Female Coronary Artery Disease Research Articles

Reduction of Myocardial Infarction and All-Cause Mortality Associated to Statins in Patients Without Obstructive CAD

ObjectivesThe aim of this work was to evaluate the prognostic impact of statin therapy in symptomatic patients without obstructive CAD. BackgroundInformation on the prognostic impact of post–coronary computed tomographic angiography (CTA) statin use in patients with no or nonobstructive coronary artery disease (CAD) is sparse. MethodsPatients undergoing CTA with suspected CAD in western Denmark from 2008 to 2017 with <50% coronary stenoses were identified. Information on post-CTA use of statin therapy and cardiovascular events were obtained from national registries. ResultsThe study included 33,552 patients, median aged 56 years, 58% female, with no (n = 19,669) or nonobstructive (n = 13,883) CAD and a median follow-up of 3.5 years. The absolute risk of the combined end point of myocardial infarction (MI) or all-cause mortality was directly associated with the CAD burden with an event rate/1,000 patient-years of 4.13 (95% CI: 3.69-4.61) in no, 7.74 (95% CI: 6.88-8.71) in mild (coronary artery calcium score [CACS] 0-99), 13.72 (95% CI: 11.61-16.23) in moderate (CACS 100-399), and 32.47 (95% CI: 26.25-40.16) in severe (CACS ≥400) nonobstructive CAD. Statin therapy was associated with a multivariable adjusted HR for MI and death of 0.52 (95% CI: 0.36-0.75) in no, 0.44 (95% CI: 0.32-0.62) in mild, 0.51 (95% CI: 0.34-0.75) in moderate, and 0.52 (95% CI: 0.32-0.86) in severe nonobstructive CAD. The estimated numbers needed to treat to prevent the primary end point were 92 (95% CI: 61-182) in no, 36 (95% CI: 26-58) in mild, 24 (95% CI: 15-61) in moderate, and 13 (95% CI: 7-86) in severe nonobstructive CAD. Residual confounding may persist, but not to an extent explaining all of the observed risk reduction associated with statin treatment. ConclusionsThe risk of MI and all-cause mortality in patients without obstructive CAD is directly associated with the CAD burden. Statin therapy is associated with a reduction of MI and all-cause death across the spectrum of CAD, however, the absolute benefit of treatment is directionally proportional with the CAD burden.

Exercise-induced changes in miRNA expression in coronary artery disease.

Micro ribonucleic acids (miRNAs) are small non-coding RNA molecules that control gene expression by translational inhibition. Exercise has been shown to affect several miRNAs' expression in healthy subjects, but this has not yet been studied in patients with coronary artery disease (CAD). Since exercise training confers beneficial long-term effects and may also trigger acute coronary events, it is of utmost interest to be able to identify those who are risk for untoward effects. Therefore, we set out toassess miRNA expression in response to maximal ergospirometry in patients with CAD. Total RNA was extracted from blood drawn immediately before and 5min after maximal cycle-ergospirometry (10 male and 10 female CAD patients). A qRT-PCR was performed for 187 target miRNAs associated with endothelial function/dysfunction, cardiovascular disease, myocardial infarction, and sudden cardiac death. In response to a maximal ergospirometry, 33 miRNAs significantly changed their expression levels. Of these miRNAs 16 were significantly differently expressed between gender. Using multi-variance analysis, nine miRNAs (let-7e-5p; miR-1; miR-19b-1-5p; miR-103a-3p; miR-148b-3p; miR-181b-5p; miR-188-5p; miR-423-5p; miR-874-3p) showed significantly different responses to maximal ergospirometry between genders. We report for the first time that in patients with CAD, miRNA expression is amenable to maximal ergospirometry and that the extent of changes differs between genders. Affected by exercise and gender were miRNAs that are associated, among others, with pathways for glucose metabolism, oxidative stress, and angiogenesis. Future studies should assess whether disease-specific miRNA expression in response to maximal exercise might serve as a marker for patient outcome.

Sex Differences in Clinical Outcomes of Patients with Stable Coronary Artery Disease after Percutaneous Coronary Intervention

Potential sex-related differences in the periprocedural and long-term postprocedural outcomes of coronary angioplasty in patients with stable coronary artery disease have been studied thoroughly over the last few decades, to determine whether female sex should be regarded as an independent risk factor that affects clinical outcomes. Based on a significant number of observational studies and meta-analyses, sex has not yet emerged as an independent risk factor for either mortality or major cardiac and cerebrovascular events, despite the fact that in the early 1980s, for several reasons, female sex was associated with unfavourable outcomes. Therefore, it remains debatable whether female sex should be considered as an independent risk factor for periprocedural and long-term bleeding events. The pharmacological and technological advancements that support current coronary angioplasty procedures, as well as the non-delayed treatment of coronary artery disease in females have certainly lessened the outcome differences between the two sexes. However, females show fluctuations in blood coagulability through their lifetime and higher prevalence of bleeding episodes associated with the antithrombotic treatment, following transcatheter coronary reperfusion interventions. In conclusion, the clinical results of percutaneous coronary intervention in patients with stable coronary artery disease, during the periprocedural and long-term postprocedural periods, appear to show no significant differences between the two sexes, except for bleeding rates, which seem to be higher in females, a difference that mandates further systematic research.

Sex-based impact of carotid plaque in patients with chest pain undergoing stress echocardiography

ObjectiveWomen with suspected angina without history of coronary artery disease (CAD) less frequently have flow-limiting stenosis (FL-CAD) and more often have microvascular disease, affecting predictive accuracy of stress echocardiography (SE)...

Weight loss following bariatric surgery decreases pericardial fat thickness lowering the risk of developing coronary artery disease.

Pericardial fat has a local atherosclerotic effect and is associated with both metabolic syndrome (MetS) and coronary artery disease (CAD). The aim of this study is to report changes in pericardial fat thickness (PFT) after bariatric surgery, and to investigate its significance on the risk of developing coronary artery disease (CAD). Academic institution. We retrospectively measured the linear pericardial thickness from patients' computed tomography (CT) scans within 5 years preoperatively and compared to any available CT scan within 5 years postoperatively. The PFT was measured at the right ventricular wall, perpendicular to the myocardium, at the level of the sternum. The risk of developing CAD was estimated by calculating the Framingham risk score (FRS). We divided the patients into 2 groups: laparoscopic sleeve gastrectomy (SG, Group 1), and laparoscopic gastric Roux-en-Y gastric bypass (LRYGB, Group 2). Common demographic characteristics and co-morbidities were collected along with the preoperative and postoperative lipid profiles. A total of 113 patients met the inclusion criteria, with 64 (56.6%) patients in group 1 and 49 (43.3%) patients in group 2. Group 1 consisted of 83.6% (n = 53) female patients versus 75.5% (n = 37) in group 2. The percent excess body mass index loss (%EBMIL) at 12 months was 74.4 ± 35.8% for group 1 versus 67 ± 30.1% for group 2 (P = .292). Pericardial thickness before surgery was 5.6 ± 1.9 mm and 4.6 ± 1.6 mm after surgery (P = .0001). The risk of CAD in females was 9.1% before and 6.6% after surgery. We found statistically significant linear association between pericardial thickness after surgery and a lower risk of CAD (P = .001). Bariatric surgery decreases the PFT lowering risk of developing CAD. Further studies may be needed to better assess these findings.

Sex Differences in All-Cause Mortality in the Decade Following Complex Coronary Revascularization

BackgroundThe poorer prognosis of coronary artery disease in females compared with males is related mainly to differences in baseline characteristics. In the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, the effect of treatment with percutaneous coronary intervention (PCI) versus coronary artery bypass grafting surgery (CABG) on mortality at 5 years differed significantly between females and males; however, the optimal revascularization beyond 5 years according to sex has not been evaluated. ObjectivesThe aim of this study was to investigate the impact of sex on mortality and sex-treatment interaction at 10 years. MethodsThe SYNTAXES (SYNTAX Extended Survival) study evaluated vital status up to 10 years in 1,800 patients with de novo 3-vessel and/or left main coronary artery disease randomized to treatment with PCI or CABG in the SYNTAX trial. All-cause death at 10 years was separately evaluated in female and male patients with complex coronary artery disease. ResultsOf 1,800 patients, 402 (22.3%) were female and 1,398 (77.7%) were males. Females had a higher 10-year mortality rate compared with males (32.8% vs. 24.7%; log-rank p = 0.002), but female sex was not an independent predictor of mortality (adjusted hazard ratio: 1.02; 95% confidence interval: 0.76 to 1.36). Mortality at 10 years tended to be lower after CABG than after PCI, with a similar treatment effect for female and male patients (adjusted hazard ratio for females: 0.90 [95% confidence interval: 0.54 to 1.51]; adjusted hazard ratio for males: 0.76 [95% confidence interval: 0.56 to 1.02]; p for interaction = 0.952). ConclusionsFemale sex was not an independent predictor of mortality at 10 years in patients with complex coronary artery disease. The interaction between sex and treatment with PCI or CABG that was observed at 5 years was no longer present at 10 years. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES], NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX], NCT00114972)

Coronary Computed Tomography Angiography To Assess Coronary Artery Disease In Females With Breast Cancer Previously Treated With Radiation Therapy.

Introduction: Breast cancer and coronary artery disease (CAD) commonly coexist and treatment with radiotherapy (RT) increases the risk of developing CAD. Studies show increased risk of acute coronary events in the first 5 years after RT and a direct relationship to median heart dose (MHD). Left sided breast cancer (LBC) confers higher risk compared to right sided (RBC) due to proximity to the treatment area. This study aims to study this relationship using coronary computed tomography angiography (CCTA) to detect subclinical atherosclerosis.

Variation in Coronary Artery Disease Pattern and Risk Factors among Female Patients of Dierent Age Groups in Bangladesh

Background &amp; objective: Coronary Artery Disease (CAD) is a devastating life-threatening condition which varies with respect to age and sex. In Bangladesh a large number of patients currently undergoes coronary angiography for a variety of indications. Due to physiological changes after menopause, the females are more prone to develop CAD. So, the risk factors and pattern of CAD in female are subject change with changing ages. The objective of this study was to compare the risk factors and pattern of CAD in female patients of different age groups.&#x0D; Methods: This cross-sectional analytical study was conducted at Ibrahim Cardiac Hospital &amp; Research Institute (ICHRI), Dhaka, Bangladesh between September 2005 to August 2016. All female patients (n = 7,627) who underwent coronary angiography during the period were included. They were identified from ICHRI dedicated Cath-lab Database. The patients were divided into three groups based on their age (Group-I ≤45 years, Group-II from age 46 to age 60 and Group-III from age 60 years onwards). A stenosis of ≥ 70% in any of the three major coronary arteries like Left Anterior Descending (LAD), Right Coronary Artery (RCA) and Left Circumflex Artery (LCX) was considered as significant stenosis, while a stenosis of ≥ 50% in left main stem (LMS) was considered significant for left main disease. The data pertaining to their risk factors and angiographic profile were compared among the three age groups to find the association of risk factors and angiographic pattern of the CAD at different age groups.&#x0D; Result: All the risk factors (diabetes, hypertension, dyslipidaemia and CKD) demonstrated their significant presence in Group II and III compared to those in Group I, while they were almost identical between Group II and III. More than 40% of the patients were overweight in all age groups and around 20% were obese including a negligible proportion with morbid obesity. ST-segment elevation MI, NSTEMI (Non-ST-elevation myocardial infarction), prior MI (Myocardial infarction), and ALVF (Acute left ventricular failure) were significantly higher in Group III than the two other groups had. However, unstable angina was significantly higher in age-group I &amp; II and atypical chest pain in Group I. Incidence of Single vessel disease (SVD) was considerably higher in group II. Double vessel diseases DVD), Triple vessel disease (TVD), LM disease was significantly higher in group III compared to two other groups. Normal CAG (Coronary angiography) finding was higher among group I, although it was not significantly different from other two groups.&#x0D; Conclusion: The study concluded that the prevalence of conventional risk factors including overweight/obesity is almost similar between middle-aged and elderly women, while they are significantly lower in early middle-aged group. The elderly women usually present with STEMI (ST-elevation myocardial infarction), non-STEMI, stable CAD, ALVF, while middle-aged women commonly present with UA (Unstable Angina) and early middle-aged women with atypical chest pain. Severe CAD including and LM disease is relatively common in elderly women than those in their early middle-aged and middle-aged cohorts. Coronary artery disease advances with advancing age. Health-care providers should not underestimate the cardiac health of women.&#x0D; Ibrahim Card Med J 2019; 9 (1&amp;2): 60-66

Gender-based differences in coronary artery disease: A prospective observational study from a North Indian state

Introduction: Coronary artery disease (CAD) causes significant morbidity and mortality in both genders, however, the importance of CAD in females is underappreciated. Aims and Objectives: This study is aimed at investigating the gender-based differences in presentation, evaluation, and outcome of CADs in a northern state of India. Materials and Methods: This is a prospective study conducted over a period of 3 years. All the patients with CAD (acute coronary syndrome or chronic stable angina) enrolled in the study were evaluated for clinical profile, angiographic profile, and the outcome. Results: A total of 3660 patients were enrolled in this study. There were 56.2% of males and 43.8% of females. Smoking as risk factor was noted in 69.6% of males and 7.9% of females, hypertension in 52.9% of males versus 65.4% of females, diabetes in 42.5% of males versus 60.7% of females, and obesity in 46.2% of males versus 57.3% of females. Male versus female mean body mass index was 24.7 versus 27.4, low-density lipoprotein 112.8 versus 123.7, high-sensitivity C-reactive protein 1.5 versus 2.9, and Lp(a) 274.9 versus 442.1, respectively. On coronary angiographic evaluation, male versus female single-vessel involvement was seen in 54.1% versus 58.8% of patients, double-vessel disease in 31.6% versus 27.6%, left main disease in 1.7% versus 3.6%, and spontaneous coronary artery dissection in 0.9% versus 1.5% patients, respectively. The overall mortality in males was 4.03% and 5.11% in females. Conclusion: Despite its atypical presentation, CAD has the worst outcome in women than men. Greater awareness of these gender-based differences will significantly improve the management and outcome of CAD in women.

Analysis of Differentially Expressed Genes in Coronary Artery Disease by Integrated Microarray Analysis.

Coronary artery disease (CAD) is a major cause of end-stage cardiac disease. Although profound efforts have been made to illuminate the pathogenesis, the molecular mechanisms of CAD remain to be analyzed. To identify the candidate genes in the advancement of CAD, microarray dataset GSE23766 was downloaded from the Gene Expression Omnibus database. The differentially expressed genes (DEGs) were identified, and pathway and gene ontology (GO) enrichment analyses were performed. The protein-protein interaction network was constructed and the module analysis was performed using the Biological General Repository for Interaction Datasets (BioGRID) and Cytoscape. Additionally, target genes-miRNA regulatory network and target genes-TF regulatory network were constructed and analyzed. There were 894 DEGs between male human CAD samples and female human CAD samples, including 456 up regulated genes and 438 down regulated genes. Pathway enrichment analyses revealed that DEGs (up and down regulated) were mostly enriched in the superpathway of steroid hormone biosynthesis, ABC transporters, oxidative ethanol degradation III and Complement and coagulation cascades. Similarly, geneontology enrichment analyses revealed that DEGs (up and down regulated) were mostly enriched in the forebrain neuron differentiation, filopodium membrane, platelet degranulation and blood microparticle. In the PPI network and modules (up and down regulated), MYC, NPM1, TRPC7, UBC, FN1, HEMK1, IFT74 and VHL were hub genes. In the target genes-miRNA regulatory network and target genes—TF regulatory network (up and down regulated), TAOK1, KHSRP, HSD17B11 and PAH were target genes. In conclusion, the pathway and GO ontology enriched by DEGs may reveal the molecular mechanism of CAD. Its hub and target genes, MYC, NPM1, TRPC7, UBC, FN1, HEMK1, IFT74, VHL, TAOK1, KHSRP, HSD17B11 and PAH were expected to be new targets for CAD. Our finding provided clues for exploring molecular mechanism and developing new prognostics, diagnostic and therapeutic strategies for CAD.

P2248Impact of Lipoprotein (a) levels on the presence and severity of coronary artery disease in female patients: a large cross-sectional Chinese cohort study

Abstract Background Lipoprotein (a) [Lp(a)] is recently recognized as a risk factor of atherosclerosis, and the development of coronary artery disease (CAD) in women is not fully understood. Purpose The present study aimed to examine the association of Lp(a) levels with the presence and severity of (CAD) in female patients pre- and post-menopause. Methods A total of 3712 female patients who received coronary angiography were consecutively enrolled. The level of Lp(a) was measured and compared among patients with and without CAD or myocardial infarction (MI), pre- or post- menopause. The association of Lp(a) with the presence of CAD and the severity of coronary atherosclerosis assessed by Gensini Score were examined. Results The average of Lp(a) levels were elevated as age increased in female subjects. Notably, women after menopause had higher Lp(a) levels compared with that before menopause [16.8 mg/dL (IQR 7.54–41.12 mg/dL) vs. 14.7 mg/dL (IQR 6.72–30.82 mg/dL), p=0.002]. Furthermore, multiple logistic regression analysis identified that Lp(a) &gt;30mg/dL was an independent risk factor of CAD in the postmenopausal female (OR1.38, 95% CI 1.13–1.69, p=0.002). Finally, Lp(a) had a positive correlation with Gensini score (r=0.11, p&lt;0.001), and Lp(a) &gt;30mg/dL was an independent risk factor for high Gensini score (OR 1.43, 95% CI 1.14–1.79, p&lt;0.001). While such results were not observed in the premenopausal females. Baseline characteristics of all patients Before menopause (n=525) Post menopause (n=3187) P value Age, (years) 46 (42–49) 62 (58–68) &lt;0.001* Hypertension, n (%) 231 (44.00) 2097 (65.80) &lt;0.001* Diabetes mellitus, n (%) 68 (12.95) 849 (26.64) &lt;0.001* LDL-C (mmol/L) 2.73±1.05 2.77±0.99 0.366 Lp(a) (mg/dL) 14.7 (6.72–30.82) 16.8 (7.54–41.12) 0.002* Data are expressed as mean ± SD or median (interquartile range) and numbers (percentages). BMI, body mass index; TC, total cholesterol; TG, triglyceride; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; Lp(a), lipoprotein(a); HsCRP, high-sensitivity C-reactive protein. *Statistically significant differences exist between two groups. CAD, coronary artery disease. Lp(a) in pre- and post-menopausal women Conclusion The present study indicated that circulating Lp(a) levels were independently associated with the presence and severity of CAD in the postmenopausal female, suggesting that further study may be needed to examine the role of Lp(a) in the development of CAD in female individuals with different menopausal status.

Randomised controlled trial in women with coronary artery disease investigating the effects of aerobic interval training versus moderate intensity continuous exercise in cardiac rehabilitation: CAT versus MICE study

BackgroundThe primary aim of the present study was to investigate the effects of aerobic interval training (AIT) versus moderate intensity continuous exercise (MICE) on aerobic exercise capacity (V̇O2peak), in women...

Lipoprotein(a) and coronary artery disease in Chinese postmenopausal female patients: a large cross-sectional cohort study

BackgroundIt has been reported that lipoprotein(a) (Lp(a)) is associated with the risk of cardiovascular disease. The present study aimed to examine the association of Lp(a) levels with the presence and...

Assessment of lipid per-oxidation and endothelial dysfunction in patients of coronary artery disease

Assessment of lipid per-oxidation and endothelial dysfunction in patients of coronary artery disease - IJCBR- Print ISSN No: - 2394-6369 Online ISSN No:- 2394-6377 Article DOI No:- 10.18231/2394-6377.2019.0003, International Journal of Clinical Biochemistry and Research-Int J Clin Biochem Res

Investigation of Renalase gene rs2576178 polymorphism in patients with coronary artery disease.

Renalase gene rs2576178 polymorphism has been demonstrated to be a risk factor of ischemic stroke, essential hypertension, and end-stage renal disease, but the association Renalase with risk of coronary artery disease (CAD) has been less reported. Therefore, we detected Renalase rs2576178 polymorphism in 449 CAD patients and 507 healthy controls using matrix-assisted laser-desorption ionization (MALDI)/time of flight (TOF)-mass spectrometry (MS). It was found that GG genotype or G allele of rs2576178 polymorphism was associated with the risk of CAD. Stratified analysis indicated that Renalase polymorphism significantly increased the risk of CAD in females, smokers, and alcoholics. However, there was no significant association between different genotypes of rs2576178 polymorphism and clinical parameters. In summary, Renalase rs2576178 polymorphism is associated with increased risk of CAD, but this finding should be confirmed by larger studies with more diverse ethnic populations.

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.

Increased Serum Leptin Levels in New-Onset, Untreated Female Patients with Coronary Artery Disease and Positively Associated with Inflammatory Markers

Background/Aims: Previous studies have suggested that leptin was associated with atherosclerosis and involved in inflammation. Gender differences between leptin and inflammatory markers have been evaluated less in untreated patients with stable coronary artery disease (CAD). Methods: In this study, a total of 394 consecutive Chinese patients who received coronary artery angiography were enrolled, including 243 patients with CAD and 151 non-CAD controls. The baseline clinical characteristics were collected and serum leptin levels were determined using ELISA. Results: The relation of serum leptin levels to inflammatory markers was found only in female patients. Leptin and white blood cell count (WBCC) as well as its subsets were significantly higher in female patients than female controls. In female patients, leptin was positively associated with C-reactive protein (CRP; r = 0.28, p = 0.016), WBCC (r = 0.261, p = 0.02), neutrophil, r = 0.268, p = 0.018, and monocyte, r = 0.228, p = 0.044. Multivariable regression analysis revealed that leptin was significantly and independently associated with CRP (β = 0.317, p = 0.004), WBCC (β = 0.278, p = 0.020), neutrophil (β = 0.262, p = 0.032), and monocyte (β = 0.245, p = 0.032). Conclusions: The serum leptin levels were higher in female patients and independently associated with CRP, WBCC, and its subsets, suggesting a potential interaction between leptin and inflammation in female CAD patients.

Interaction between ALOX15 polymorphisms and coronary artery disease in North Indian population

ABSTRACTBackground: Coronary artery disease (CAD) is major cause of death and morbidity worldwide. Arachidonate 12/15-lipoxygenase (ALOX) is a member of the lipid peroxidizing enzyme family and implicated in the pathogenesis of atherosclerosis, but with contradicting results. Aim: The present study aimed to investigate the association of two polymorphisms in ALOX15 (rs2619112 and rs7217186) and the risk of CAD in North Indian population. Methods: A total of 500 angiographically confirmed CAD patients and 500 control subjects of North Indian population were recruited in the case-control study and genotyped by PCR-RFLP. Results: The data showed a significant association between the two polymorphisms and CAD. Multiple logistic regression revealed heterozygous genotype of both the polymorphisms viz. GA of rs2619112 and CT of rs7217186 to be associated with significant high risk of CAD after adjustment for confounders (p = 0.034, OR = 2.274, 95% CI (1.062–4.870) and p = 0.000, OR = 3.407, 95% CI (2.092–5.548) respectively). Stratified analysis based on gender showed GA and AA of rs2619112 each significantly increased the risk of CAD in females (p = 0.001, OR = 13.120, CI = 2.780–61.928; p = 0.028, OR = 5.393, CI = 1.196–24.316 respectively) whereas only GA increased CAD risk in males (p = 0.005, OR = 2.277, CI = 1.290–4.020). In case of rs7217186, CT and TT showed a significant high risk of CAD in males (p = 0.000, OR = 4.048, CI = 2.678–6.119; p = 0.000, OR = 2.861, CI = 1.928–4.245). Conclusion: The present study shows that rs7217186:C > T and rs2619112:G > A of ALOX15 are associated with increased risk of CAD in the North Indian population.

Association between HLA-DQB1 alleles and susceptibility to coronary artery disease in Southern Han Chinese

Accumulated evidence indicates that polymorphisms in human leukocyte antigens (HLA) are associated with susceptibility to coronary artery disease (CAD). However, whether HLA-DQB1 alleles are correlated with susceptibility to CAD is unclear. In this study, significantly lower frequencies of the allele groups (DQB1*03:01:01G and DQB1*05:03:01G) and the genotypes (DQB1*03:01:01G/DQB1*03:01:01G and DQB1*03:01:01G/DQB1*05:03:01G) were observed in the CAD group compared with that in the controls. However, notably higher frequencies of DQB1*04:01:01G and genotype DQB1*05:01:01G/DQB1*03:01:01G were observed in the CAD patients than in the controls. Further analysis in subgroups showed that DQB1*03:01:01G was present at a significantly lower frequency in both female and male CAD patients compared with the corresponding controls; however, DQB1*04:01:01G was overtly high only in male CAD patients. CAD patients with diabetes showed a negative association with DQB1*03:01:01G and DQB1*05:03:01G and a positive association with DQB1*04:01:01G, DQB1*03:02:01G and DQB1*03:03:02G. Results of logistic regression analysis indicated that DQB1*03:01:01G and DQB1*05:03:01G were significantly associated with reduced susceptibility to CAD, but DQB1*04:01:01G, DQB1*03:02:01G and DQB1*03:03:02G had no correlation with CAD. Together, these findings indicate that CAD in Southern Han Chinese is negatively associated with HLA-DQB1*03:01:01G and DQB1*05:03:01G, and males with HLA-DQB1*04:01:01G are likely to have high risk for CAD.

Leptin predicts short-term major adverse cardiac events in patients with coronary artery disease

Introduction: Leptin is an adipose tissue-derived hormone associated with cardiovascular risk factors. We examined whether leptin predicts major adverse cardiac events (MACE) in coronary artery disease (CAD) patients.Methods: Fasting plasma leptin levels were measured in 1327 male and 619 female CAD patients. The patients were followed up for two years. The primary endpoint (MACE) was the composite of a hospitalisation for congestive heart failure (CHF) or a cardiac death. The secondary endpoint was the composite of an acute coronary syndrome (ACS) or a stroke.Results: In regression analysis including established risk variables, high leptin levels were associated with a significantly increased risk of MACE (HR 3.37; 95%CI 1.64–6.90; p = 0.001) and ACS or stroke (HR 1.95; 95%CI 1.29–2.96; p = 0.002). Adding leptin to the risk model for MACE increased the C-index from 0.78 (95%CI 0.71–0.85) to 0.81 (0.74–0.88) and improved classification (NRI 0.36; 95%CI 0.13–0.60; p = 0.002) and discrimination of the patients (IDI 0.016; 95%CI 0.001–0.030; p = 0.031).Conclusions: High plasma leptin levels predict short-term occurrence of CHF or cardiac death and ACS or stroke in patients with CAD independently of established risk factors. The possible harmful effects of leptin should be thoroughly investigated.Key messagesLeptin is a peptide hormone secreted mainly by adipose tissue. It has been associated with several cardiovascular risk factors.High leptin levels predict the short-term occurrence of congestive heart failure or cardiac death and ACS or stroke in patients with CAD independently of established risk factors.The possible detrimental effects of leptin on the cardiovascular system should be thoroughly investigated.