Coronary Artery Disease In Men Research Articles

Is There a Need for Sex-Tailored Lipoprotein(a) Cut-Off Values for Coronary Artery Disease Risk Stratification?

Lipoprotein(a) [Lp(a)] plasma level is a well-known risk factor for coronary artery disease (CAD). Existing data regarding the influence of sex on the Lp(a)-CAD relationship are inconsistent. To investigate the relationship between Lp(a) and CAD in men and women and to elucidate any sex-specific differences that may exist. Data of patients with Lp(a) measurements who were admitted to a tertiary university hospital, Koc University Hospital, were analyzed. The relationship between Lp(a) levels and CAD was explored in all patients and in subgroups created by sex. Two commonly accepted Lp(a) thresholds ≥ 30 and ≥ 50 mg/dL were analyzed. A total of 1858 patients (mean age 54 ± 17 years; 53.33% females) were included in the analysis. Lp(a) was an independent predictor of CAD according to the multivariate regression model for the entire cohort. In all cohort, both cut-off values (≥ 30 and ≥ 50 mg/dL) were detected as independent predictors of CAD (p < 0.001). In sex-specific analysis, an Lp(a) ≥ 30 mg/dL was an independent predictor of CAD only in women (p < 0.001), but Lp(a) ≥ 50 mg/dL was a CAD predictor both in men and women (men, p = 0.004; women, p = 0.047). The findings of this study may suggest that different thresholds of Lp(a) level can be employed for risk stratification in women compared to men.

Peripheral arterial disease in women.

Peripheral arterial disease (PAD) represents one of the most frequent manifestations of atherosclerosis in men and women. In both sexes, PAD is related to classical risk factors of atherosclerosis, which are similarly distributed, but some additional factors determine differences between men and women. More frequent asymptomatic disease in women than in men and less frequent screening in women may result in a false underestimation of the prevalence of PAD in women. All these factors may cause delayed diagnosis and treatment of PAD in women. Estrogen hormones have vasoprotective properties that lower the prevalence of atherosclerosis in women of younger age. However, estrogen probably does not have a protective role against the development of cardiovascular disease in women of an older age. Hormone replacement therapy (HRT) of less than one year does not appear to reduce the odds of developing PAD in postmenopausal women. It may even increase the risk of morbidity from vascular interventions. However, some studies indicated that HRT for more than one year significantly decreases the risk of PAD if administered early after the last menstruation. Also, treatment of PAD in women differs to some extent from men.

Sex-specific plasma-proteome of incident coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): This work was supported by a Leiden University Medical Center MD/PhD research grant to V.Q. Sier and Dr. R. Noordam is supported by an innovation grant from the Dutch Heart Foundation. Purpose The onset and symptomatology of coronary artery disease (CAD) are different for men and women, yet insights into sex-specific biological mechanisms causing CAD are limited. To increase insight in the onset of CAD in men and women, we performed a sex-specific proteome-wide association analysis using data from a large cohort of middle-aged participants from the UK Biobank. Methods Associations between 2,923 plasma proteins and CAD incidence (angina pectoris, acute myocardial ischemia, chronic myocardial ischemia) were examined in European-ancestry participants from the UK Biobank who were free of CAD at baseline. Plasma samples were collected at baseline (2006-2010), and CAD incidence was monitored continuously for a median (interquartile range) follow-up of 5,013 (4775-5251) days. Using Cox proportional hazard modelling, the associations between CAD incidence and plasma protein levels were examined, adjusted for age, sex, body mass index, socioeconomic status, type 2 diabetes mellitus, and cholesterol-lowering and insulin drug use at baseline. The Metascape portal was employed for pathway analyses to identify (sex-specific) biological pathways. Results In a total sample comprising 40,829 individuals (55% women, mean age (sd) 56.9 (8.10)), featuring 3,155 incident CAD cases, our sex-combined model demonstrated significant associations between 93 proteins and hazard for CAD. Pathway analyses identified early plasma proteomic changes related to cytokine-cytokine receptor interactions (p=3.42e-17), matrix remodelling (p=9.24e-14, p=1.08 e-9), regulation of innate and adaptive immune cells (p=1.92e-12, p=3.88e-9), and angiogenesis (p=5.34e-9). Stratification by sex revealed distinct sex-specific proteomic patterns linked to CAD incidence, with 10 female-specific and 49 male-specific significant proteins. Through interaction analyses, we demonstrated that 8 proteins were distinctly associated with a significant increased hazard in women, while 20 proteins were significantly associated with increased hazard for CAD in men. Pathway analyses identified a significant female-specific relation between CAD incidence and matrix remodelling (p=9.72e-15, p=3.19e-13), angiogenesis/hypoxia (p=1.41e-12), and inflammatory signalling (p=7.18e-10, p=8.01e-10) pathways, whereas male-specific top pathways related to inflammatory signalling (p=9.58e-25), matrix remodelling (p=1.22e-17), and immune cell response/recruitment (p=3.08e-16, p=8.34e-12). Conclusion Using large-scale association analyses of proteomics data with CAD, we identified sex-specific proteomic profiles. Distinct patterns in more angiogenic (women) and more immune cell response (men) profiles were found. These findings contribute novel insights to the development of CAD, potentially guiding future sex-specific research and clinical strategies for disease prevention.Proteome-wide analysis for CAD incidence

Associations of Increased Red Cell Distribution Width Levels with the Severity of Carotid Artery Stenosis: Cross-sectional Study Results.

Red blood cell distribution width (RDW) is being actively studied as a biomarker in various cardiovascular diseases (CVDs). The aim of this study was to conduct a comparative analysis of RDW in patients with carotid atherosclerosis, comparing it with an assessment of the severity of carotid artery stenosis (CAS). The Duplex registry database was used to conduct this retrospective cross-sectional study. The study participants underwent a complete blood count test, analysis for lipid profile, and carotid ultrasound. The patients were divided into 5 groups depending on CAS degree: none; 20%-49%; 50%-69%; 70%-99%; and occlusion. Data from 2548 patients were included in the final analysis (mean age: 57.9 ± 12.3 years; 51% males [n = 1301]). The analysis confirmed the relationship between the increase in the RDW index and CAS gradation increase in men (Kr-W H = 16.43; P = 0.0009), but was not confirmed in women (Kr-W H = 4.32; P = 0.22). Significantly higher levels of high-density lipoprotein cholesterol and platelets and lower levels of red blood cell and white blood cells were registered in female patients without CAS and with CAS < 50% compared with men (P < 0.001). The results of the present study showed that RDW is an indicator whose increase is associated with an increase in the degree of carotid atherosclerosis in men, but not in women. This allows to discuss the role of the RDW index as a possible new laboratory biomarker of inflammation and progression of atherosclerosis, which can make an additional contribution to the formation of increased morbidity and mortality in men from atherosclerotic CVD.

Premature coronary artery disease in all-comers undergoing first PCI

Abstract Background The prevalence of coronary artery disease (CAD) increases with age, yet some individuals develop obstructive CAD at younger age. Purpose The present analysis aimed to assess differences in baseline risk profile and 3-year adverse event risk between patients undergoing percutaneous coronary intervention (PCI) for premature or non-premature CAD. Methods We pooled patient-level data of four randomized PCI trials in all-comers (TWENTE (clinicaltrials.gov: NCT01066650); DUTCH PEERS (NCT01331707); BIO-RESORT (NCT01674803); and BIONYX (NCT02508714)), who had no previous coronary revascularization (by PCI or coronary artery bypass surgery) or myocardial infarction (MI). Premature CAD was defined as CAD in men &amp;lt;50 years and in women &amp;lt;55 years, while non-premature CAD was classified as CAD in older patients. Main clinical endpoint was major adverse cardiac events (MACE), a composite of all-cause mortality, any MI, emergent coronary bypass surgery, or clinically indicated target lesion revascularization. Results Of all 6,171 PCI patients with first revascularizations, one out of seven (n=887, 14.4%) had premature CAD. These patients had lower rates of diabetes (10.6% vs. 16.6%, p&amp;lt;0.001), hypertension (32.7% vs. 50.7%, p&amp;lt;0.001), hypercholesterolemia (35.9% vs. 40.3%, p=0.012), and peripheral arterial disease (2.0% vs. 6.6%, p&amp;lt;0.001). Yet, they were more often overweight (76.2% vs. 69.8%, p&amp;lt;0.001), smoker (60.7% vs. 26.4%, p&amp;lt;0.001), and had more often a family history of CAD (59.8% vs. 44.5%, p&amp;lt;0.001). Patients with premature CAD suffered more often from acute ST-segment elevation MI and underwent less often treatment of calcified or bifurcated lesions (Table 1). At 3-year follow-up, the main endpoint MACE did not differ significantly between patients with premature and non-premature CAD (6.6% vs. 9.4%; adj.HR:0.86, 95%-CI:0.65-1.16, p=0.33; Figure 1). All-cause mortality was lower in patients with premature CAD (0.8% vs. 4.4%; adj.HR:0.23, 95%-CI:0.10-0.52, p&amp;lt;0.001). Yet, in patients with premature CAD the rate of repeated target vessel revascularization was higher than in patients with non-premature CAD (6.1% vs. 4.3%; adj.HR: 1.63, 95%-CI:1.18-2.26, p=0.003). In addition, their definite stent thrombosis risk was higher (1.0% vs. 0.5%; adj.HR:3.20, 95%-CI:1.39-7.38; p=0.006) than in patients with non-premature CAD. Conclusions One out of seven patients who were treated with PCI had premature CAD, and these patients had less complex risk profiles. Patients with premature CAD had higher risks for repeated revascularization and stent thrombosis, but the 3-year all-cause mortality risk was lower. In patients with premature CAD, long-term outcome after PCI might be improved by addressing modifiable risk factors such as smoking and overweight.Figure 1:Kaplan-Meier cumulative event

Effects of Vitamin K2 and D Supplementation on Coronary Artery Disease in Men: A RCT

BackgroundExtent and progression of coronary artery calcification (CAC) are strong predictors of myocardial infarction and mortality. ObjectivesThis study aims to investigate if vitamin K2 and D supplementation can reduce CAC progression. MethodsA total of 389 participants were randomized to supplementation with vitamin K2 (720 μg/day) and D (25 μg/day) vs placebo in a multicenter double-blinded randomized controlled trial. The primary endpoint (progression of aortic valve calcification) has been reported. This study reports CAC progression in participants with no ischemic heart disease. CT scans were performed at baseline, 12, and 24 months. ΔCAC and coronary plaque volume were evaluated in the entire group and in 2 subgroups. A safety endpoint was the composite of myocardial infarction, coronary revascularization, and all-cause mortality. ResultsIn total, 304 participants (male, mean age 71 years) were identified. The intervention and placebo group both increased in mean CAC scores from baseline to 24-month follow-up (Δ203 vs Δ254 AU, P = 0.089). In patients with CAC scores ≥400 AU, CAC progression was lower by intervention (Δ288 vs Δ380 AU, P = 0.047). Plaque analyses showed no significant difference in progression of noncalcified plaque volume (Δ-6 vs Δ46 mm3, P = 0.172). Safety events were fewer in participants receiving supplementation (1.9% vs 6.7%, P = 0.048). ConclusionsPatients with no prior ischemic heart disease randomized to vitamin K2 and D supplementation had no significant reduction in mean CAC progression over a 2-year follow-up compared to placebo. Although the primary endpoint is neutral, differential responses to supplementation in those with CAC scores ≥400 AU and in safety endpoints are hypothesis-generating for future studies.

Association between soft drink consumption and carotid atherosclerosis in a large-scale adult population: The TCLSIH cohort study

Background and aimsCarotid atherosclerosis indicates an increased risk for cardiac-cerebral vascular disease. Given the pattern of consumption in China, sugar-sweetened beverage is the main type of soft drink consumed. As soft drinks contain a high amount of fructose, they may be a risk factor of carotid atherosclerosis. A prospective cohort study was conducted to investigate the association between soft drink consumption and the incidence of carotid atherosclerosis in a Chinese adult population. Methods and resultsA total of 3828 participants (men: 2007 and women: 1821) were included. Carotid atherosclerosis was measured by using ultrasonography and was defined by increased carotid intima-media thickness and/or carotid plaques. Soft drink consumption was assessed using a validated food frequency questionnaire. Cox proportional hazards regression analysis was used to assess the association of soft drink consumption categories with the incidence of carotid atherosclerosis. During a mean follow-up of 3.20 years, 1009 individuals of the 3828 eligible participants developed carotid atherosclerosis. After adjusting for potential confounding factors, we compared the higher levels to the lowest level of soft drink consumption in women, and we estimated the multivariable hazard ratios and 95% confidence intervals of incident carotid atherosclerosis to be 1.09 (0.80, 1.50), and 1.56 (1.14, 2.13) (P for trend <0.05). However, there was no significant association between soft drink consumption and the incidence of carotid atherosclerosis in men or total population. ConclusionThe result indicated that soft drink consumption was associated with a higher incidence of carotid atherosclerosis in women. Trial registeredUMIN Clinical Trials Registry. Trial registration numberUMIN000027174. Trial registration websitehttps://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000031137.

Sex differences in the association between minor nonspecific ST-segment and T-wave abnormalities and coronary artery calcification

Background and aimsAlthough minor nonspecific ST-segment and T-wave abnormalities (NSSTTA) have been associated with adverse cardiovascular outcomes, their relationship with subclinical atherosclerosis remains controversial. Therefore, the associations between electrocardiographic (ECG) abnormalities, including NSSTTA, and coronary artery calcification (CAC) were investigated in this study. MethodsThis cross-sectional study included 136,461 Korean participants with no known cardiovascular disease or cancer, who underwent a health checkup including ECG and computed tomography to measure the coronary artery calcium score (CACS) by Agatston method between 2010 and 2018. ECG abnormalities were defined in accordance with the Minnesota Code using an automated ECG analysis program. A multinomial logistic regression model was used to calculate prevalence ratios (PRs) with 95% confidence intervals (CI) for each CACS category. ResultsIn men, both NSSTTA and major ECG abnormalities were associated with all levels of CACS. The multivariable-adjusted PRs (95% CI) for CACS >400 comparing NSSTTA and major ECG abnormalities to the reference (neither NSSTTA nor major ECG abnormalities) were 1.88 (1.29–2.74) and 1.50 (1.18–1.91), respectively. Women with major ECG abnormalities were more likely to have a CACS of 101–400, the PRs (95% CI) comparing major ECG abnormalities to the reference group was 1.75 (1.18–2.57). NSSTTA were not associated with any CACS level in women. ConclusionsNSSTTA and major ECG abnormalities are associated with CAC in men, though NSSTTA were not associated with CAC in women, suggesting that NSSTTA should be considered sex-specific risk factors for coronary artery disease in men, but not in women.

Sex differences in the risk of arterial stiffness among adults with different glycemic status and modifications by age.

Studies indicate lower, comparable, and higher cardiovascular risks in women vs men in normal glucose regulation (NGR), prediabetes, and diabetes, respectively. However, this sex difference is uncertain and aging might play a part. We aimed to estimate sex differences in arterial stiffness in NGR, prediabetes, or diabetes and the potential modifications by age. We used baseline data of 9618 participants aged ≥40 years in a large community-based cohort study in Shanghai. Glycemic status was determined by history of diabetes, fasting and 2-h post-load glucose levels, and hemoglobin A1c levels. Arterial stiffness was examined by brachial-ankle pulse wave velocity (ba-PWV). Multivariable linear regression analysis was conducted to examine the associations between sex and ba-PWV levels in glycemic and age categories. Before adjustment for age, women had lower, comparable, and higher ba-PWV vs men in the NGR, prediabetes, and diabetes groups, respectively. In participants aged 40-59 years, women were associated with lower ba-PWV levels in generally all glycemic strata after adjustment for age and other confounders. In participants aged ≥60 years, women were associated with significantly higher ba-PWV levels (β coefficient=71.5; 95% confidence interval=23.4, 119.7) and the sex difference was attenuated in the groups of prediabetes and diabetes with a borderline significant interaction between sex and glycemic status (p for interaction=.068). The sex difference in cardiovascular risks in adults with NGR, prediabetes, or diabetes was dependent on age. Our findings provide new evidence for prioritizing preventive treatment against atherosclerosis in men vs women with different glycemic status.

Relationship between Serum Testosterone Level and Carotid Intima-Media Thickness among Korean Men and Postmenopausal Women.

Given that the role of serum testosterone on incident cardiovascular disease has been uncertain, it is necessary to find out the relationship between serum testosterone and carotid atherosclerosis. The study participants included 1,302 Korean adults (873 men and 429 postmenopausal women) who participated in the Healthy Twin Study and were not receiving androgen deprivation therapy. The participants were classified into three groups: men aged <40 and ≥40 years and postmenopausal women. Total testosterone (TT) and sex hormone-binding globulin (SHBG) concentrations were measured using electrochemiluminescence immunoassays, and free testosterone (cFT) levels were calculated using Vermeulen's method. Carotid intima-media thickness (IMT) was measured at three levels using a high-resolution B-mode ultrasound equipped with a 7-MHz linear transducer. The associations between sex hormone concentrations and carotid IMT were evaluated using a mixed linear regression analysis. After adjusting for cardiovascular risk factors, TT was found to be inversely associated with common carotid IMT in men aged ≥40 years, with a 4.5% decrease in common carotid IMT for every one-standard deviation increase in TT concentration (P=0.0063). In contrast, TT was not significantly associated with carotid IMT in all segments in men aged <40 years and postmenopausal women. Additionally, SHBG and cFT were not associated with carotid IMT in any segment. The significant association between TT level and common carotid IMT in men aged ≥40 years suggests that decreased testosterone levels are involved in the development of atherosclerosis in men.

Relationship between sexual differences and cardiovascular risk factors in the prevalence of asymptomatic coronary disease

BackgroundThis study investigated the sexual differences of coronary artery disease (CAD) prevalence and its association with cardiovascular risk factors in the asymptomatic population. MethodsIn total 6434 asymptomatic participants without known CAD (1740 women and 4694 men) underwent coronary computed tomography angiography (CCTA). The prevalence of significant CAD (diameter stenosis ≥50%) and other CCTA findings were compared by sex, and its influence on CAD was investigated in groups stratified by the number of cardiovascular risk factors, including age (>55 years), hypertension, diabetes, dyslipidemia, and current smoking. ResultsThe prevalence of current smokers, hypertension, and diabetes were higher in men than women. The mean coronary artery calcium score was 13.1 ± 58.4 for women and 51.1 ± 158.2 for men; the coronary atherosclerosis burden indices were significantly higher in men than women. Significant CAD was identified in 65 women (3.7%) and 429 men (9.1%), showing a significant association (adjusted odds ratio [OR] 2.38, P < 0.001). The relatively higher risk for significant CAD in men was observed in patients with fewer risk factors, and the risk difference was not significant in patients with many risk factors (adjusted ORs: 7.69, 3.37, 1.71, 1.31, and 0.88 in patients with 0, 1, 2, 3, and 4–5 risk factors, respectively). The association between sex and risk factor groups was significant (P < 0.001). ConclusionsIn the asymptomatic population, a significantly higher CAD prevalence was noted in men than women. However, women with a high number of cardiovascular risk factors showed a CAD prevalence similar to that of men.

Association between iron status and incident coronary artery disease: a population based-cohort study

Disorders of iron metabolism has been implicated in cardiovascular disease. However, the association of serum iron stores and coronary artery disease (CAD) remains inconsistent. Here, we investigated the associations of serum iron metabolism with the incidence of CAD, the severity of coronary artery stenosis, metabolic biomarkers, and the risk of major adverse cardiovascular event (MACE). A total of 643 CAD patients and 643 healthy controls were enrolled to assess the associations of serum iron status with the presence of CAD, the severity of CAD, and the risk of MACE. Serum iron metabolism and other metabolic markers were measured in all subjects. All statistical analyses were analyzed using SPSS22.0 software and STATA statistical package. Serum level of iron metabolism markers, including serum iron, unsaturated transferrin iron binding capacity (UIBC), Total iron binding capacity (TIBC) levels, in CAD groups was significantly lower than the control group (P < 0.001). UIBC and TIBC were negatively correlated with ferritin in both sexes. Each unit increase of serum iron and TIBC were found to have a protective role for CAD in women (iron: OR 0.794, 95% CI (0.647–0.973), TIBC: OR 0.891, 95% CI (0.795–0.999), P < 0.05). However, high ferritin level was significant associated the CAD incident in both sexes (OR 1.029, 95% CI (1.002–1.058) in men, OR 1.013, 95% CI (1.0–1.025) in women, P < 0.05). Serum iron metabolism markers exhibited no significant association with the severity of CAD. Increased serum level of iron and TIBC levels were found to have a protective role for CAD in women, but not in men. Elevated serum ferritin is independently and positively associated with CAD in men and women.

Influence of gender on coronary atherosclerosis and inflammatory biomarker profile: a CT angiographic study

Abstract Background and aims The burden of coronary atherosclerosis differs between men and women. Beyond traditional cardiovascular risk factors, inflammatory biomarkers can influence plaque formation and progression. We analyzed the influence of gender difference on coronary atherosclerosis and inflammatory cytokines. Methods Coronary CT-Angiography was performed in 301 patients and plaque morphology was quantitatively and qualitatively assessed using semi-automated software (Autoplaque version 2.5, Cedars-Sinai Medical Center, Los Angeles, CA). We analyzed total (TPV), non-calcified (NCPV), calcified (CPV) and low-density plaque volume in mm3 (LDPV, defined as plaque attenuation &amp;lt;30HU). Serum was analyzed for various cytokines including Interleukin (IL)-1a, IL-1b, IL-2, IL-4, IL-6, IL-7, IL-8, IL-10, IL-13, Il-15, IL-17, TNF-a, IFNg, CRP, MCP-1, MIP-1a, Eotaxin, G_CSF and GM-CSF using Luminex assay. Results Out of 301 patients, 94 (31%) were female and 207 (69%) were male. As compared to women, men were significantly younger (62 vs. 57 years, p&amp;lt;0.001) and showed a higher BMI (28 vs. 26 kg/m2, p=0.005). No differences were seen for hypertension, hyperlipidemia, diabetes, smoking habits and family history of CAD. All plaque characteristics showed significant higher values in men as compared to women (all p&amp;lt;0.05). In men, cytokine profile showed significantly lower serum levels for IL-2 (3.20 [3.20; 7.01] vs. 4.31 [3.20; 9.68]; p=0.01) and Interferon-gamma (3.20 [3.20; 14.72] vs. 8.76 [3.20; 26.26]; p&amp;lt;0.001) and significantly higher levels for MCP-1 (224 [117; 327] vs. 155 [49; 260]; p&amp;lt;0.001). In multivariable logistic regression analysis, Interferon-gamma showed significant inverse association to male gender (OR 0.35; 95% CI: 0.17–0.72; p=0.004), but IL-2 and MCP-1 did not. The association of Interferon-gamma to gender was independent of age (OR 0.57; 95% CI: 0.43–0.76; p&amp;lt;0.001) and BMI (OR 2.12; 95% CI 1.25–3.62; p=0.006) Conclusion Coronary plaque volume and morphology significantly differs between men and women and so does the inflammatory cytokine profile. Albeit significantly lower coronary plaque burden in women, serum levels of interferon-gamma - a known pro-inflammatory cytokine - was significantly higher in women with independent association to gender. Whether interferon-gamma plays contradicting roles in the process of coronary atherosclerosis in men and women needs to be explored in future studies to identify potential gender-specific targets for therapeutic interventions. Funding Acknowledgement Type of funding sources: None.

Circulating Fibroblast Growth Factor 21 and Total Testosterone in Type 2 Diabetes Mellitus Men With Coronary Heart Disease.

BackgroundFibroblast growth factor 21 increased in population with type 2 diabetes mellitus (T2DM), while serum total testosterone often decreased in men with T2DM. This study aimed to investigate the relationship between the prevalence of coronary artery disease (CAD) and circulating FGF21 concentrations and serum testosterone in T2DM men.Methods490 men with T2DM from January 2021 to December 2021 were recruited from the Renmin Hospital of Wuhan University, and they were divided into CAD group (n=248) and control group (n=242). FGF21 were determined based on ELISA principle and serum total testosterone was measured in a liquid chromatography mass spectrometer LC/MS-8050 (Shimadzu, Japan). Logistic and restricted cubic spline analyses were performed to examine the association between the prevalence of CAD and circulating FGF21 concentrations and serum testosterone in T2DM men. The receiver operating curve (ROC) analysis was used to explore the predictive performance.ResultsCirculating FGF21 levels were higher in T2DM men with CAD compared with those without CAD [214.63 (121.82, 348.64) pg/ml vs 166.55 (94.81,254.48) pg/ml, p<0.001], while serum total testosterone was lower [3.08 ± 0.07 ng/ml vs 3.76 ± 0.09 ng/ml, p<0.001]. The fully adjusted odds ratio (OR) and 95% confidence intervals (95%CI) was 2.956(1.409,6.201) for those in quartile 4 of FGF21 versus quartile 1 and the fully adjusted OR (95%CI) was 0.346(0.174,0.686) for those in quartile 4 of testosterone versus quartile 1. The receiver operating curve (ROC) analysis showed that the area under the curve (AUC) of combination of FGF21 and testosterone for predicting the occurrence of CAD in men with T2DM was 0.702 (95% CI: 0.667-0.741).ConclusionCirculating FGF21 levels were positively associated with CAD in men with T2DM, whereas serum total testosterone levels showed an inverse correlation with CAD in diabetic men.

Mortality from acute types of coronary artery disease in men and women in Russia in 2015 and 2019

Aim. To comparison standardized mortality rates (SMRs) among men and women from acute types of coronary artery disease (CAD) and their regional variability in Russia in 2015 and 2019.Material and methods. The Federal State Statistics Service (Rosstat) data on the population and the number of deaths from CAD based on the brief nomenclature of death causes using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) in 2015 and 2019 in 82 Russian subjects are presented. For each sex, SMR was calculated for acute (primary) and recurrent myocardial infarction (MI) (I21-I22), for other types of acute CAD (I20, I24.1-9), as well as average regional SMRs, coefficient of variation (CV).Results. The average regional SMR for each of the acute CAD types among men was significantly higher than among women both in 2015 (p&lt;0,0001) and in 2019 (p&lt;0,0001). For the period of 2015-2019 in men, SMR from all acute CAD types decreased by 22,5%, from acute MI — by 7,4%, from recurrent MI — by 22,2% and from other acute CAD types — by 25,8%, while in women, these figures were 11,8, 8,8, 19,0 and 29,7%, respectively. The men-to-women SMR ratio in 2015 and 2019 were 2,79/2,72 for all acute CAD types, 2,58/2,55 for all MI cases, and 3,36/4,18 for other acute CAD types. The minimum CV values (41,9% among men in 2019 and 44,7% among women in 2015) were recorded for acute MI, while the maximum CV values (129,3% among men and 158,6% among women in 2019) for other acute CAD types.Conclusion. Over the period of 2015-2019, the average regional SMR from acute CAD types in men and women decreased in Russia, with a more noticeable decrease for men. Greater regional variability in mortality, especially for other acute CAD types, poses the problem of finding organizational, methodological and strategic solutions to clarify the criteria for coding and refine the logistics schemes for providing healthcare for doubtful or uncertain diagnostic signs of acute CAD.

The Association Between Serum Testosterone Levels and Coronary Artery Disease in Men

Background: Death due to coronary artery disease (CAD) is twice higher in men than women, and older men are more susceptible to the disease. Serum testosterone levels decrease with increasing age. Objectives: In this study, we aim to study the association between serum testosterone levels and Gensini scores in men. Methods: This cross-sectional study was conducted on 60 men above 40 years who had undergone coronary angiography. Thirty of them had normal coronary vessels, and 30 had coronary artery disease. For each group, the Gensini score was calculated. Results: Serum testosterone levels in the CAD group and the control group were 4.04 ± 2.56 and 5.59 ± 2.20 ng/mL, respectively (P &lt; 0.05), and free testosterone levels in the CAD patients and the control groups were 7.32 ± 5.24 and 12.91 ± 3.27 pg/mL respectively (P &lt; 0.001). Sex hormone binding globulin (SHBG) levels in the CAD and the control groups were 28.88 ± 15.30 and 38.2 ± 19.9 nmol/mL, respectively (P = 0.04). Univariate analysis showed a significant association between Gensini score and total and free testosterone levels. The receiver operating characteristic curve (ROC) showed that the cut-off point of 7.97 had a sensitivity of 73.3% and specificity of 90% in predicting a high Gensini score (AUC = 0.799, P &lt; 0.001). Conclusions: Findings of our study demonstrated that serum free testosterone levels have a significant correlation with Gensini score and CAD severity.

Separate and Joint Associations of Cardiorespiratory Fitness and Healthy Vascular Aging With Subclinical Atherosclerosis in Men.

Achieving healthy vascular aging (HVA) is important for decelerating age-related cardiovascular disease risk. We evaluated the interplay between HVA, cardiorespiratory fitness (CRF), and subclinical atherosclerosis. We analyzed data on 3722 men who underwent cardiopulmonary exercise testing in a health examination program. HVA was defined as blood pressure <140/90 mm Hg without hypertension and brachial-ankle pulse wave velocity <1266 cm/s. CRF was directly measured by peak oxygen uptake. Subclinical atherosclerosis was defined as coronary artery calcification scores of >0 and ≥100 and a mean carotid artery intima-media thickness (CIMT) >75th percentile for each age group as well as >0.8 mm of CIMT. Separate and joint associations of HVA and CRF with subclinical atherosclerosis were evaluated. Each 1 metabolic equivalent increment in CRF was associated with 23% higher odds for having HVA. HVA was associated with lower odds of coronary artery calcification but not CIMT. CRF modified the association between HVA and CIMT>0.8 mm (interaction: P=0.01); HVA was associated with lower odds of CIMT>0.8 mm in fit men with no significant association between HVA and CIMT>0.8 mm in unfit men. Compared with no HVA and being unfit, HVA and being fit was associated with lower odds of subclinical atherosclerosis, but there was no significant association between HVA and being unfit with subclinical atherosclerosis. HVA and higher CRF are each associated with a lower risk of subclinical atherosclerosis in men. Higher CRF is associated with a higher prevalence of HVA and may modify the association between HVA and subclinical atherosclerosis.

GENDER-RELATED DIFFERENCES IN CORONARY ARTERY DISEASE IN PATIENTS WITH RESISTANT HYPERTENSION

Objective: Hypertension (HTN) is a major risk factor for cardiovascular disease (CVD). Gender differences in clinical aspects of CVD do exist and women seem to have poorer outcomes as compared to men. However the evidence regarding gender-related prognosis in the HTN scenario is controversial. Resistant HTN (RH) in women has been associated to a high increased risk of long-term CV events including death. We aim to evaluate gender differences in the occurrence of obstructive coronary artery disease (CAD) in patients (pts) with RH and suspected symptoms/signs of CAD referred to cath lab. Design and method: Patients were retrospectively included based on admission at Hypertension Department of a tertiary Academic Hospital from May/2010 through May/2014. RH was defined as blood pressure (BP) &gt; = 140/90 mmHg on &gt; 3 anti-HTN drugs or BP&lt; 140/90 mmHg using &gt; = 4 drugs. Results: From a total of 1519 pts (883 pts excluded due incomplete data), a final cohort of 634 was established, 357(56,3%) women, mean age 52.5 ± 11 years, body mass index 30.4 ± 6 kg/m2, BP at admission 171 ± 29 / 101 ± 17 mmHg, on use of 3.5 ± 1 anti-HTN drugs. From these, 186 (30%) pts were submitted to coronary angiography. Diagnosis of CAD (coronary stenosis &gt; 50% in at least one major vessel) was made in 113(60%) pts, 45% women. The only risk factor associated to CAD in men was diabetes (38%-CAD vs. 17% non-CAD), while in women the presence of CAD was significantly (p&lt; 0.05) related to the presence of dyslipidemia (72%-CAD vs 46%-non CAD), family of history of CAD (56%-CAD vs 27%-non CAD), age (57yrs-CAD vs. 50 yrs-non CAD), hypertriglyceridemia (176 mg/dl -CAD vs. 114 mg/dl-non CAD), blood glucose (142 mg/dl -CAD vs. 109 mg/dl-non CAD) and lower glomerular filtration rate (58 ml.min.1.73 m2- CAD vs 73 ml.min.1.73 m2-no CAD). Conclusions: In pts with RH, the prevalence of CAD is higher in women than expected. There are gender differences regarding risk factors related to CAD in RH, where diabetes was the only CAD risk factor in men, while dyslipidemia and chronic kidney disease are significant risk factors for women, challenging current knowledge

Association of various lipid parameters with premature coronary artery disease in men

Aim. To assess the relationship between premature coronary artery disease (CAD) and various lipid parameters.Material and methods. This retrospective longitudinal study included 166 men aged 57±9 years with coronary CAD with onset before age of 55. The control group consisted of 62 men (60±8 years old) who did not have CAD and peripheral arterial disease. In all patients, data on following lipid profile parameters were collected: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-high-density lipoprotein cholesterol (non-HDL-C) and lipoprotein(a) (Lp(a)) at the time of CAD onset, while in control group patients — at the first visit to the A.L. Myasnikov Institute of Clinical Cardiology. These indicators were measured in blood plasma at the time of enrollment in all patients. In addition, the concentration of LDL-C corrected for Lp(a)-cholesterol (LDL-Ccorr) was calculated. Hypercholesterolemia was diagnosed with an initial level of TC &gt;5 mmol/l, or LDL-C ≥3,0 mmol/l, or non-HDL-C ≥3,8 mmol/l, while hyperlipoproteinemia(a) (HLP(a)) — at the level of Lp(a) ≥30 mg/dl.Results. Lipid metabolism disorders were significantly more common in patients with premature CAD compared to the control group. Lp(a) concentration ≥30 mg/dl, along with elevated levels of non-HDL-C or LDL-Ccorr, were associated with premature CAD, regardless of heredity and smoking, in the general cohort of examined men. Kaplan-Meier survival analysis showed that any type of lipid metabolism disorder was associated with an increased risk of premature CAD. In addition, patients with isolated elevated Lp(a) concentrations lived to the CAD onset 8 years earlier — 47 vs 55 years, p&lt;0,02. The probability of premature CAD was maximum when the elevated level of non-HDL-C and HLP(a) was combined (hazard ratio, 2,91 (95% CI 1,96-4,33), p&lt;0,0001).Conclusion. HLP(a) is an independent factor of premature CAD, even with normolipidemia, which confirms the need for routine measurement of Lp(a) in clinical practice.

Lipoprotein(a) concentration and the blood content of INFγ-producing T-helpers 17 (Th17/1) in males with premature coronary artery disease

Aim. To analyze the relationship of blood lipid profile parameters, including the level of lipoprotein(a) (Lp(a)), and the content of circulating CD4+ T-lymphocytes with premature coronary artery disease (CAD).Material and methods. This retrospective cross-sectional study included 76 men aged 40 to 79 years. Patients were divided into following groups: main group — patients with CAD (58 [54;64] years, n=56) onset before the age of 55; control group — patients (62 [57;66] years, n=20) without CAD and obstructive CAD and peripheral arterial disease. Statins were taken by 51 (91%) and 9 (45%) patients in the main and control groups, respectively. In serum and plasma samples, lipid spectrum parameters and Lp(a) concentration were determined. Cellular phenotyping was performed by direct immunofluorescence in a culture of mononuclear leukocytes isolated from blood. To determine cytokines, cells were in vitro activated with inhibitor of intracellular transport of secretory proteins. Cell fluorescence was determined using flow cytometry.Results. Patients of both groups were comparable in age, body mass index, prevalence of hypertension and diabetes. Blood Lp(a) concentrations were higher in the CAD group than in the control group (49 [10;102] mg/dL vs 12 [4,3;32] mg/ dL, p&lt;0,05). The content of INFγ-producing T-helpers 17 (Th17/1) was also higher in the CAD group (19 [15;24] vs 13 [11;22], % of Th17, p=0,05). Logistic regression revealed that elevated Lp(a) levels (≥30 mg/dL) and relative amounts of Th17/1 (&gt;14% of Th17) independently of each other, atherogenic lipoprotein cholesterol levels, classical risk factors, and statin use were associated with premature CAD in the general group of patients with odds ratio (OR) of 4,6 (95% confidence interval (CI), 1,1-20,2) and 10,9 (2,1-56,7), p&lt;0,05, respectively. The combination of Lp(a) &gt;30 mg/dl and Th17/1 over 14% significantly increased the risk of premature CAD (OR, 28,0, 95% CI, 4,31-181,75, p=0,0005).Conclusion. We have shown for the first time that an increased Lp(a) concentration with an increased Th17/1 content is associated with the premature CAD in men.