Atherosclerosis In Coronary Vessels Research Articles

Методические подходы к персонифицированной оценке риска здоровью, обусловленного напряженностью трудового процесса и ее отдельными компонентами

High work intensity (HWI) can occur in various occupational groups and induce health disorders, which means occu-pational health risk (OHR) assessment is necessary This article describes methodical approaches to assessing OHR caused by HWI with a possibility to examine contributions made by its specific components and transition to personified risk assessment. The suggested approaches to assessing OHR caused by HWI include subjective assessment of the factor and health self-assessment. They allow identifying additional likelihood of health disorders and performing further risk assessment when exposure to HWI grows by one unit as per separate HWI indicators describing its specific components. Personified risk assessment involves using a template created for specific HWI components (intellectual, sensory, or emotional loads; work monotony; work regime). The approaches were tested on workers with mostly mental work (n = 137, respondents’ mean age was 43.9 ± 8.01 years; mean work records were 14.5 ± 3.7 years). Calculated data of personified levels of the integral health risk were used to rank likely health outcomes as per their priority. Mental disorders and diseases involving elevated blood pressure were established to correspond to ‘high’ health risk. Myopia, strained headache, atherosclerosis of peripheral vessels, and chronic laryngitis corresponded to ‘medium’ risk. Certain disorders involving the immune mechanism, tinnitus, ischemic heart disease, and atherosclerosis of coronary vessels as well as stomach and duodenum ulcer corresponded to ‘moderate’ risk. Detailed HWI assessment made it possible to identify its leading components; the shares of sensory and emotional loads in the integral health risk reached 29.0 ± 2.4 and 25.9 ± 3.9 % accordingly (р = 0.37). It is advisable to use these findings for creating personified activities aimed at OHR mitigation.

Methodical approaches to personified assessment of health risks caused by work intensity and its specific components

High work intensity (HWI) can occur in various occupational groups and induce health disorders, which means occu-pational health risk (OHR) assessment is necessary. This article describes methodical approaches to assessing OHR caused by HWI with a possibility to examine contributions made by its specific components and transition to personified risk assessment. The suggested approaches to assessing OHR caused by HWI include subjective assessment of the factor and health self-assessment. They allow identifying additional likelihood of health disorders and performing further risk assessment when exposure to HWI grows by one unit as per separate HWI indicators describing its specific components. Personified risk assessment involves using a template created for specific HWI components (intellectual, sensory, or emotional loads; work monotony; work regime). The approaches were tested on workers with mostly mental work (n = 137, respondents’ mean age was 43.9 ± 8.01 years; mean work records were 14.5 ± 3.7 years). Calculated data of personified levels of the integral health risk were used to rank likely health outcomes as per their priority. Mental disorders and diseases involving elevated blood pressure were established to correspond to ‘high’ health risk. Myopia, strained headache, atherosclerosis of peripheral vessels, and chronic laryngitis corresponded to ‘medium’ risk. Certain disorders involving the immune mechanism, tinnitus, ischemic heart disease, and atherosclerosis of coronary vessels as well as stomach and duodenum ulcer corresponded to ‘moderate’ risk. Detailed HWI assessment made it possible to identify its leading components; the shares of sensory and emotional loads in the integral health risk reached 29.0 ± 2.4 and 25.9 ± 3.9 % accordingly (р = 0.37). It is advisable to use these findings for creating personified activities aimed at OHR mitigation.

Risk factors and inflammatory markers in acute coronary syndrome-ST elevation myocardial infarction (STEMI).

The increasing prevalence of coronary artery disease [CAD] poses worrying statistics. Atherosclerosis of coronary vessels is the main culprit for the spectrum of CADespecially acute coronary syndrome. Atherosclerosis is regarded as a consequence of inflammatory changes in the coronaries. Our study aimed to assess the role of risk factors and inflammatory markers with acute ST-elevation myocardial infarction [STEMI]. 100 patients with ST-elevation Myocardial infarction [STEMI] and 100 age and sex matched controls were included in the study. A history of risk factors like smoking, hypertension, diabetes and hypertension was noted. A venous blood sample was obtained for analysis of inflammatory markers. The data thus obtained was statistically analyzed. The cases had a significant number of risk factors such as smoking, hypertension, and diabetes mellitus, previous history of CAD, increased body mass index [BMI], and raised high sensitive C-reactive protein [hs-CRP]. Patients with anterior myocardial infarction were older and had hypertension and diabetes mellitus. Patients with inferior myocardial infarction had high BMI, raised erythrocyte sedimentation rate [ESR] and alcoholism. Smokers, patients with diabetes mellitus, high total cholesterol, Low-density lipoprotein [LDL] cholesterol, and hs-CRP were more prone to complications. Patients with a greater number of risk factors and raised inflammatory markers were at high risk of STEMI and its complications. An approach to control the modifiable risk factors like obesity and lifestyle changes can reduce the disease burden.

The role of dendritic cells the in development of atherosclerosis of coronary vessels in the experiment.

The dynamics of quantitative and qualitative changes of the dendritic cells (DC) of coronary arteries wall at different stages of atherosclerosis development was investigated. Animals received human native low density lipoproteins. Dendritic cells were detected by using polyclonal antibodies S-100 and monoclonal antibodies CD1a (clone O10). A semiquantitative scale from 0 to 3 points was used to determine the intensity of expression of immunohistochemical markers. Histological examination of coronary arteries wall was perfomed by hemothoxylin-eosin, orsein andsudanIII. The first increase of the number of dendritic cells was observed at the 10th week after start of experiment, which corresponded to prelipid stage of atherosclerosis. The second increase of the number of dendritic cells was noted at the 13week and was characterized by moderate expression of markers (2 points) and morphologically responded to the stage of lipoidosis. The late stages of the experiment (18-20 week) were characterized by the maximal increase of DC and a high expression of immunohistochemical markers (3 points).

Is Acute Coronary Syndrome Secondary to Coronary Vasculitis Underestimated in Daily Cardiology Practice?

Acute coronary syndrome (ACS) is an increasing clinical diagnosis in daily practice. ACS is a life-threatening condition with high mortality rate if left untreated. The better-known risk factors for ACS are dyslipidemia, diabetes mellitus, hypertension2 and coronary vasospasm. Coronary vasculitis is the least appreciated cause of ACS that is subject to neglect among clinicians. Coronary vasculitis (CV) may occur as a single organ vasculitis (SOV) or in the context of specific systemic vasculitides. CV may be the initial presentation of specific systemic vasculitis. Current concept indicates the “worse prognosis” in myocardial infarction associated with elevated acute phase reactants, while these could be the critical point in missed-diagnosis of occult coronary vasculitis as classic cases with atherosclerosis of coronary vessels as the culprit mechanism. We suppose that if elevated CRP/ ESR be due to inflammatory process within the vessel wall, then a classic approach of anticoagulants, thrombolytic therapy or primary coronary angioplasty paradoxically could be dangerous13 and, vice versa, different look with using glucocorticoids could be lifesaving, the medication that later on proved that can improve prognosis in ACS and MI. So, with increasing prevalence of acute coronary syndromes in younger people, the possibility of underestimating coronary vasculitis is potentiated and emphasizing only on classic and common risk factors of ACS is not prudent.

Diabetic Patients with an Acute Myocardial Infarction in Terms of Risk Factors and Comorbidities Management: Characteristics of the Highest-Risk Individuals.

Patients with diabetes mellitus (DM) and acute myocardial infarction (AMI) are heterogeneous individuals with different clinical status compared to patients without DM. The aim of this study was to analyze the group of diabetic patients with ST-segment elevation MI (STEMI) or non-ST-segment elevation infarction (NSTEMI) including risk factors, medical history, laboratory findings, advancement of coronary vessel atherosclerosis, and diagnostics and therapeutic modalities performed. A comparison of groups according to the type of MI was also made. The study involved all (n = 130) patients with DM and AMI, hospitalized in the Department of Cardiology, Medical University of Silesia, Katowice, in 2012. Clinical presentation, medical history, laboratory tests, imaging studies and additional tests as well as treatment management data were collected. Statistical analysis of the data obtained was performed using STATISTICA® software. Coronary angiography was performed in 120 subjects (92.3%). NSTEMI almost doubled STEMI occurrence in the study group (65.4% vs. 34.6%). Left main disease (LMD) was more often diagnosed in the NSTEMI subgroup of patients (14.1% vs. 6.7%). There were no significant differences between the compared groups as far as clinical presentation and comorbidities are concerned; more frequent previous PCI in NSTEMI patients was noticed, however (37.7% vs. 17.8%; p = 0.0195). The STEMI subgroup was characterized by higher leukocytosis (13.2 vs. 10.0 × 103/μL; p < 0.001) and serum glucose concentration (217 vs. 182 mg%; p = 0.001); they were also treated with invasive methods more frequently (95.5% vs. 75%; p < 0.001) and the left anterior descending artery was delivered with stents more frequently (63.3% vs. 48.7%; p = 0.0426). Patients with DM and AMI are burdened with metabolic disorders and numerous risk factors. They require aggressive diagnostics and therapy including new revascularization techniques and optimal medical treatment. Regardless of the type of AMI (STEMI or NSTEMI), the study group was homogeneous in terms of complaints, comorbidities and metabolic profile.

Estimation of the state of the tissues of periodontium in patients with the cardiovascular diseases

Abstract: In all patients with cardio-vascular pathology is noted one or another degree of the lesion of the tissues of periodontium therefore into the complex treatment of the diseases of peri-odontium with the development CVD it is necessary to addition of antiosteoporetic therapy. Keywords: cardiovascular diseases, diseases of periodontium, atherosclerosis of coronary vessels, ischemic disease of heart, tissues of periodontium. In the recent decades the problem of the con-nection between the status of the health of the oral cavity in patients with the cardiovascular pathol-ogy is considered as extremely urgent. The influ-ence of the centers of the chronic infection of oral cavity on the development of general diseases is recognized as that meant in all countries of world. Thus, according to the data of the World Health Organization, based on the Dentistry examination of the population of 53 countries, the diseases of periodontium are encountered in 68–98 % (Peters -en P.E., 2005). A quantity of people, which suffer

Prevalence of coronary heart disease in HIV-positive individuals in Harare, Zimbabwe

<h3>Introduction and objectives</h3> The HIV/AIDS pandemic is a global menace that has established a footprint across continents. Although coronary heart disease in HIV infection has been recognised as a major cause of morbidity in the industrialised nations, the situation in developing nations is skewed towards infectious disease with pericardial pathology and cardiomyopathy constituting the bulk of the disease in HIV-positive patients. This study sought to establish the prevalence of coronary disease in black Zimbabwean HIV-positive individuals and correlate with the level of immunosuppression, treatment status, and CD4+ cell counts. <h3>Materials and methods</h3> A case-control autopsy study was performed on 80 HIV-positive cases and 80 HIV-controls which were consecutive forensic autopsies conducted at Parirenyatwa Central Hospitals in Harare, Zimbabwe. <h3>Results</h3> Twelve (15%) cases of coronary vessel atherosclerosis were found in the HIV-positive cases with a M:F ratio of 1:1. Six (7.5%) cases were detected in the HIV-negative controls. This represented a significant increase after multivariate analysis and there was a positive association with a low CD4+ cell counts (<200 cells/μL). <h3>Conclusion</h3> Coronary heart disease is now significantly prevalent in HIV-positive black African patients and should be actively investigated with a view to reducing the attendant morbidity and mortality.

Apolipoprotein A-II

Apolipoprotein A-II

Transcription activity of MMP-2 and MMP-9 metalloproteinase genes and their tissue inhibitor (TIMP-2) in acute coronary syndrome patients

Acute coronary syndromes (ACS) are a consequence of coronary vessel atherosclerosis and they are a leading cause of death in industrialized countries. One of the ACS causative factors is the deranged ratio equilibrium of the matrix metalloproteinase/tissue inhibitor of metalloproteinases (MMPs/TIMPs). Assessment of transcriptional activity of metalloproteinase genes using Human Genome-U133A oligonucleotide microarrays and selection of candidate genes differentiating ACS patients from healthy subjects and finally, QRT-PCR (quantitative real time polymerase chain reaction) confirmation of the results. The study involved 67 ACS patients, admitted on a consecutive basis, to the Cardiology Clinic as well as 24 healthy subjects (control). Ribonucleic acid isolated from peripheral blood mononuclear cells was analyzed by QRT-PCR. Transcriptional activity of the analyzed gene was assessed with TaqMan gene expression assays. U Mann-Whitney test was used to compare the results. Homogeneity of the investigated group was assessed through hierarchical clusterization whereas the nine genes differentiating ACS patients from healthy persons were selected using the Bland-Altman technique. Among these genes three (platelet derived growth factor D, NUAK family SNF1-like kinase 1 and peroxisomal biogenesis factor 1) showed decreased transcriptional activity whereas the remaining six genes (MMP-2 and MMP-9, CDK5RAP3, transmembrane BAX inhibitor motif containing 1, adenylate cyclase-associated protein 1 and TIMP-2) were increased. MMP-2, MMP-9 and TIMP-2 were further characterized by QRT-PCR. The obtained results permit to conclude that the increased expression of MMP-2 and MMP-9 metalloproteinases and their tissue inhibitor (TIMP-2) is responsible for disturbed equilibrium of the metalloproteinase/tissue inhibitors system and as a consequence, for destabilization of atherosclerotic plaque and occurrence of the acute coronary syndrome in the investigated group of patients.

QT Prolongation, Torsade de Pointes, Myocardial Ischemia From Coronary Vasospasm, and Headache Medications. Part 1: Review of Serotonergic Cardiac Adverse Events With a Triptan Case

Serotonin (5-hydroxytryptamine)(1B/1D) agonists are vasoconstrictors that can affect coronary and cerebral arteries. Retrosternal chest, arm, and jaw pain following triptan use is generally attributed to "triptan sensations" and dismissed as noncardiac. However, triptans narrow normal coronary arteries and occasionally trigger vasospasm. They are contraindicated in atherosclerotic vascular disease. Part 1 of this review examines the relationship of medications used in migraine with the likelihood of causing vasospasm or vasoconstriction, and the triggering of cardiac arrhythmias. We report an illustrative case of polymorphic ventricular tachyarrhythmia, electrocardiogram changes consistent with cardiac ischemia, and acquired corrected QT interval lengthening following oral sumatriptan in a 53-year-old migraineur without risk factors for coronary artery disease (CAD). Extensive evaluation revealed insignificant single coronary vessel atherosclerosis and coronary artery vasospasm on ergonovine challenge. The report highlights the hidden risk that may underlie a "triptan sensation" and the possible association of the vasospastic features of Raynaud's phenomenon, migraine headaches, and coronary vasospasm. Part 1 discusses the risks for Torsade de Pointes, vasospasm, and ischemia, with a review and discussion of case reports of triptan-associated cardiovascular events in migraineurs with and without CAD risk factors or documented CAD; of the epidemiology and studies of triptans, vasospasm, and cardiovascular morbidity; and of the relationship of variant angina, migraine, and vasospastic disease. In the second part of this review, headache medications and their propensity for corrected QT prolongation will be summarized.

Transcriptional Activity of Tumour Necrosis Factor α (TNF‐α) in Patients with Subclinical Coronary Atherosclerosis – Preliminary Results

The most frequent cause of ischaemic heart disease is coronary arteriosclerosis. This study was aimed at assessing gene expression of TNFA and its two receptors (TNFR1, TNFR2), as well as determining coronary artery calcium score (CACS) in the context of occurrence of classical risk factors in patients with subclinical atherosclerosis of coronary vessels. The study involved 47 subjects with complaints of chest pain and suspicion of acute coronary syndrome or stable coronary disease. Additionally, CACS was assessed by 64-slice computerized tomography. QRT-PCR molecular studies were performed using RNA isolated from peripheral blood mononuclear cells. Preliminary results of molecular studies on patients with subclinical coronary atherosclerosis revealed a significantly lower numbers of TNFR1 and TNFR2 gene copies as compared with healthy subjects. In addition, it can be demonstrated that among classical risk factors hypertension is of substantial importance in the progression of coronary arteries’ calcification, and that in the examined group CACS increases together with the rising number of classical risk factors involved. No correlation was observed, however, between expression of TNFA, TNFR1 and TNFR2 genes and the value of CACS. Conclusions: 1. The occurrence of hypertension facilitates initiation and progression of arteriosclerotic lesions in blood vessels including the coronary ones; the raised number of circulatory disease classical risk factors involved correlates with elevated calcification of coronary arteries as shown by 64‐slice computerized tomography scans. 2. Significantly decreased numbers of TNFR1 and TNFR2 gene copies observed in the investigated group may play a significant role in initiation and progression of arteriosclerosis.

Coronary artery atherosclerosis in patients with the initial and the early stage of chronic renal failure

Abstract The recent clinical data indicate that the initial and the early stages of chronic renal failure (CRF) may lead to increased incidence of cardiovascular complications and increased extent of coronary artery disease (CAD). This retrospective study was aimed to determine the effects of coexisting diabetes mellitus type 2 (DM-2) and the extent of atherosclerosis in coronary vessels in patients with mildly reduced kidney function (glomerular filtration rate GFR = 89–60 ml/min) and moderately reduced kidney function (GFR = 59–30 ml/min). The study patients included 53 subjects with creatinine concentration above 120 μmol/l as a cut-off level for the initial stage and compensated CRF. The distributions of coronary artery stenosis were also analysed with respect to DM-2 coexistence and levels of haemoglobin glikolised (HbA1c). The odds ratio of pathological changes in coronary arteries in patients with GFR = 44–30 ml/min, with respect to the number of affected vessels — only one, more than one or more than two — were 7.22, 4.90 and 3.55, respectively. In CRF patients with GFR = 60–89 ml/min the odds ratio of one, more than one and more than two vessels with stenosis and CAD was 1.93, 1.70 and 1.53, respectively. DM-2 was not related to the risk of significant coronary artery stenosis and did not enhance the pre-existing changes in the study setting. Our results demonstrate that the initial and the early stages of CRF were significant risk factors for coronary stenoses and for enhancing the pre-existing changes.

Accelerated progression of atherosclerosis in coronary vessels with minimal lesions that are bypassed: Cashin WL, Sanmarco MD, Nessim SA, et al. N Engl J Med 1984; 311:824–828

Accelerated progression of atherosclerosis in coronary vessels with minimal lesions that are bypassed: Cashin WL, Sanmarco MD, Nessim SA, et al. N Engl J Med 1984; 311:824–828

Accelerated Progression of Atherosclerosis in Coronary Vessels with Minimal Lesions That Are Bypassed

Accelerated progression of atherosclerosis is known to occur in surgically bypassed coronary arteries in which the preoperative stenosis was greater than 50 per cent. To assess the effect of coronary bypass on vessels with lesser degrees of stenosis, we studied 85 men who had undergone coronary bypass surgery. In this group we identified bypass grafts placed in 37 arteries with minimal atherosclerosis, which was defined as less than 50 per cent stenosis of the vessel diameter. In the same 85 men there were 93 coronary vessels with minimal atherosclerosis for which a bypass graft had not been placed. Progression of atherosclerosis, defined as further loss of at least 25 per cent of the lumen, during an average follow-up period of 37 months was more than 10 times as frequent (38 per cent vs. 3 per cent) in bypassed arteries with minimal atherosclerosis as in comparable arteries that were not bypassed. These findings support the view that minimally diseased coronary arteries should not be bypassed.

The state of myocardial mast cells in atherosclerotic cardiosclerosis

In 1954, Constantmides and Cairns reported a relationship between the severity of atherosclerosis in coronary vessels and the number of mast cells in the myocardium. In the future, this issue has been repeatedly discussed, but the conclusions of various researchers are largely contradictory. Some authors [11, 14, 17] share this opinion, others [12, 13] do not find a connection between the number of mast cells and the severity of atherosclerosis. In later works carried out by domestic researchers (L. P. Ermilov, 1962; N. D. Kanshina, 1965), along with the number of mast cells in the connective tissue of the myocardium, their functional activity was studied for a number of morphological features. We have not found any works devoted to the histochemical study of mast cells in the myocardium in atherosclerosis.