Risk Of Atherosclerosis In Patients Research Articles

Serum lipids and risk of atherosclerosis in xanthelasma palpebrarum: A systematic review and meta-analysis

The association between dyslipidemia and xanthelasma palpebrarum (XP) remains controversial, and no definite evidence has indicated atherosclerosis risk in patients with XP. The present study was a systematic review and meta-analysis to elucidate the association of serum lipid profiles and risk of atherosclerotic diseases with XP. We systematically searched for the eligible comparative studies published before April 15, 2019, in the databases of PubMed, Web of Science, Embase, and Cochrane Library. A random-effects model was used to calculate the standard mean difference with 95% confidence interval for each pooled estimate. The qualitative analyses included 15 case-control studies with 854 patients with XP. Compared with the controls, the patients with XP had significantly higher serum levels of total cholesterol and low-density lipoproteins, significantly higher apolipoprotein B levels, and relatively lower apolipoprotein A1 levels, and the carotid intima-media thickness was significantly higher. Patients with XP had significantly higher serum levels of atherogenic low-density lipoproteins and bore significantly higher risk of atherosclerosis than the controls. Careful monitoring and targeted intervention for prevention of cardiovascular diseases is essential for these patients.

Anti-Annexin V and Cardiovascular Risk Factors in Systemic Lupus Erythematosus

Background and Objective: It has been proposed that anti-annexin V as a novel proposed mechanism for the increased prevalence of atherosclerosis among patients with Systemic Lupus Erythematosus (SLE). Here we aimed to compare anti-annexin V levels between SLE patients and healthy controls and to determine the correlation of anti-annexin with various cardiovascular risk factors. Materials and Method: Sixty patients with SLE and 30 healthy sex and age matched persons included in the current cross sectional study that was selected from outpatient Rheumatology clinics in the city of Mashhad-Iran. Anti-annexin V and the other parameters including cardiovascular risk factors(age, smoking, blood pressure, diabetes mellitus, lipoproteins levels, previous history of documented or clinically suspected atherosclerosis, obesity, premature ovarian failure, high sensitive C-reactive protein, vascular cell adhesion protein 1 and homocystein) measured using enzyme linked immuno-assay. Results: Anti-annexin V had a significant positive correlation with LDL levels in the SLE group (p=0.03). Anti-annexin V levels were not significantly different between the two groups (p=0.40). Conclusion: We could not show the role of anti-annexin V as a predictor of atherosclerosis risk in patients with lupus under study.

The association between IL-17A and IL-23R polymorphisms and coronary artery disease risk in a Middle Eastern Chinese population.

BackgroundPolymorphisms in IL‐17A and IL‐23R may affect the expression of these genes and could contribute to a patient's susceptibility to coronary artery disease (CAD). Although this association was investigated by previous studies, the relationship remains unclear.MethodWe conducted this hospital‐based case‐control study to determine whether polymorphisms in these two genes could be associated with a risk of CAD. A total of 191 patients and 131 controls, as determined by SXscore, were enrolled in this study. The genotyping was performed with the Sequenom MassARRAY platform.ResultsThe results showed that that the FPG and HbA1C levels were higher in patients with CAD than in the controls. In addition, the HDL and ApoA1 levels were significantly higher in the controls than in the cases. In contrast, the Lp(a) level was significantly lower in the controls than in the patients. The IL‐17A rs2275913 and IL‐23R rs6682925 polymorphisms were associated with an increased risk of CAD (rs2275913: AA vs GG: crude OR = 2.16, 95% CI = 1.08‐4.30; AG/AA vs GG: crude OR = 1.81, 95% CI = 1.04‐3.15; rs6682925 CC vs TT: crude OR = 1.91, 95% CI = 1.00‐3.63). The subgroup analysis by SXscore revealed that the IL‐23R rs6682925 polymorphism (CT/CC vs TT: crude OR = 3.72, 95% CI = 1.19‐11.66) was associated with an increased risk of CAD in patients with a high SXscore.ConclusionThis study suggested that T2DM, Lp(a), HDL‐c, and ApoA1 were risk factors of CAD and that the IL‐17A rs2275913 and IL‐23R rs6682925 polymorphisms may contribute to susceptibility to CAD.

Relationship Between Number of Multiple Risk Factors and Coronary Artery Disease Risk With and Without Diabetes Mellitus.

To determine the degree of control of multiple risk factors under real-world conditions for coronary artery disease (CAD) according to the presence or absence of diabetes mellitus (DM) and to determine whether reaching multifactorial targets for blood pressure (BP), low-density lipoprotein-cholesterol (LDL-C), HbA1c, and current smoking is associated with lower risks for CAD. We investigated the effects on subsequent CAD of the number of controlled risk factors among BP, LDL-C, HbA1c, and current smoking in a prospective cohort study using a nationwide claims database of 220,894 individuals in Japan. Cox regression examined risks over a 4.8-year follow-up. The largest percentage of participants had two risk factors at target in patients with DM (39.6%) and subjects without DM (36.4%). Compared with those who had two targets achieved, the risks of CAD among those who had any one and no target achieved were two and four times greater, respectively, regardless of the presence of DM. The effect of composite control was sufficient to bring CAD risk in patients with DM below that for subjects without DM with any two targets achieved, whereas the risk of CAD in the DM group with all four risk factors uncontrolled was 9.4 times more than in the non-DM group who had achieved two targets. These findings show that composite control of modifiable risk factors has a large effect in patients with and without DM. The effect was sufficient to bring CAD risk in patients with DM below that in the non-DM group who had two targets achieved.

Moderate Serum γ-Glutamyl Transferase Level Is Beneficial for Heart Failure After Percutaneous Coronary Intervention.

Objective: Previous studies suggested that elevated serum γ-glutamyl transferase (GGT) level is an independent predictor of coronary artery disease (CAD) and heart failure (HF). However, whether serum GGT level has a predictive role for HF after percutaneous coronary intervention (PCI) remains unclear. This study aimed to evaluate the association of GGT with HF after PCI in a Chinese population. Methods: Five thousand six hundred thirty-eight patients were divided into three groups according to GGT tertiles: first tertile (GGT <19.6 U/L; n = 1875), second tertile (GGT ≥19.6-32.9 U/L; n = 1880), and third tertile (GGT ≥32.9 U/L; n = 1883). There were 165 (2.9%) HFs during a long-term follow-up. The average follow-up time was 35.9 ± 22.6 months. Results: The incidence of HF in the first tertile is 62 (3.3%), second tertile is 38 (2.0%), and third tertile is 65 (3.5%). The HF incidence was significantly lower in second tertile compared with that in the first tertile or in the third tertile (both P < 0.05). A U-shaped curve was observed according to quintiles (Q1:3.4%, Q2: 3.0, Q3:1.6%, Q4: 2.9%, Q5: 3.7%, P = 0.042). The multivariate Cox proportional hazards model showed after adjustment of confounders, the association remains significant (P = 0.046). Conclusions: This study indicated that serum GGT concentration was independently associated with HF after PCI. The baseline serum GGT level less than 19.6 or ≥32.9 increases HF risk in CAD patients who underwent PCI.

MicroRNAs 342 and 450 together with NOX‐4 activity and their association with coronary artery disease in diabetes

Dysregulation of miRNAs has been associated with many clinical conditions, including coronary artery disease (CAD). MiRNAs roles in patients with type 2 diabetes mellitus (T2D) with or without CAD, however, have not been clearly understood. Therefore we studied the expression of miRNAs 342 and 450 and the activity of the NADPH oxidase 4 (NOX-4), and their association with anthropometric and biochemical parameters of hyperglycaemia and dyslipidaemia. Blood was collected from 200 outpatient subjects, divided into four groups of 50 individuals including control, T2D, CAD, and T2D with CAD. CAD was further divided based on CAD with angina, CAD clots, and CAD ischaemia to differentiate the primary cause of CAD. We measured the miRNAs 342 and 450 expression and NOX-4 activity, in addition to routine parameters. The expression of miRNAs 342 and 450 and NOX-4 activity was significantly different between groups. Furthermore, they presented significant correlations with routine parameters, providing evidence of a potentially beneficial role in stratifying the risk for CAD in patients with T2D. The results of this study suggest that the expression of miRNAs 342 and 450 and NOX-4 activity may help identify those individuals with T2D at high risk for developing CAD as well as the prognosis in those with established CAD.

TCTAP A-110 Effect of Diabetics and Gender on the Occurrence of Coronary Artery Disease

Coronary artery disease (CAD) is a proven complication of diabetes mellitus (DM) in both genders. As per vast research studies showed the increased risk for CAD in patients with diabetes compared with the non-diabetics. DM is an established risk factor for cardiovascular disease (CVD) with

The triglyceride paradox in the mortality of coronary artery disease

BackgroundThe role of triglyceride (TG) in secondary prevention of patients with coronary artery disease (CAD) was debated. In the present study, we assessed the association between admission TG levels and long-term mortality risk in CAD patients.MethodsA retrospective analysis was conducted from a single registered database. 3061 consecutive patients with CAD confirmed by coronary angiography were enrolled and were grouped into 3 categories by the tertiles of admission serum TG levels. The primary end point in this study was all-cause mortality and the secondary end point was cardiovascular mortality.ResultsThe mean follow-up time was 26.9 ± 13.6 months and death events occurred in 258 cases and cardiovascular death events occurred in 146 cases. Cumulative survival curves indicated that the risk of all-cause death decreased with increasing TG level (Tertile 1 vs. Tertile 2 vs. Tertile 3 = 10.3% vs. 8.6% vs. 6.3%, log rank test for overall p = 0.001). Cox regression analysis showed an independent correlation between TG level and risk of all-cause mortality [hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.58–0.86] and cardiovascular mortality (HR 0.67, 95% CI 0.51–0.89) in total patients with CAD. Subgroup analysis found the similar results in patients with acute coronary syndrome and acute myocardial infarction.ConclusionsThis study found an inverse association between TG levels and mortality risk in CAD patients, which suggests that the “TG paradox” may exist in CAD patients.Trial registrationChiCTR, ChiCTR-OOC-17010433. Registered 17 February 2017 - Retrospectively registered.

Ensemble-based Classification Models for Predicting Post-Operative Mortality Risk in Coronary Artery Disease

IntroductionThere has been an increased demand for more accurate prediction tools to aid clinical decision-making regarding disease diagnosis prognosis for coronary artery disease(CAD) patients. Patients undergoing CABG surgery are older and a larger number have had previous heart surgery. Consequently, mortality after CABG is expected to increase despite procedural advances.&#x0D; Objectives and ApproachThis study aims to compare the predictive performance of random forest(RF) and logistic regression(LR) classifiers for predicting 30-day and 1-year post-operative mortality risk in CAD patients who underwent CABG. Data was obtained by linking the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease(APPROACH) registry, a prospective longitudinal data of patients undergoing cardiac catheterization in Alberta, Canada, to vital statistics database. All patients who underwent first-time isolated CABG between January 1, 2007 and December 31, 2012 were included in the analysis. Area under the receiver operating curve(AUC) was used to compare the predictive performance of LR and RF regression.&#x0D; ResultsOf the 4,908 eligible subjects who underwent isolated CABG during the study period, mortality estimates of 30-day and 1-year post CABG surgery were 1.59% and 3.85%, respectively. Descriptive analysis revealed that age, sex, hypertension, dialysis, cerebrovascular disease, chronic obstructive pulmonary disease, and chronic heart failure were associated with 30-day and 1-year mortality. The accuracy of the LR and RF regression classifiers in predicting 30-day mortality were 74.1, and 99.7%, respectively. While the accuracy of the former and latter classifiers in predicting 1-year post CABG mortality were 74% and 97.4%, respectively.&#x0D; Conclusion/ImplicationsThis study shows that RF classifier results in better predictive accuracy than LR in predicting post-operating mortality risk in CAD patients. Machine learning models are potentially usefully for developing clinical prediction models that can be used to aid the monitoring of post-discharge outcomes in the management of cardiovascular diseases.

Risk of Coronary Artery Disease in Patients With Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis

BackgroundThe association between chronic inflammation and the accelerated development of atherosclerosis is well recognized. However, it remains controversial as to whether the risk of coronary artery disease (CAD) is elevated in patients with systemic lupus erythematosus (SLE). The objective of this meta-analysis was to obtain a better estimate of the risk of CAD in patients with SLE. MethodsAn English-restricted literature review was conducted according to PRISMA guidelines using key databases, surveying all articles published through October 31, 2017. Specific search terms included “SLE” and “coronary artery disease” as well as appropriate MeSH terms. The Newcastle-Ottawa scale was used for quality assessment. ResultsNine studies were identified and included in this meta-analysis. The pooled risk ratio of CAD in patients with SLE was 3.39 (95% CI: 2.15–5.35). The statistical heterogeneity of this meta-analysis was high, with an I2 value of 79.5%. An elevated risk of CAD was consistently observed in both female and male SLE patients (pooled risk ratio: 3.27 [95% CI: 2.01–5.30] and 3.16 [95% CI: 2.02–4.94], respectively). ConclusionsSLE patients are at significantly higher risk of developing CAD. However, as relatively few studies were available for incorporation into this meta-analysis, there is a clear need for further studies with larger sample sizes that better parse gender-related differences in CAD susceptibility among SLE patients. Future work to standardize cardiovascular risk factor identification and monitoring in SLE patients is also needed.

Current concepts in the management of stable ischemic heart disease and acute coronary syndrome in patients with hemophilia.

Coronary artery disease (CAD), including stable ischemic heart disease (SIHD) and acute coronary syndrome (ACS), remains the leading cause of death in the US and one of the primary modalities used in the treatment of CAD is percutaneous coronary intervention (PCI). Despite the potential benefits of PCI in high risk CAD patients, the risk of hemorrhage presents a dilemma in the treatment of patients with hemophilia A and B. In an attempt to provide guidance on the management of SIHD and ACS in patients with hemophilia, we present the case of a patient with moderate hemophilia B and ACS who subsequently underwent PCI followed by a review of the associated literature.

Impact of Type II Diabetes on the Presentation of Coronary Artery Disease and Outcomes of Percutaneous Coronary Intervention in Female Patients

Abstract Background Coronary artery disease (CAD) is a well-established complication of type II diabetes mellitus affecting both men and women worldwide. A vast amount of research has shown evidence of increased risk for CAD in patients with type II diabetes compared with the general population and that this increased relative risk is more prevalent in women. The primary aim of this study is to observe the impact of type II diabetes on the severity of CAD at the time of presentation and also on the outcomes of CAD after PCI (percutaneous coronary intervention) in female patients. Methods A prospective single-center study for the period of 1 year, including 267 female CAD patients who underwent PCI was conducted. The patient population was divided into two major groups of which 171 (64%) patients had type II diabetes (group A) and 96 (36%) patients were nondiabetic (group B). The clinical presentations of CAD in type II diabetics and nondiabetics were compared in the form of chronic stable angina (CSA), acute coronary syndrome (ACS), left ventricular (LV) dysfunction, renal dysfunction, and the number of vessels involved. Primary outcomes were compared in the form of major adverse cardiovascular events (MACE), whereas secondary outcomes were compared in the form of statin-induced myopathy, also referred to as contrast-induced nephropathy (CIN). Results At presentation, 60 (35.08%) of 171 female patients with type II diabetes (group A) had CSA and 121 (70.76%) had ACS. Baseline creatinine was determined to be 1.17 ± 1.02 mg/dL amongst the participants. Moreover, 51 (29.8%) patients were observed to have LV dysfunction. The total number of lesions treated in this group was 237. Among group B, that is, 96 nondiabetic female patients, 62 (64.5%) patients had CSA, 34 (35.4%) had ACS, 39 (40.6%) had LV dysfunction, the baseline creatinine was (0.95 ± 0.39) mg/dL. The total number of lesions treated was in this group was 130.The difference in incidence of CSA, ACS, and renal dysfunction was statistically significant with p = 0.000, 0.000, and 0.016, respectively. The incidence of CSA was greater in group B, that is, nondiabetics; whereas, the incidence of ACS and renal dysfunction was found to be greater in group A, that is, type II diabetics. Moreover, the number of vascular territories involved was found to be more in patients with type II diabetes. Although, the incidence of severe LV dysfunction was greater in patients with type II diabetes, the difference was not statistically significant.When considering 1 year outcomes in female patients with type II diabetes, three cases of deaths, one case of acute stent occlusion, one subacute stent occlusion, one periprocedural myocardial infarction (MI), one CSA, one statin-induce myopathy, and one rhabdomyolysis are reported. Whereas, in nondiabetic female patients, one case of death, one CSA, one CIN, one chronic thrombus right radial artery, and one pseudoaneurysm and rupture are reported. Conclusion The results from this study suggest that in female patients with CAD, ACS presentation is more common in type II diabetes; whereas, CSA presentation is more common in nondiabetics. Moreover, multi-vessel involvement is more common in type II diabetes. Following PCI, there has been an increase in the prevalence of MACE, statin-induced myopathy and rhabdomyolysis in patients with type II diabetes. In conclusion, type II diabetes has been reported to significantly influence the severity of presentation, number of lesions involved, and complications following PCI.

The relationship between platelet volume and risk of atherosclerosis in patients with psoriasis

Objective The aim of this research was to evaluate the relation between the mean platelet volume (MPV) and clinical aspects (onset, duration, and severity) in patients with psoriasis. In addition, the purpose was to evaluate the possible risk of atherosclerosis in these patients. Background Psoriasis is an inflammatory skin disease affecting 2–4% of the world population. However, studies in developing countries have reported higher prevalence rates of ∼4.6% on an average. MPV is an indicator of platelet activation, and it is a newly emerging risk factor for patients with atherothrombotic psoriasis. Patients and methods A case–control study was conducted on 40 patients with variable degrees of psoriasis severity (cases) and they were compared with 20 matched healthy participants (controls). All participants were selected from dermatology inpatients and outpatient clinics of the Menoufia University Hospital in the period from September 2015 to March 2016. Full detailed history, routine laboratory investigations, clinical features, Psoriasis Area and the Severity Index (PASI) scores, and carotid intima-media thickness (CIMT) and nonalcoholic fatty liver disease (NAFLD) values were taken for each participant (cases and controls). Results There were statistically no significant differences between patients with psoriasis and control groups regarding age, sex, BMI, total cholesterol, and triglycerides (P>0.05%, for all), whereas patients with psoriasis had significantly higher systolic and diastolic blood pressure, fasting plasma glucose, mean MPV and CIMT values, and frequency of ultrasound-diagnosed NAFLD than the control group. In addition, BMI, duration of illness, PASI, and mean values of MPV were significantly (P=0.5) elevated in patients with psoriasis with atherosclerosis than patients with psoriasis without atherosclerosis. Moreover, MPV level was correlated positively with age, BMI, duration of psoriasis, PASI score, and CIMT in the atherosclerotic psoriatic case group. Moreover, CIMT and PASI score were correlated positively with BMI, duration of illness, MPV, systolic blood pressure, diastolic blood pressure, glycated hemoglobin, and NAFLD in the psoriasis patient group, whereas CIMT was significantly correlated positively with PASI score. Conclusion Psoriasis is associated with high MPV. So, MPV is a good indicator of psoriasis severity. Thus, MPV is a good positive test for early detection of premature atherosclerosis in patients with psoriasis. This study may confirm previous observation indicating increased platelet activation in psoriasis. Increased platelet activity could contribute toward increasing the atherosclerotic risk in patients with psoriasis.

The Associations between Apolipoprotein E Gene Epsilon2/Epsilon3/Epsilon4 Polymorphisms and the Risk of Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus.

Background and Objective: Apolipoprotein E (APOE) plays important roles in lipoprotein metabolism and cardiovascular disease. Evidence suggests the APOE gene epsilon2/epsilon3/epsilon4 (ε2/ε3/ε4) polymorphisms might be associated with the susceptibility of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). However, no clear consensus has yet been established. Therefore, the aim of this meta-analysis is to provide a precise conclusion on the potential association between APOE ε2/ε3/ε4 polymorphisms and the risk of CAD in patients with T2DM based on case-control studies.Methods: Pubmed, Embase, Chinese National Knowledge Infrastructure (CNKI), and Wanfang databases were searched for all relevant studies prior to August 2017 in English and Chinese language. The pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were used to assess the strength of the relationships. The between-study heterogeneity was evaluated by Cochran's Q-test and the I2 index to adopt fixed- or random- effect models.Results: A total of 13 studies were eligible for inclusion. There was evidence for significant associations between APOE ε4 mutation and the risk of CAD in patients with T2DM (for ε3/ε4 vs. ε3/ε3: OR = 1.69, 95% CI = 1.38–2.08, P < 0.001; for ε4/ε4 vs. ε3/ε3: OR = 2.72, 95% CI = 1.61–4.60, P < 0.001; for ε4/ε4+ε3/ε4 vs. ε3/ε3: OR = 1.83, 95% CI = 1.52–2.22, P < 0.001; for ε4 allele vs. ε3 allele: OR = 1.64, 95% CI = 1.40–1.94, P < 0.001). In contrast, no significant associations were found in genetic model of APOE ε2 mutation (for ε2/ε2 vs. ε3/ε3: OR = 1.67, 95% CI = 0.90–3.09, P = 0.104; for ε2/ε3 vs. ε3/ε3: OR = 1.18, 95% CI = 0.93–1.51, P = 0.175; for ε2/ε2+ε2/ε3 vs. ε3/ε3: OR = 1.26, 95% CI = 0.88–1.82, P = 0.212; for ε2 allele vs. ε3 allele: OR = 1.34, 95% CI = 0.98–1.84, P = 0.07).Conclusions: The APOE gene ε4 mutation is associated with an increased risk of CAD in patients with T2DM, while the ε2 variation has null association with this disease.

Relation between low-density lipoprotein cholesterol/apolipoprotein B ratio and triglyceride-rich lipoproteins in patients with coronary artery disease and type 2 diabetes mellitus: a cross-sectional study

BackgroundThe low-density lipoprotein cholesterol/apolipoprotein B (LDL-C/apoB) ratio has conventionally been used as an index of the LDL-particle size. Smaller LDL-particle size is associated with triglyceride (TG) metabolism disorders, often leading to atherogenesis. We investigated the association between the LDL-C/apoB ratio and TG metabolism in coronary artery disease (CAD) patients with diabetes mellitus (DM).MethodsIn the cross-sectional study, the LDL-C/apoB ratio, which provides an estimate of the LDL-particle size, was calculated in 684 consecutive patients with one additional risk factor. The patients were classified into 4 groups based on the presence or absence of CAD and DM, as follows: CAD (−) DM (−) group, n = 416; CAD (−) DM (+) group, n = 118; CAD (+) DM (−) group, n = 90; CAD (+) DM (+) group, n = 60.ResultsA multi-logistic regression analysis after adjustments for coronary risk factors revealed that the CAD (+) DM (+) condition was an independent predictor of the smallest LDL-C/apoB ratio among the four groups. Furthermore, multivariate regression analyses identified elevated TG-rich lipoprotein (TRL)-related markers (TG, very-LDL fraction, remnant-like particle cholesterol, apolipoprotein C-II, and apolipoprotein C-III) as being independently predictive of a smaller LDL-particle size in both the overall subject population and a subset of patients with a serum LDL-C level < 100 mg/dL. In the 445 patients followed up for at least 6 months, multi-logistic regression analyses identified increased levels of TRL-related markers as being independently predictive of a decreased LDL-C/apoB ratio, which is indicative of smaller LDL-particle size.ConclusionsThe association between disorders of TG metabolism and LDL heterogeneity may account for the risk of CAD in patients with DM. Combined evaluation of TRL-related markers and the LDL-C/apoB ratio may be of increasing importance in the risk stratification of CAD patients with DM. Further studies are needed to investigate the useful clinical indices and outcomes of these patients.Clinical Trial Registration UMIN (http://www.umin.ac.jp/) Study ID: UMIN000028029 retrospectively registered 1 July 2017

Use of a haptic biofeedback in the rehabilitation of patients with total knee arthroplasty (TKA): A pilot study

To investigate the association between increased carotid intima-media thickness (CIMT), homocysteine level, and MTHFR C677T (rs1801133) gene polymorphism in Egyptian people with rheumatoid arthritis (RA).280 Egyptian women (160 RA patients and 120 controls) were included in the study. CIMT was measured using high resolution B-mode ultrasonography and homocysteine levels were measured using enzyme-linked immunosorbent assay. While, MTHFR C677T polymorphism was analyzed by polymerase chain reaction–restriction fragment length polymorphism.We found that subjects who carried the TT genotype and T allele were significantly more likely to develop RA with 2.9 and 1.5 fold, respectively. RA patients carrying the T allele presented a statistically significant increased risk of developing atherosclerosis compared with those carrying the C allele. Moreover, MTHFR TT genotype was independent risk factor of thick CIMT.C677T MTHFR gene polymorphism is associated with RA in Egyptians. MTHFR 677TT carriers had higher concentrations of serum Hcy than did subjects harboring the CC and CT genotypes. The presence of 677T allele increases the risk of atherosclerosis in patients with RA. This increased risk of atherosclerosis could be due to hyperhomocysteinemia.

Influence of MTHFR C677T gene polymorphism in the development of cardiovascular disease in Egyptian patients with rheumatoid arthritis

ObjectiveTo investigate the association between increased carotid intima-media thickness (CIMT), homocysteine level, and MTHFR C677T (rs1801133) gene polymorphism in Egyptian people with rheumatoid arthritis (RA). Subjects and methods280 Egyptian women (160 RA patients and 120 controls) were included in the study. CIMT was measured using high resolution B-mode ultrasonography and homocysteine levels were measured using enzyme-linked immunosorbent assay. While, MTHFR C677T polymorphism was analyzed by polymerase chain reaction–restriction fragment length polymorphism. ResultsWe found that subjects who carried the TT genotype and T allele were significantly more likely to develop RA with 2.9 and 1.5 fold, respectively. RA patients carrying the T allele presented a statistically significant increased risk of developing atherosclerosis compared with those carrying the C allele. Moreover, MTHFR TT genotype was independent risk factor of thick CIMT. ConclusionsC677T MTHFR gene polymorphism is associated with RA in Egyptians. MTHFR 677TT carriers had higher concentrations of serum Hcy than did subjects harboring the CC and CT genotypes. The presence of 677T allele increases the risk of atherosclerosis in patients with RA. This increased risk of atherosclerosis could be due to hyperhomocysteinemia.

Practice setting and secondary prevention of coronary artery disease.

IntroductionPatients with established coronary artery disease (CAD) are at high risk of recurrent cardiovascular events. The aim of the analysis was to compare time trends in the extent to which cardiovascular prevention guidelines have been implemented by primary care physicians and specialists.Material and methodsFive hospitals with cardiology departments serving the city and surrounding districts in the southern part of Poland participated in the study. Consecutive patients hospitalized due to an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6–18 months after hospitalization. The surveys were carried out in 1997–1998, 1999–2000, 2006–2007 and 2011–2013.ResultsThe proportion of smokers increased from 16.0% in 1997–1998 to 16.4% in 2011–2013 among those who declared that a cardiologist in a hospital outpatient clinic decided about the treatment, from 17.5% to 34.0% (p < 0.01) among those treated by a primary care physician, and from 7.0% to 19.7% (p = 0.06) among patients treated in private cardiology practices. The corresponding proportions were 44.6% and 42.4% (p < 0.01), 47.7% and 52.8% (p = 0.53), 44.2% and 42.2% (p = 0.75) for high blood pressure, and 42.5% and 71.2% (p < 0.001), 51.4% and 79.6% (p < 0.001), 52.4% and 72.4% (p < 0.01) for LDL cholesterol level not at recommended goal. The proportion of patients prescribed cardioprotective medications increased in every analyzed group.ConclusionsThe control of cardiovascular risk in CAD patients has only slightly improved since 1997/98 in all health care settings. The greatest potential for further improvement was found among patients whose post-hospital care is provided by primary care physicians. It is associated with promotion of a no-smoking policy and enhanced prescription of guideline-recommended drugs.

Homocysteine Metabolism and Hematological Parameters in Early Stage of Phenytoin Treated Epileptic Children.

Long-term antiepileptic drug (AED) therapy has been associated with metabolic consequences that lead to an increase in risk of atherosclerosis in patients with epilepsy. Earlier published studies showed conflicting results about the levels of hematological parameters, serum homocysteine, folate, and vitamin B12, in epileptics treated with phenytoin monotherapy. Therefore, we evaluated homocysteine metabolism and hematological parameters in early stage of phenytoin treated epileptic children. A total of 64 newly diagnosed epileptic children with mean age 10.09 ± 2.56 years were enrolled at the start of study. However, after 3 months follow up, the final total sample size was only 50 epileptic children. Fourteen children dropped out of study due to poor follow up. Serum homocysteine levels were measured by enzyme immunoassay method. Serum folate and vitamin B12 levels were estimated by Competitive Chemiluminescent Enzyme Immunoassay method. Hematological parameters were analysed by an automated hematology analyzer (Cell counter), Sysmex XT-1800i, using commercially available reagents. In our study the anthropometric and hematological parameters did not show any significant difference after phenytoin monotherapy as compared to before therapy in epileptic children. The serum homocysteine level in epileptic children was found to be significantly increased after phenytoin (PHT) monotherapy as compared to before therapy. Moreover, a highly significant decrease was observed in the serum folate and vitamin B12 levels after phenytoin monotherapy as compared to before therapy in epileptic children. Phenytoin monotherapy may cause a significant increase in the levels of serum homocysteine and a significant decrease in the serum folate and vitamin B12 levels in children with epilepsy, and the significant changes in above mentioned parameters occur early in the course of treatment. This could be responsible for a higher prevalence of cardiovascular incidents in epileptic children taking phenytoin monotherapy. Therefore, it may be useful to do early screening and treatment of increased serum homocysteine levels in epileptic children under phenytoin monotherapy to prevent atherosclerosis and its complications. Hematological parameters should also be strictly monitored regularly in individuals administered with PHT monotherapy. If there are persistent alterations, the administration of the drugs should be discontinued.

Echocardiographic Epicardial Fat Thickness Measurement: A new Screening Test for Subclinic Atherosclerosis in Patients With Inflammatory Bowel Diseases

OBJECTIVE:Inflammatory bowel diseases (IBD) consist of a number of chronic inflammatory diseases. Inflammatory process is known to be involved in all stages of atherosclerosis. Early atherosclerosis is reflected by increased levels of carotid artery intima media thickness (c-IMT) and high-sensitivity C-reactive protein (hs-CRP). Epicardial fat thickness (EFT) strongly influences both the formation and progression of atherosclerosis. Recent studies have demonstrated a relationship between c-IMT and hs-CRP levels and the risk of atherosclerosis in patients with IBD. However, no study has yet compared EFT between patients with IBD and the general healthy population. Hence, this study was designed to further evaluate whether patients with IBD have higher EFT values with increased c-IMT and hs-CRP levels compared to those in the healthy population.METHODS:A total of 110 patients with IBD and 105 healthy volunteers were enrolled into this study. EFT was evaluated by transthoracic echocardiography. c-IMT levels were measured using an ultrasound scanner with a linear probe. The plasma levels of hs-CRP were measured using a highly sensitive sandwich ELISA technique.RESULTS:The hs-CRP and c-IMT levels of patients with IBD were significantly higher than those of the control group. The EFT values of patients with IBD were significantly higher than those of the control group (0.54±0.13 vs. 0.49±0.09, p=0.002).CONCLUSION:Echocardiographic EFT measurements of patients with IBD were significantly higher than those of the normal population, which may be associated with an increased subclinical atherosclerosis risk in these patients.