Coronary Heart Disease Complications Research Articles

Effect of Sodium TanshinoneⅡA Sulfonate on Uric Acid, Sicam-1, ET-1 and FMD in Patients with Coronary Heart Disease Complicated with Hyperuricemia.

This study was to observe the effect of Sodium TanshinoneⅡA Sulfonate (ST-ⅡAS) on blood uric acid (UA), human Soluble Intercellular Adhesion Molecule-1 (sICAM-1), Endothelin-1 (ET-1) and percentage of brachial artery Flow-Mediated Dilatation (FMD) in individuals with Hyperuricemia Complicated Coronary Heart Disease (HC-CHD). The study's participants were 108 patients with HC-CHD who attended our hospital between January 2020 and June 2022. In the trial, the patients were split into two groups with 54 instances each: the general group and the observation group. The observation group received ST-IIAS therapy, while the general group received standard care. The experiment chose to observe and compare the difference of uric acid, sICAM-1, ET-1, FMD, therapeutic effectiveness and negative effects between the two groups at various times. Results showed that on the 14th day, the observation group's amounts of UA, sICAM-1, and ET-1 were inferior to the general group (P<0.05); On the 7th and 14th days, the observation group's amount of ET-1 was lower than that of the general group (P<0.05); The observation group's FMD of patients on the 14th day was inferior to the general group after treatment (P<0.05); The observation group's overall effective rate was 94.44% higher than the general group's (P<0.05); The observation group experienced fewer negative responses than the general group did (P<0.05). In conclusion, ST-ⅡAS can be used for uric acid, vascular endothelial systolic and diastolic function in patients with HC-CHD, and has better clinical efficacy and lower risk of adverse reactions.

Serum metabolomic analysis revealed potential metabolite biomarkers for diabetes mellitus with coronary heart disease.

Diabetes, including its predominant form, type 2 diabetes mellitus (T2DM), has a distinctive correlation with coronary heart disease (CHD). Patients with diabetes have shown statistically higher potential risk of developing CHD complications than those without diabetes. In this study, we have conducted a metabolomic analysis of serum samples from healthy controls as well as patients with T2DM or both T2DM and CHD (CHD-T2DM). Statistical analysis of the metabolomic data revealed 611 and 420 significantly altered metabolic signatures in T2DM and CHD-T2DM patients, respectively, when compared to the healthy controls. Meanwhile, 653 metabolic features were significantly different between the CHD-T2DM and T2DM groups. Some of the metabolites at significantly different levels were identified and may serve as potential biomarkers for T2DM or CHD-T2DM. We selected three candidates, phosphocreatine (PCr), cyclic guanosine monophosphate (cGMP) and taurine for further validation among independent T2DM, CHD-T2DM and healthy control populations. These three metabolites were found to be significantly elevated in the CHD-T2DM group when compared to both T2DM and healthy control groups by the metabolomic analysis. Our results indicated that both PCr and cGMP but not taurine were successfully validated and may serve as predictive biomarkers of CHD in patients with T2DM.

A multi-population phenome-wide association study of genetically-predicted height in the Million Veteran Program.

Height has been associated with many clinical traits but whether such associations are causal versus secondary to confounding remains unclear in many cases. To systematically examine this question, we performed a Mendelian Randomization-Phenome-wide association study (MR-PheWAS) using clinical and genetic data from a national healthcare system biobank. Analyses were performed using data from the US Veterans Affairs (VA) Million Veteran Program in non-Hispanic White (EA, n = 222,300) and non-Hispanic Black (AA, n = 58,151) adults in the US. We estimated height genetic risk based on 3290 height-associated variants from a recent European-ancestry genome-wide meta-analysis. We compared associations of measured and genetically-predicted height with phenome-wide traits derived from the VA electronic health record, adjusting for age, sex, and genetic principal components. We found 345 clinical traits associated with measured height in EA and an additional 17 in AA. Of these, 127 were associated with genetically-predicted height at phenome-wide significance in EA and 2 in AA. These associations were largely independent from body mass index. We confirmed several previously described MR associations between height and cardiovascular disease traits such as hypertension, hyperlipidemia, coronary heart disease (CHD), and atrial fibrillation, and further uncovered MR associations with venous circulatory disorders and peripheral neuropathy in the presence and absence of diabetes. As a number of traits associated with genetically-predicted height frequently co-occur with CHD, we evaluated effect modification by CHD status of genetically-predicted height associations with risk factors for and complications of CHD. We found modification of effects of MR associations by CHD status for atrial fibrillation/flutter but not for hypertension, hyperlipidemia, or venous circulatory disorders. We conclude that height may be an unrecognized but biologically plausible risk factor for several common conditions in adults. However, more studies are needed to reliably exclude horizontal pleiotropy as a driving force behind at least some of the MR associations observed in this study.

Using a Systems Approach to Explore the Mechanisms of Interaction Between Severe Covid-19 and Its Coronary Heart Disease Complications.

Frontiers requested research on how a systems approach can explore the mechanisms of cardiovascular complications in Covid-19. The focus of this paper will thus be on these detailed mechanisms. It will elucidate the integrated pathogenic pathways based on an extensive review of literature. Many severe Covid-19 cases and deaths occur in patients with chronic cardiovascular comorbidities. To help understand all the mechanisms of this interaction, Covid-19 complications were integrated into a pre-existing systems-based coronary heart disease (CHD) model. Such a complete model could not be found in literature. A fully integrative view could be valuable in identifying new pharmaceutical interventions, help understand how health factors influence Covid-19 severity and give a fully integrated explanation for the Covid-19 death spiral phenomenon seen in some patients. Covid-19 data showed that CHD hallmarks namely, Hypercoagulability, Hypercholesterolemia, Hyperglycemia/Hyperinsulinemia, Inflammation and Hypertension have an important effect on disease severity. The pathogenic pathways that Covid-19 activate in CHD were integrated into the CHD model. This fully integrated model presents a visual explanation of the mechanism of interaction between CHD and Covid-19 complications. This includes a detailed integrated explanation of the death spiral as a result of interactions between Inflammation, endothelial cell injury, Hypercoagulability and hypoxia. Additionally, the model presents the aggravation of this death spiral through the other CHD hallmarks namely, Hyperglycemia/Hyperinsulinemia, Hypercholesterolemia, and/or Hypertension. The resulting model further suggests systematically how the pathogenesis of nine health factors (stress, exercise, smoking, etc.) and seven pharmaceutical interventions (statins, salicylates, thrombin inhibitors, etc.) may either aggravate or suppress Covid-19 severity. A strong association between CHD and Covid-19 for all the investigated health factors and pharmaceutical interventions, except for β-blockers, was found. It is further discussed how the proposed model can be extended in future to do computational analysis to help assess the risk of Covid-19 in cardiovascular disease. With insight gained from this study, recommendations are made for future research in potential new pharmacotherapeutics. These recommendations could also be beneficial for cardiovascular disease, which killed five times more people in the past year than Covid-19.

Development features of coronavirus disease complications in patients with coronary heart disease

Background and Aims: To study the incidence and clinical features of myocardial infarction development in patients with coronary heart disease (CHD) after suffering coronavirus disease. Methods: We studied clinical condition of 64 patients admitted with chest pain complaints to the emergency room of the multidisciplinary clinic of the Tashkent Medical Academy. The average age was 52,5±2,4 years. Results: Only 41 patients (64%) had acute myocardial infarction (MI) with various localization. The group included 10 women and 31 men. The pain verbal scale showed a low level of pain syndrome, as well as an atypical location of pain in the heart. In 13 patients, was detected a high level of IgG of coronavirus infection, whereas IgM level was high in 28 patients. The level of fibrinogen in the blood plasma averaged 355 g/l, the blood sugar level was around 7.3 mmol/l on an empty stomach, hematocrit level increased to approximately 0.49 l/l. In men, was noted the decrease of blood hemoglobin to 101.6 g/l. The rest of the indicators were practically not deviated from the norm. The ECG shows typical elevations of the ST segment from the isoline. Conclusions: Atypical clinical development signs of MI in patients with CHD is associated with a previous coronavirus infection, a large amount of lung tissue damage, a low awareness of patients about possible complications of CHD and low adherence to maintenance drug therapy after suffering Covid-19.

Treatment of Complicated Coronary Heart Disease after Successful Prehospital Resuscitation in a Public Place

The current problem of modern medicine is the lack of public awareness about personal health, late diagnosis of diseases, untimely prehospital care and treatment of existing complications. This applies to all branches of medicine, especially cardiology and cardiac surgery. Coronary heart disease occupies one of the leading places in the structure of mortality due to cardiovascular diseases. This is mainly due to the fact that patients seek medical care with complicated forms of coronary heart disease like sudden cardiac death, cardiac arrhythmia (ventricular fibrillation, AV blockade, sinus bradycardia and tachycardia), formation of left ventricular (LV) aneurysm, LV free wall rupture and LV false aneurysm, mitral regurgitation. In such cases, all actions must be early, staged, well established, and concordant with clear algorithm.&#x0D; The aim. To demonstrate our clinical case as an example of proper logistics, rapid response and timely surgical treatment of complicated forms of coronary heart disease.&#x0D; Clinical case. Patient F., born in 1964, was admitted to the clinic on March 24, 2021 with a diagnosis of coronary heart disease: acute non-Q-wave myocardial infarction of the posterolateral LV since March 22, 2021. Clinical death with successful resuscitation at the prehospital stage (03/22/2021). Ventricular fibrillation (03/22/2021). Multivessel coronary artery disease. Mitral valve regurgitation grade II-III. Tricuspid valve regurgitation grade I-II. Pulmonary hypertension grade I. Hypertensive disease grade III, degree 3, risk 4 (very high). Heart failure II A with a moderately reduced LV ejection fraction (47%). NYHA3. Closed chest injury (03/22/2021): fracture of the ribs without displacement: ribs 4-8 on the left, ribs 4-8 on the right. He considers himself ill since March 22, 2021, when he suddenly felt severe pain in his chest and fell unconscious. According to witnesses, the man got out of the subway and fell unconscious, without breathing and pulse. Due to the presence of defibrillators at the subway station, successful resuscitation was conducted by police officers before the ambulance crew arrival. Clinical and instrumental studies were performed after hospitalization. The patient was taken to the operating room on 03/24/2021 at 5:30 PM, 50 minutes after admission to the National Amosov Institute, Kyiv. Urgent off-pump coronary artery bypass grafting of 3 coronary arteries was performed. A cardioverter-defibrillator was implanted due to the history of clinical death and the conclusion of daily ECG monitoring. The intra- and postoperative period was uneventful, the patient was discharged in satisfactory condition for rehabilitation.&#x0D; Conclusions. Our clinical experience shows that timely prehospital care, proper logistics and surgical correction of coronary heart disease not only saves but also significantly improves the quality of life of the patient in the future.

Contribution of lncRNA CASC8, CASC11, and PVT1 Genetic Variants to the Susceptibility of Coronary Heart Disease.

The purpose of this study was to explore the relationship between lncRNA CASC8, CASC11, and plasmacytoma variant translocation 1 (PVT1). genetic variants and coronary heart disease (CHD) susceptibility among a Chinese Han population. Five single nucleotide polymorphisms were genotyped by Agena MassARRAY platform among 464 CHD patients and 510 healthy controls. Binary logistic regression models by calculating odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the association between selected single nucleotide polymorphisms and CHD risk. Multifactor dimensionality reduction analysis was performed to analyze gene-gene interaction. PVT1 rs4410871 (OR = 0.77, P = 0.040) was associated with a reduced risk of CHD occurrence in the Chinese population. CASC11 rs9642880 (OR = 1.49, P = 0.021) was a risk factor for increased CHD susceptibility in subjects over 60 years old, and PVT1 rs4410871 was a protective factor for CHD susceptibility in males (OR = 0.67, P = 0.015) and smokers (OR = 0.62, P = 0.047). Complications (hypertension or diabetes) of CHD influenced the association between CASC8, CASC11, and PVT1 genetic polymorphisms and CHD predisposition. Moreover, CASC8, CASC11, and PVT1 polymorphisms were related to the number of pathological branches and Gensini score in CHD patients. The study displayed the contribution of CASC8, CASC11, and PVT1 genetic polymorphisms to CHD predisposition, and these variants could serve as potential biomarkers of CHD susceptibility. These findings contribute to enhancing the understanding of the role of lncRNA polymorphisms in CHD risk.

Experience in the Use of Artificial Fibrillation in the Correction of Postinfarction Left Ventricular Aneurysms as the Most Appropriate Alternative to Pharmaco-Cold Protection of the Heart

Coronary heart disease (CHD) is the leading cause of death in the world. In most cases, the disease is complicated by myocardial infarction (MI) followed by the formation of a left ventricular aneurysm (LVA), ruptures of the interventricular septum, ischemic cardiomyopathy, mitral regurgitation and arrhythmias. Postinfarction left ventricu-lar aneurysm is the most common and severe complication of CHD. There are a lot of methods of LVA surgical correc-tion, including Cooley’s linear repair technique, purse-string technique of Jatene and endoventriculoplasty using the Dor technique. Over the last year, 43 left ventricular aneurysm repair surgeries were carried out at the NatioМешковаnal M. M. Amosov Institute of Cardiovascular Surgery. Depending on the comorbidities, age, left ventricular contractility and other factors, plastic correction was performed using artificial fibrillation (n = 24 [55.8%]) or cardioplegic solution (n = 19 [44.2%]) for myocardial protection. Significant difference in the mean duration of the operation, the time the patient was on the artificial circulation, the amount of inotropic support, the time of mechanical ventilation, and the contractile function of the left ventricle (LV) was observed. In group 1, where artificial left ventricular fibrillation was used for myocardial protection, the mean duration of the surgery was 1.9 ± 0.2 h shorter. Accordingly, the patient’s stay on the artificial circulation decreased by 92.2 ± 0.3 minutes. Also, the duration of mechanical ventilation was significantly shorter: 4.6 ± 0.8 hours and 7.3 ± 0.7 hours in groups 1 and 2, respectively.&#x0D; And most importantly, in the group 1 the ejection fraction increased by 2.3 ± 0.45% compared with 1.17 ± 0.43% in the group 2. However, all the other parameters were similar in both groups. This gives reason to consider artificial ven-tricular fibrillation as the most appropriate method of myocardial protection in the future.

Chapter 6 - Neurological complications of coronary heart disease and their management

While risk factors for the development of neurovascular and coronary heart disease (CHD) are similar, it is important to consider neurologic complications of CHD separately, as many of these complications are a direct result of the underlying condition or procedures performed to treat atherosclerotic coronary disease. Stroke after myocardial infarction (MI) and acute coronary syndromes (ACSs) is not infrequent, occurring in 0.7%-2.5% of patients within 6 months of the coronary event. The etiology of these events can be frequently traced to the development of left ventricular thrombus (LVT) formation after large MI episodes. Often, however, these events are directly related to catheter-based procedures or anticoagulation strategies utilized to treat the ACS. Ischemic strokes outnumber hemorrhagic strokes in this population. While there is a modest evidence base for use of anticoagulation to treat LVT, catheterization-related ischemic stroke and anticoagulation-related hemorrhagic stroke are typically managed via standard approaches.

Smoking Is a Risk Factor of Coronary Heart Disease through HDL-C in Chinese T2DM Patients: A Mediation Analysis.

Objective To investigate associations between smoking and cardiovascular and cerebrovascular complications in type 2 diabetes mellitus (T2DM) patients. Methods This is a cross-sectional study. Of 971 T2DM patients aged 14–93 years old in this study, 182 had ever smoked and 789 never smoked. Propensity score matching (PSM) reduced the confounding bias between groups. Logistic regression analysis was performed on matched data to evaluate coronary heart disease (CHD) and stroke risk. In addition, the mediation analysis was conducted among smoking exposure, HDL-C, and CHD. Results A total of 139 pairs of patients who had never and ever smoked were matched. Logistic regression analysis showed that compared with patients who never smoked, those who smoked > 20 cigarettes per day (CPD) had a higher risk of CHD (odds ratio [OR]: 3.09, 95% confidence interval [CI]: 1.21–7.89). Additionally, after adjusting for age, sex, origin, occupation, smoking status, body mass index, waist circumference, and diabetes duration, the OR for CHD with >20 years of cumulative smoking (pack-years) was 2.21 (95% CI: 1.05–4.65). Furthermore, we observed a significant dose-response relationship between CPD and lower high-density lipoprotein cholesterol (HDL-C) (P < 0.001). Moreover, the mediation analysis showed that the indirect effect mediated by HDL-C accounted for 86% (effect = 0.0187, 95% CI: 0.0100–0.0316). Conclusions Smoking may be a risk factor for CHD in T2DM patients. T2DM patients should stop smoking or reduce the CPD to prevent the onset of CHD. Moreover, to prevent CHD complications, monitoring HDL-C levels in T2DM patients who smoke may be necessary.

Correlation of risk factors for coronary heart disease in type-2 diabetes mellitus using the chi-square method

The male sex is taken into account a crucial risk issue for coronary heart disease (CHD) within the general population, however, studies on diabetic patients counsel that diabetic girls have a better risk of developing CHD. This study was to determine whether there is correlation between risk factors and the incidence of CHD in patients with type 2 DM. Furthermore, this work also investigates the mathematical model work in calculating the magnitude of the risk of variables against the tendency of CHD complications for patients with type 2 diabetes. This research utilizes current information on the setup of Dr. Soetomo Hospital’s medical records in 2015-2016. Samples were all patients with type 2 diabetes with CHD and without CHD reported in the inpatient medical records of Dr. Soetomo Hospital Surabaya. Data processing was carried out using the chi-square test technique. As a result, the system is proof to calculate the worth of the chi-square and confirm the results of conditions on every variable. There is a distinction in price between the calculations of the chi-square on the system with the calculation of the manual chi-square test. This is often caused by taking variety of digits behind completely different commas (,). The variables of gender, age, GDA, GDP, GD2PP, triglycerides, HDL, weight, smoking, and length failed to have a significant relationship on the incidence of CHD in patients with sort two DM. Sterol variables and lipoprotein levels have a highly vital relationship within the incidence of CHD for patients with sort two polygenic disease.

Prevalence of deep venous thrombosis in chronic refractory wounds and its influencing factors

Objective: To investigate the incidence and risk factors of lower extremities deep venous thrombosis (DVT) in patients with chronic refractory wounds (chronic wounds). Methods: A retrospective analysis of 722 cases of chronic wounds admitted to the First People's Hospital of Zhengzhou from January 1, 2015 to December 31, 2018 was carried out, and clinical data such as gender, age, wound involves the lower extremities, wound type, duration of wound, D-dimer level and complicated diabetes, hypertension, coronary heart disease, cerebral infarction, pneumonia and sepsis/septic shock were collected. The patients were divided into DVT group and non-DVT group according to the color ultrasound test. Multivariate binary logistic regression analysis was used to screen the independent risk factors of DVT in patients with chronic wounds. Results: There were 55 (7.6%) patients in DVT group, of which 44(80.0%) were diagnosed as chronic DVT by conventional lower extremities venous color ultrasound screening at admission, and the remaining 11(20.0%) were newly diagnosed during hospitalization. There were no significant differences in gender, wound involves the lower extremities, duration of wound, complicated diabetes and hypertension between DVT group and non-DVT group (all P>0.05); and the differences were statistically significant in age, wound type, D-dimer level, complicated coronary heart disease, cerebral infarction, pneumonia and sepsis/septic shock (all P<0.05). Multivariate binary logistic regression analysis showed age [OR=2.260 (95%CI: 1.584-3.224)], D-dimer level [OR=14.201 (95%CI: 6.101-33.055)], complicated coronary heart disease [OR=2.731 (95%CI: 1.210-6.162)] and sepsis/septic shock [OR=3.170 (95%CI: 1.115-9.016)] were independent risk factors for DVT (all P<0.05). Conclusion: Chronic wounds patients have a higher incidence of DVT, most of which are chronic DVT, and age, D-dimer level, complicated coronary heart disease and sepsis/septic shock are independent risk factors for DVT in chronic wounds.

Second-Hand Smoke Exposure Among Coronary Heart Disease Patients.

PurposeThe objectives of this study were to assess second-hand smoke (SHS) exposure among coronary heart disease (CHD) patients at home, in transportation, workplace, public and social places; to examine the demographic factors that predict SHS exposure; and to investigate the relationship between SHS exposure and CHD complications, age at the time of diagnosis, and number of admissions in the last year.Patients and MethodsA descriptive cross-sectional design was used with a convenient sample of 400 CHD patients from three hospitals in Jordan. A modified version of the Smoking Scale for Adults (SS-A) was used.ResultsThe percentage of SHS exposure was 64% in public places, 51.5% in social places, 48.5% in the household, 31% in transportation, while it was only 14.8% in the workplace. In addition, being male, employed, having a younger age and lower education significantly predicted higher exposure to SHS. Exposure to SHS was positively associated with CHD complications and the number of admissions, while it was negatively associated with the age at diagnosis with CHD.ConclusionCollaboration is needed among all health care sectors to adopt educational strategies about SHS exposure and to activate policies to prohibit smoking in public places.

Prevalence of chronic kidney disease and its determinants in coronary heart disease patients in 24 European countries: Insights from the EUROASPIRE IV survey of the European Society of Cardiology.

Aims Chronic kidney disease (CKD) is associated with the development and progression of coronary heart disease (CHD), in addition to classic cardiovascular risk factors. We analysed the prevalence of CKD in CHD patients from 24 European countries in the ambulatory setting and in a preceding hospital stay for CHD (index). Methods and results A total of 7998 EUROASPIRE IV participants (median 65 years of age, 76% male) attended a study visit 6-36 months after the index hospitalisation. CKD was classified according to stages of estimated glomerular filtration rate (eGFR) and albuminuria (urinary albumin/creatinine ratio). In stable CHD conditions (study visit), 17.3% had CKD (eGFR <60 mL/min/1.73 m2) with variation among participating countries (range 13.1-26.4%). A further 12% presented with preserved eGFR but significant albuminuria. During the hospital stay due to a coronary event, impaired kidney function was observed in 17.6% (range 7.5-38.2%). Risk factors for impaired kidney function included older age, female gender, classic cardiovascular (CV) risk factors, details of CHD history and congestive heart failure (multivariate regression). Of all patients, 38.9% had declined, 31.3% were stable and 29.8% had improved kidney function between hospital discharge and the study visit, dependent on age, gender, CV risk factors, CHD history and cardiac dysfunction (multivariate regression). Conclusions Every fifth CHD patient had CKD, while every tenth exhibited albuminuria as the sole indicator of kidney damage. These subjects are at increased risk of progression of CKD and CHD complications. After hospital stays due to CHD, there is potential of recovery of kidney function, but our findings underline the importance of identifying patients who are at high risk of developing CKD in order to counteract disease progression.

Knowledge of the Patient’s Family Member about Risk Factors and Complications of Coronary Heart Disease

Objective: To assess knowledge about risk factors and complication of coronary heart disease (CHD).Method: It was a cross-sectional type of study and research participants were one of the family members of the patient suffering from coronary heart disease. The sample population and unit of sample were households. A total of 147 participants were selected from Inpatient Department of the National Institute of Cardio-Vascular Disease, Sher-e-Bangla Nagar, Dhaka from January 2013 to July 2013 following purposive method of sampling on the basis of defined selection criteria. The research instrument was a pre-tested face-to-face interviewer questionnaire. Knowledge level of the respondents was assessed using Likert type of scale incorporate in the questionnaire.Results: Most of the research participants (95.2%, n=140) were educated and only 4.8% (n=07) found illiterate. In profession, 29.9% (n=44) of the respondents were housewife, 36.1% (n=53) service holder, 22.4% (n=24) businessmen and 11.6% (n=17) students. Their average monthly income was Tk. 9149±108 and their family income was Tk. 3448±7 in average. The mean age of the respondents was 33.1±6.8 years of which 76.9% (n=113) married and rest of them (23.1%, n=34) unmarried. Among the respondents, 50.3(n=74) were male and 49.7% (n=73) female respectively. The level of knowledge of the respondents about risk factors and complication of coronary heart disease on the basis of gender, education and occupation was assessed. Of them, 75.5% (n=111) had poor knowledge about risk factors and complication of coronary heart disease, 24.5% (n=36) satisfactory knowledge and none of them had good knowledge about it which was significantly associated with the level of education, occupational and monthly income status of the respondents.Conclusion: An individual can modify or avoid many risk factors to prevent CHD or minimize the complication of CHD except age and genetic factors. However, need based health education and behavioral change intervention programs among the risk populations (target populations) and to ensure easy access in public healthcare facilities may be the most important applicable ways to control and/or prevention of CHD in Bangladesh.J MEDICINE July 2016; 17 (2) : 84-90

Higher education is associated with reduced risk of heart failure among patients with acute myocardial infarction: A nationwide analysis using data from the CVDNOR project.

Coronary heart disease (CHD) outcomes are characterised by socioeconomic gradients. Although heart failure (HF) is a severe complication of CHD, sparse evidence exists on the association between socioeconomic status and HF among coronary patients. This study aimed to explore potential educational differences in the risk of HF among acute myocardial infarction (AMI) patients in Norway during 2001-2009. A total of 70,506 patients hospitalised for an incident (first) AMI and without history of HF were included in the analyses. Information on education was obtained from the Norwegian Education Database and categorised into primary, secondary or tertiary. In 12,487 (17.7%) patients, HF was present at admission or developed during the AMI hospitalisation (early-onset HF). Compared to patients with primary education, patients with secondary or tertiary education had 9% [incidence rate ratio (IRR) = 0.91; 95% confidence interval (CI): 0.87-0.94] and 20% (IRR = 0.80; 95% CI: 0.75-0.86) lower risks of early-onset HF, respectively. Of the 54,095 AMI patients discharged alive without concurrent HF, 6375 (11.8%) were subsequently hospitalised with or died from late-onset HF during a median follow-up period of 3.4 years. Compared to patients with primary education, those with secondary or tertiary education had 14% [hazard ratio (HR = 0.86; 95% CI: 0.82-0.91] and 27% (HR = 0.73; 95% CI: 0.66-0.80) lower risks of HF, respectively. Educational differences in the risk of HF were not influenced by gender. We observed an inverse association between educational level and risk of HF. More efforts in preventing this severe complication of AMI among less educated patients may help to reduce the socioeconomic gap in survival following coronary events.

Expected value of the additional state in evaluating the method of quantification and uncertainty of additional states in an analytical model of grade I hypertension.

BackgroundIn the construction of pharmacoeoconomic models, simplicity is desirable for transparency (people can see how the model is built), ease of analysis, validation (how well the model reproduces reality), and description. Few reports have described concrete methods for constructing simpler models. Therefore we focused on the value of additional states and uncertainty in disease models with multiple complications.ObjectivesThe objective of this study was to examine the possibility of ranking additional states in disease models with multiple complications using a method for evaluating the quantification and uncertainty of additional states.MethodsThe expected value of additional states (EVAS) was formulated to calculate the value of additional states from the variation between analytic models using the net benefit method, and uncertainty was subtracted from the variation. We also verified the usefulness and availability of this method in grade I hypertension as a verification of the disease model. We assumed that stroke was recognized as an associated complication of hypertension in the basic model. In addition, stroke recurrence, coronary heart disease (CHD), and end-stage renal disease (ESRD) were assumed to represent other complications of hypertension. Ten thousand Monte Carlo simulations were performed, and the probability distribution was assumed to be the beta distribution in clinical parameters. The ranges of clinical parameters were ±6.25%, 12.5%, 25%, and 50% of the standard deviation from the mean value.ResultsThe EVAS in complications of CHD showed the greatest uncertainty. In contrast, the EVAS of ESRD differed from stroke recurrence in the value ranking by uncertainty.ConclusionsThe EVAS has the potential to determine the ranking of additional states based on the quantitative value and uncertainty in disease models with multiple complications.Electronic supplementary materialThe online version of this article (doi:10.1186/s40780-014-0006-z) contains supplementary material, which is available to authorized users.

Pathophysiological Characteristics of Phlegm-stasis Cementation Syndrome in Coronary Heart Disease: a Review and Update

The pathophysiological characteristics of Phlegm-stasis Cementation Syndrome in Coronary Heart Disease (CHD) has been summarized in this article. According to epidemiological investigations, phlegm-stasis cementation syndrome has become a dominant syndrome in CHD along with the improvement in living and dietary condition. The interaction between blood stasis and phlegm turbidity that is called Phlegmstasis Cementation Syndrome exists in CHD and other diseases. The bridge linked blood stasis and phlegm turbidity lies in the adversely effects of lipid metabolism disorder on platelet activation, vascular function and hemorheology indexes. Lipid metabolism disorder also can induce persistent inflammation including monocyte/macrophage activation and oxidative stress. Inflammation also is an important stimulating factor for atherosclerosis and the biology that underlies the complications of CHD, which belonged to the concept of “toxin” in Traditional Chinese medicines (TCM). On the other hand, the important function of inflammatory process on abnormal hemorheology, platelet activation and vascular dysfunction can be used to elucidate the basic pathogenetic condition of the toxin inducing blood stasis in TCM. Therefore, it is this pathological process that can be used to address the basic pathogenetic theory of phlegm turbidity inducing the symptom of toxin and blood stasis, and subsequently phlegm-stasis cementation in TCM. We deduced that lipid metabolic disturbance, inflammation activation, vascular dyfunction and hemorheological disorders could be as pathophysiological characteristics of Phlegm-stasis cementation syndrome.

Meta-Analysis of the Association between Transforming Growth Factor-Beta Polymorphisms and Complications of Coronary Heart Disease

ObjectiveTo investigate the association between common transforming growth factor beta (TGF-β) single nucleotide polymorphisms (SNP) and significant complications of coronary heart disease (CHD).MethodWe performed a meta-analysis of published case-control studies assessing the association of TGF-β SNPs with a range of CHD complications. A random effects model was used to calculate odds ratios and confidence intervals. Analyses were conducted for additive, dominant and recessive modes of inheritance.ResultsSix studies involving 5535 cases and 2970 controls examining the association of common SNPs in TGF-β1 with CHD were identified. Applying a dominant model of inheritance, three TGF-β1 SNPs were significantly associated with CHD complications: The T alleles of rs1800469 (OR = 1.125, 95% CI 1.016–1.247, p = 0.031) and rs1800470 (OR = 1.146, 95% CI 1.026–1.279, p = 0.021); and the C allele of rs1800471 (OR = 1.207, 95% CI 1.037–1.406, p = 0.021).ConclusionThis meta-analysis suggests that common genetic polymorphisms in TGF-β1 are associated with complications of CHD.

Abstract P307: Chitin-Glucan Fiber Effects on Oxidized Low-Density Lipoprotein: A Randomized Controlled Trial

Oxidized low-density lipoprotein (OxLDL) is believed to play a role in the progression of atherosclerotic coronary heart disease (CHD) and the development of diabetes complications. This randomized, double-blind, placebo-controlled study of a novel insoluble fiber derived from the mycelium Aspergillus niger , chitin-glucan (CG) (ARTINIA™), evaluated 135 patients with fasting LDL-cholesterol 130-189.9 mg/dl and fasting glucose &lt;=125 mg/dl. Participants were randomly assigned to receive CG (4.5 g/day; n=34), CG (1.5 g/day; n=33), CG (1.5 g/day) plus olive extract (n=33), or matching placebo (n=35) for 6 weeks. The primary outcome measure was the between-group difference in OxLDL. Secondary outcome measurements included effects upon lipid, glucose, insulin, and F2-isoprostane levels. After 6 weeks, CG 4.5 g/day (CG-4.5) significantly reduced mean OxLDL 3.8 U/L compared to baseline (58.0 U/L vs 61.8 U/L, respectively; P =0.006), and reduced OxLDL 4.97 U/L compared to placebo (P=&lt;0.05). Other treatment groups generally had no significant effect upon OxLDL. CG treatment groups reduced LDL-cholesterol levels 3.2–;6.5% compared to placebo (P&lt;0.05). In this study population without diabetes mellitus or elevated glucose levels, CG did not significantly affect high density lipoprotein cholesterol, triglycerides, glucose, insulin, F2-isoprostanes, or the homeostasis model assessment of insulin resistance. Treatments were well tolerated and with adverse experiences comparable to placebo. These results suggest that chitin-glucan, a novel insoluble fiber, may significantly reduce OxLDL and LDL-cholesterol levels, which may have therapeutic implications for patients at risk for CHD or other diabetes complications.