk factor for high Gensini and Syntax scores (p=0.029 and p=0.035, respectively), together with age (p=0.001 and p=0.002, respectively) and serum glucose levels (p=0.017 and p=0.012, respectively). Serum GGT levels on admission are associated with increased burden of atherosclerosis in patients with ACS. This may account for the cardiovascular outcomes associated with increased GGT levels.

Anti‐apolipoprotein A‐1 autoantibodies as biomarker for atherosclerosis burden in patients with periodontitis

Anti-apolipoprotein A-1 (anti-apoA-1) IgG is a potential marker of atherosclerotic plaque vulnerability and cardiovascular complications. In patients with periodontitis the presence of anti-apoA-1 IgGs in serum and their association with atherosclerosis is unknown. One-hundred and thirty subjects with periodontal disease and 46 healthy subjects, matched for age and gender, participated in this study. Anti-apoA-1 IgG, high-sensitivity C-reactive protein (hsCRP) and matrix metalloproteinase (MMP) -2, -3, -8 and -9 were measured in serum samples. An ankle-brachial index (ABI) value below 1.11 served as a surrogate marker of atherosclerosis. Predictive accuracies of biomarkers for abnormal ABI were determined using receiver-operating characteristics curves and logistic regression analyses. Compared with healthy controls, periodontitis patients showed lower median ABI values (1.10 vs. 1.15; p < 0.0001), a higher prevalence of anti-apoA-1 IgG positivity (23.8% vs. 6.5%; p = 0.009) and higher concentrations of hsCRP (1.62 mg/L vs. 0.85 mg/L; p = 0.02) and MMP-9 (435 μg/mL vs. 283 μg/mL; p < 0.0001). In patients younger than 50 years of age (n = 66), anti-apoA-1 IgG was found to be the best predictor for an abnormal ABI (area under the curve = 0.63; p = 0.03). Anti-apoA-1 IgG positivity increased the risk of having an abnormal ABI (odds ratio = 4.20; p = 0.04), independently of diabetes, smoking and body mass index. Anti-apoA-1 IgG positivity and atherosclerosis, as reflected by abnormal ABI, were more prevalent in periodontitis patients than in age- and gender-matched controls. In younger periodontitis patients, anti-apoA-1 IgG was found to be the best predictor of atherosclerosis burden.

Effects of Prolonged Intensive Lipid Therapy on Carotid IMT: A Study of the 20-Year Familial Atherosclerosis Treatment (FATS): Observational Study∗

average of 18 years. Subsequently, they continued on therapy with simvastatin/ezetimibe (S/E) plus niacin. Carotid ultrasound was performed in 39 active participants at the time of starting (S/E) plus niacin and 2 years after. Bilateral carotid scans were performed including anterior and lateral views. Cross-sectional images were collected to identify carotid plaque. CIMT of the 10 mm segment distal to the carotid bulb of the far wall of the common carotid artery was measured. The maximum wall thickness (MWT) was assessed using cross sectional images. Plaque was defined as MWT $ 1.5 mm. Results: In subjects who had been intensively treated for 18 years with initial untreated LDL-C of 200 mg/dL, triglycerides of 207 mg/dL, and HDL-C of 41 mg/dL, combination lipid therapy with (S/E) plus niacin effectively lowered LDL-C to 68632 mg/dL, triglycerides to 92 6 39 mg/dL, non-HDL-C to 82 6 29 mg/dL, and ApoB to 77 6 28 mg/dL while maintaining HDL-C at 60 6 20 mg/dL and apoA1 at 154 6 37 mg/dL. Both mean CIMT (mm) (0.72 6 0.13 vs. 0.73 6 0.13) and MWT (mm) (2.54 6 1.21 vs. 2.65 6 1.16) did not change significantly over 2 years. At the time of therapy initiation, the mean CIMT (mm) in patients with (n 5 8) and without (n 5 31) the presence of plaque was 0.71 6 0.13 and 0.73 6 0.12, P 5 .72. At the 2-year follow up, the mean CIMT (mm) in patients with (n 5 5) and without plaque (n 5 34) was 0.72 6 0.11 and 0.73 6 0.14, P 5 .86. The correlation between CIMT and MWT at the initial time point was 0.058 and 0.135 at the 2-year follow-up. Conclusions: In patients on combination therapy who were previously treated with prolonged intensive lipid therapy, CIMT and MWT did not change significantly over 2 years. Furthermore, there was no correlation between carotid plaque burden and CIMT. These findings suggest that CIMT evaluation may not be a sensitive marker for tracking treatment effect in prolonged and intensively treated patients, and may not be a reliable marker to study the atherosclerosis burden in patients with established carotid plaque.