Male Coronary Artery Disease Research Articles

Association between C1431T polymorphism in peroxisome proliferator-activated receptor-γ gene and coronary artery disease in Chinese Han population

The C1431T polymorphism in peroxisome proliferator-activated receptor-γ (PPARγ) has been shown to be associated with diabetes, obesity, and metabolic syndrome. However, it is unclear whether this polymorphism is associated with coronary artery disease (CAD). Therefore, we conducted a hospital-based case-control study with 864 CAD patients and 1008 controls to explore the association between the PPARγ C1431T polymorphism and risk of CAD in Chinese Han population. Subjects with the variant genotypes (CT + TT) had a 39% decreased risk of CAD relative to CC carriers (adjusted odds ratio, 0.61; 95% confidence interval, 0.49-0.76). Our results suggested that the C1431T polymorphism was associated with a higher body mass index in both CAD patients and controls. Moreover, this polymorphism was also found to be associated with a higher HDL cholesterol level and a lower blood glucose level in CAD patients. In stratified analyses, the T allele was significantly associated with reduced risk of CAD in males, subjects with age <62 years, and non-smokers. In conclusion, the PPARγ C1431T polymorphism is associated with decreased risk of CAD in Chinese Han population.

Relevance of Water Gymnastics in Rehabilitation Programs in Patients With Chronic Heart Failure or Coronary Artery Disease With Normal Left Ventricular Function

BackgroundExercise training is included in cardiac rehabilitation programs to enhance physical capacity and cardiovascular function. Among the existing rehabilitation programs, exercises in water are increasingly prescribed. However, it has been questioned whether exercises in water are safe and relevant in patients with stable chronic heart failure (CHF), coronary artery disease (CAD) with normal systolic left ventricular function. The goal was to assess whether a rehabilitation program, including water-based gymnastic exercises, is safe and induces at least similar benefits as a traditional land-based training. Methods and ResultsTwenty-four male CAD patients and 24 male CHF patients with stable clinical status participated in a 3-week rehabilitation. They were randomized to either a group performing the training program totally on land (CADl, CHFl; endurance + callisthenic exercises) or partly in water (CADw, CHFw; land endurance + water callisthenic exercises). Before and after rehabilitation, left ventricular systolic and cardiorespiratory functions, hemodynamic variables and autonomic nervous activities were measured. No particular complications were associated with both of our programs. At rest, significant improvements were seen in CHF patients after both types of rehabilitation (increases in stroke volume and left ventricular ejection fraction [LVEF]) as well as a decrease in heart rate (HR) and in diastolic arterial pressure. Significant increases in peaks V˙O2, HR, and power output were observed in all patients after rehabilitation in exercise test. The increase in LVEF at rest, in HR and power output at the exercise peak were slightly higher in CHFw than in CHFl. ConclusionsAltogether, both land and water-based programs were well tolerated and triggered improvements in cardiorespiratory function.

Burden of abdominal obesity in cardiac rehabilitation patients: Results from the Swiss CaRe study

The burden of abdominal obesity (AO) and its association with other cardiovascular risk factors is not known in coronary artery disease (CAD) patients attending cardiac rehabilitation (CR). The aim of this study was, therefore, to investigate the prevalence of AO and differences in cardiovascular risk factors between AO and non-AO patients. 415 consecutive male CAD patients (mean age 58 ± 11 years) attending a three-month outpatient CR programme were assessed. Differences in cardiovascular risk profile, including blood lipids, psychosocial and socioeconomic status and exercise capacity, were compared in relation to AO and checked for obesity measured by body-mass index (BMI) in a multivariate analysis. Mean waist circumference was 102 ± 11 cm. Patients of lower educational level had a higher prevalence of AO (p = 0.021) than patients with a higher educational level. AO was significantly associated with diabetes (p = 0.003) and hypertension (p <0.001). In AO patients, HDL-C levels were lower (p <0.001) and triglyceride levels higher (p = 0.006) than in non-AO patients. There was no difference in exercise capacity between AO and non-AO patients, but AO patients had a higher resting heart rate (p = 0.021). AO is highly prevalent in CAD patients attending CR. AO is, independently of BMI, associated with metabolic lipid disorders and autonomic cardiovascular dysregulation, suggesting an increased cardiovascular risk. AO patients therefore need particular attention during CR and follow-up care.

Determinants of Lower Extremity Amputation or Revascularization Procedure in Patients With Peripheral Artery Diseases: A Population-Based Investigation

We used the National Health Insurance Claim data in Taiwan to evaluate determinants for nontraumatic lower extremity amputation (LEA) or peripheral revascularization procedures (PRP) in patients with peripheral artery diseases (PAD). We identified 14 241 patients. Sex-specific odds ratios of age, diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), cerebral vascular accident (CVA), or using cilostazol for LEA or PRP were explored. In patients with PAD, 14.3% of male and 7.4% of female had LEA; whereas 7.1% of male and 4.6% of female had PRP. Among male patients, HTN and CAD were significant risk factors for LEA, whereas DM and using cilostazol had protective roles. Findings in female patients were similar. For PRP, elderly patients had less such procedures. The risk/protective factors were similar. In conclusion, PAD patients having DM and using cilostazol had less LEA or PRP, whereas those having HTN and CAD had more LEA or PRP.

Prevalence and extent of coronary artery disease determined by 64-slice CTA in patients with zero coronary calcium score

The purpose of the study was to assess the presence and extent of atherosclerosis determined by 64-slice CTA in patients with 0 coronary calcium score (CACS) and to evaluate the affect of demographic features and risk factors on the atheroma burden of these patients. 883 cases (378 (42.8%) male, 505 (57.2%) female, mean age 51.28) with zero CACS were included in the study. Cases underwent CTA because of carrying risk factors or having chest pain or atypical symptoms. A non-enhanced CT scan was obtained for calcium scoring immediately before CTA in all cases. CT examinations were performed by 64-slice scanner (Toshiba, Aquillon 64, Toshiba Medical Systems, Otowara, Japan). Coronary artery disease (CAD) was graded according to CTA findings and five groups were defined. In 703 cases (79.6%) CTA was normal while 180 (20.4%) cases had positive CTA findings and 43 cases (4.9%) had CTA obstructive lesion. Cases with positive CTA findings were significantly older than those with normal CTA Diabetes was a significant risk factor of CAD in both male and female cases. Dyslipidemia was associated with CAD in males and family history of CAD was a significant risk factor for females with positive CTA findings. This study demonstrated that considerable amount of patients with zero CAC score have positive CTA findings. Age and diabetes are the risk factors, which were associated with positive CTA findings in both sexes. Dyslipidemia was a significant risk factor in males and family history of CAD in females. Especially in patients with risk factors CTA is better than CAC scoring in determining the atheroma burden.

Coronary Artery Disease Risk Factors in Urban Areas of Yazd City, Iran

Coronary artery disease (CAD) is a major cause of mortality and morbidity with high health care cost in both developed and developing countries. CAD accounts for nearly 50% of all yearly deaths in Iran. The aim of this study is to explore the main CAD risk factors in the urban areas of Yazd in the Islamic Republic of Iran. A hospital-based case-control study was conducted to investigate the role of the important CAD risk factors in urban area of Yazd city from December 2007 to June 2008. A total of 436 subjects in the age group of 30 to 75 years (218 cases and 218 controls) were included in this study. The tools of enquiry were a pretested and precoded questionnaire, physical examination, and laboratory findings. A confidence level of 95% and study power of 80% were considered for the interpretation of possible significant findings. Gender-wise stratified analysis was separately done for men and women using multiple conditional logistic regression. A total of 75.5% of the participants were men and 24.5% were women. Five variables, including unskilled jobs, physical inactivity, giving positive history of hypertension, high levels of waist/hip ratio, and low levels of high-density lipoprotein (HDL) were the factors that could account for significant predictors of CAD in males on the logistic model (P < .05). No such significant CAD predictors were found for women. The findings showed that categories of nonprofessional, physical inactivity, positive history of hypertension, wais/hip ratio ≥0.9 and HDL levels ≤40 mg/dL are the significant risk factors that can predict CAD in male residents of Yazd.

Clinical analysis in men of premature coronary artery disease with abnormal glucose metabolism

Objective To analyse of male premature coronary artery disease with abnormal glucose metabolism of traditional risk factors and coronary lesion characteristics. Methods Collection of clinical data and angiographic results, the traditional risk factors and coronary lesion characteristics were analyzed statistically of 60 male patients with premature coronary artery disease with abnormal glucose metabolism( PCAD group) , 106cases of male non-premature coronary artery disease with abnormal glucose metabolism( non-PCAD group), 66cases of male non-coronary artery disease ( non-CAD group). Results Risk factor analysis showed that, PCAD group the proportion of overweight and positive family history was significantly higher than non-PCAD group (P＜ 0.01 ). Compared with non-CAD group,the PCAD group and the traditional risk factors closely related. Coronary angiography showed that, rate of single-vessel disease in PCAD group was higher than that in the non-PCAD group (P＜0.05), coronary angiography was lower the average of points ( P ＜ 0.01 ). Conclusion Traditional risk factors is closely related to the incidence of PCAD group. The single-vessel disease of PCAD group is higher than that in the non-PCAD group. Key words: Male; Premature coronary artery disease; Glucose metabolism; Risk factors

Sex-dependent effect of liver growth factor on atherosclerotic lesions and fatty liver disease in apolipoprotein E knockout mice.

Since the hepatic mitogen, liver growth factor (LGF), improves vascular structure and function in a hypertensive rat model and exhibits antioxidant activity, it may play a role in the development of atherosclerosis. To test this hypothesis, 14 male and 11 female apolipoprotein E (apoE)-deficient mice with a C57BL/6J genetic background were injected intraperitoneally twice a week with 1.7 microg of LGF per mouse for ten weeks. Plasma carbohydrates, inflammatory and lipid parameters, apolipoproteins A-I and A-II and paraoxonase activity were assessed at the end of the experimental period. Histological and chemical analyses of the livers and quantification of aortic atherosclerotic lesions were also carried out. LGF administration changed neither plasma lipid nor inflammatory parameters. ApoA-I and arylesterase activity were not affected by LGF either, while apoA-II decreased significantly in males but not in females. Plasma apoA-II correlated positively with liver fat in males but negatively in females. Atherosclerotic area lesions in males receiving LGF were 25% lower than in control mice. Likewise, a significant reduction of fatty liver disease was also observed in males in association with decreased levels of insulin, leptin and resistin. These results indicate that administration of LGF modulates atherosclerotic lesions in a sex-dependent manner. This effect is independent of plasma cholesterol, triglycerides, IL-6, MCP-1 and TNF-alpha and is related to a remodelling of HDL particles characterised by a decrease in apoA-II induced by changes in hepatic mRNA expression. Hence, LGF administration could be used as a safe alternative to control fatty liver disease and atherosclerosis in males.

Effects of Cardiac Rehabilitation on Cardiovascular Events in Elderly Patients with Stable Coronary Artery Disease

The elderly population has rapidly grown in Japan, resulting in a remarkable increase of patients with coronary artery disease (CAD). The elderly people have a higher incidence of acute myocardial infarction in comparison with younger population. Cardiac rehabilitation (CR) has numerous benefits including reduction of mortality and cardiovascular events in patients with CAD. Because of these high rates of morbidity and mortality, primary and secondary prevention programs are important strategies not only for modifying cardiovascular risk factors, but also for improving mortality and quality of life. However, the long-term effect of phase III CR in elderly patients with stable CAD is still unknown. PURPOSE: To assess the effects of phase III comprehensive CR on mobility and mortality of cardiovascular diseases in elderly male Japanese patients with CAD. METHODS: We analyzed 111 elderly male CAD patients (≥65 years) including 37 subjects participating in the supervised CR during six months and 74 age-matched controls. We followed the patients for up to 3,500 days, until the occurrence of death and one of the following major adverse cardiovascular events (MACE): cardiovascular death, acute coronary syndrome (ACS), refractory angina requiring revascularization, admission for congestive heart failure (CHF), and stroke. RESULTS: All cause mortality tended to be lower in the CR group than in the control group (14 vs. 28%, P=0.081). The MACE incidence was significantly lower in the CR group than in the control group (30% vs. 62%, P=0.001). The other incidences of cardiovascular death, ACS, refractory ischemia requiring percutaneous coronary intervention or coronary artery bypass grafting, admission for CHF, stroke, and cancer were not significantly different between the two groups. Kaplan Meier analysis demonstrated that the CR group had a significantly lower rate of MACE, but not all-cause death, during the entire follow-up period (P=0.007, P=0.194, respectively). Multivariate Cox proportional hazard analysis showed that the MACE incidence was significantly lower in the CR group than in the control group [adjusted hazard ratio 0.43 (95% CI 0.20-0.91), P=0.027]. CONCLUSIONS: Phase III CR has beneficial effects for reduction of cardiovascular events even in elderly patients with stable CAD.

PP-055 INFLUENCE OF TEMPERAMENT AND CHARACTER DIMENSIONS ON CORONARY ARTERY DISEASE IN TURKISH MALES

Objective: The importance of the personality trait variables remains unclear in the patients with coronary artery disease (CAD). The aim of this study was to assess the effect of temperament and character dimensions on male patients with CAD. Methods: In the case-control study, 279 male CAD patients and 101 healthy male controls were examined using temperament and character inventory (TCI), which is a 240 question, self-reporting true-false questionnaire designed to assess the four dimensions of temperament (i.e. novelty seeking [NS], harm avoidance [HA], reward dependence [RD] and persistence [P]) and the three dimensions of character (i.e. self-directedness [SD], cooperativeness [C] and self –transcendence [ST]). CAD was defined as a stenosis at least 50% in at least one major coronary artery. Results: The CAD patients scored higher on HA, P and ST and scored lower on NS, SD and C than that of the controls. Mean age of CAD patients was significantly higher than that of the controls (50.6±9.4 vs 33.4±11.5, p<0.0001). The multiple regression model generated by excluding age and the other risk factors of CAD revealed that NS (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.80-0.95, p=0.002), HA (OR 1.12, 95% CI 1.04-1.20, p=0.003), SD (OR 0.89, 95% CI 0.83-0.96, p=0.004) were independently associated with CAD. Conclusions: This study suggests that CAD male patients have distinctive temperament and character dimensions. Harm avoidance is associated with a higher risk of CAD, but both novelty seeking and self-directedness are associated with a lower risk of CAD.

Total lymphocyte deficiency attenuates AngII-induced atherosclerosis in males but not abdominal aortic aneurysms in apoE deficient mice

Objective T and B lymphocytes are associated with atherosclerosis and aneurysms. Angiotensin II (AngII) infusion into hypercholesterolemic mice results in augmentation of atherosclerosis and abdominal aortic aneurysm (AAA) formation. In this study, we determined whether total lymphocyte deficiency reduced AngII-induced vascular diseases. Methods and Results ApoE deficient (apoE −/−) mice were cross-bred with recombination activating gene-1 (Rag-1) deficient mice that lack mature T and B lymphocytes. Heterozygous littermates (Rag-1 +/−) have normal lymphocytic function and served as controls. Male and female apoE −/− mice that were either Rag-1 +/− or −/− were fed a normal laboratory diet and infused with either saline or AngII (1000 ng/kg/min) subcutaneously via osmotic mini pump for 28 days. Total lymphocyte deficiency had no significant effect on body weight and systolic blood pressure prior to and during AngII infusion. However, it was associated with decreased serum cholesterol concentrations. AngII infusion increased atherosclerotic lesion area in Rag-1 +/− mice compared to saline ( P = 0.017 in males and P = 0.004 in females). This effect was significantly blunted in Rag-1 −/− male ( P = 0.044), but not female mice. AngII-infusion promoted increased width of the abdominal aorta, with a greater effect in males. Despite the reduction in atherosclerosis in males, Rag-1 deficiency had no significant effect on AngII-induced aortic dilation in either gender. Conclusion T and B lymphocyte deficiency attenuates AngII-induced atherosclerosis in males but not AAA formation in apoE −/− mice.

Persistency of depression is associated with subclinical coronary atherosclerosis in males: Commentary on the study of Hamer et al.

The importance of psychosocial factors such as stress, anxiety, anger and depression, as risk factors for atherosclerotic coronary artery disease, has been investigated over the years [1–4]. In the particular case of depression, which is one of the most prevalent psychiatric disorders, it has been shown that the presence of depressive symptoms was associated with worse cardiovascular prognosis in several studies, in different populations, with or without previous cardiovascular disease [1–4].

Risk Factors for and the Prevalence of Peripheral Arterial Disease and its Relationship to Carotid Atherosclerosis: The Kyushu and Okinawa Population Study (KOPS)

Peripheral arterial disease (PAD) is associated with cerebrovascular disease, ischemic heart disease, and other cardiovascular disease. We investigated the prevalence of and factors related to PAD to clarify the relationship between PAD and carotid atherosclerosis in a cross-sectional population-based study. The study included 2,402 (900 males and 1,502 females; mean+/-SD=64.9+/-10.9 years) of 3,862 residents of two Japanese rural areas who reported for a free health examination in 2005 or 2006. An ankle brachial index value < or =0.9 was considered to be PAD. The carotid artery intima-media thickness (CA-IMT) was measured by carotid ultrasound. The prevalence of PAD was 1.71% (n=41) of all participants. The risk factors independently associated with a significantly higher risk of PAD, identified by multivariate analysis, are as follows: For males, age, dyslipidemia, and CA-IMT, and for females, age, waist circumference, and dyslipidemia. The prevalence of PAD in Japan was confirmed to be lower than that of similar studies performed in other countries. PAD was strongly correlated with age and dyslipidemia in both sexes, carotid atherosclerosis in males, and abdominal fat in females.

Effects of Phase III Cardiac Rehabilitation on Mortality and Cardiovascular Events in Elderly Patients With Stable Coronary Artery Disease

Cardiac rehabilitation (CR) has numerous benefits, including reduction of mortality and cardiovascular events, in patients with coronary artery disease (CAD). However, the long-term effect of phase III CR in elderly patients with stable CAD is still unknown. The 111 elderly male CAD patients (>or=65 years), including 37 subjects participating in supervised CR for 6 months and 74 age-matched controls, were analyzed. The patients were followed for up to 3,500 days, until the occurrence of death or 1 of the following major adverse cardiovascular events (MACE): cardiovascular death, acute coronary syndrome, refractory angina requiring revascularization, admission for congestive heart failure, or stroke. All-cause mortality tended to be lower in the CR group than in the Control group (14% vs 28%, P=0.081). The MACE incidence was significantly lower in the CR group than in the Control group (30% vs 62%, P=0.001). Multivariate Cox proportional hazard analysis showed that the MACE incidence was significantly lower in the CR group than in the Control group [adjusted hazard ratio 0.43 (95% confidence interval 0.20-0.91), P=0.027]. Phase III CR has the beneficial effect of reducing cardiovascular events even in elderly patients with stable CAD.

Changes in adiponectin multimer distribution in response to atorvastatin treatment in patients with type 2 diabetes

Multimeric high molecular weight (HMW) forms of adiponectin were previously shown to be inversely associated with the extent of atherosclerosis in males and are down-regulated in patients with the metabolic syndrome and type 2 diabetes. In this study, potential influences of atorvastatin therapy on adiponectin multimer distribution were studied in patients with type 2 diabetes. The effect of 40 mg atorvastatin on HMW, medium molecular weight (MMW), and low molecular weight (LMW) isoforms of adiponectin were investigated in 75 patients (23 females; 52 males) with type 2 diabetes in an 8-week-long, placebo-controlled and randomized study. Adiponectin multimeric isoforms were detected by Western blot analysis. After atorvastatin therapy the median serum concentration of HMW adiponectin increased significantly by 42.3% (1.68 vs. 2.39 microg/ml; P < 0.001), while concentrations of MMW adiponectin and LMW adiponectin significantly decreased by 20.8% and 23.2%, respectively (MMW: 3.31 vs. 2.62 microg/ml, P = 0.047; LMW: 0.56 vs. 0.43 microg/ml, P = 0.033). Median total adiponectin levels were not significantly altered by atorvastatin treatment (6.0 vs. 6.2 microg/ml, P = 0.898). Consequently, the HMW: total-adiponectin ratio significantly increased by 25.0% (0.40 vs. 0.50; P = 0.013). Atorvastatin therapy is associated with significant changes in adiponectin multimer distribution in patients with type 2 diabetes. Since total adiponectin levels were not affected by intervention, atorvastatin may shift adiponectin size towards the HMW form.

Training-induced increase in nitric oxide metabolites in chronic heart failure and coronary artery disease: an extra benefit of water-based exercises?

Rehabilitation programs involving immersed exercises are more and more frequently used, with severe cardiac patients as well. This study investigated whether a rehabilitation program including water-based exercises has additional effects on the cardiovascular system compared with a traditional land-based training in heart disease patients. Twenty-four male stable chronic heart failure patients and 24 male coronary artery disease patients with preserved left ventricular function participated in the study. Patients took part in the rehabilitation program performing cycle endurance exercises on land. They also performed gymnastic exercises either on land (first half of the participants) or in water (second half). Resting plasma concentration of nitric oxide metabolites (nitrate and nitrite) and catecholamine were evaluated, and a symptom-limited exercise test on a cycle ergometer was performed before and after the rehabilitation program. In the groups performing water-based exercises, the plasma concentration of nitrates was significantly increased (P = 0.035 for chronic heart failure and P = 0.042 for coronary artery disease), whereas it did not significantly change in the groups performing gymnastic exercise on land. No changes in plasma catecholamine concentration occurred. In every group, the cardiorespiratory capacity of patients was significantly increased after rehabilitation. The water-based exercises seemed to effectively increase the basal level of plasma nitrates. Such changes may be related to an enhancement of endothelial function and may be of importance for the health of the patients.

Changing Patterns in Mortality and Disease Outcomes for Patients with Systemic Lupus Erythematosus

Survival of patients with systemic lupus erythematosus (SLE) has improved significantly, but new morbidities have emerged, leading to altered patterns of outcome in this disease. We examined changes in mortality and other outcomes over time in a large SLE cohort. A group of 1241 patients from the University of Toronto Lupus Clinic followed prospectively were divided into 4 entry cohorts - 1: 1970-1978, 2: 1979-1987, 3: 1988-1996, 4: 1997-2005. These cohorts were followed through four 9-year calendar periods defined over the same intervals. Both cohort and calendar effects were assessed for the following outcomes: mortality (standardized mortality ratio; SMR), disease activity over time (adjusted mean SLEDAI; AMS), cumulative damage (Systemic Lupus International Collaborating Clinics Damage Index; SDI), coronary artery disease (CAD), and osteonecrosis (ON). Cox regression models were used to further investigate mortality and the influence on it of the disease-related factors. Over the 36-year period of the study, 211 deaths occurred. The overall SMR in the first and last decades were 12.60 (95% CI: 9.13, 17.39) and 3.46 (95% CI: 2.71, 4.40) respectively. When SMR were stratified by the entry cohort and calendar period, there is evidence of a calendar-period effect but no cohort effect. The AMS decreased over the decades, while SDI, CAD, and ON increased. There were significant detrimental effects for male sex, CAD, AMS, SDI, and use of immunosuppressive drugs and significant protective effects for use of antimalarials and the effect of calendar period on mortality. Our study demonstrates improved survival in patients with SLE over a 36-year period. Disease-related variables included in the model are important factors for mortality in this SLE cohort, but could not completely explain the trend of improved survival over calendar period observed.

Conventional and non-conventional coronary risk factors in male premature coronary artery disease patients already having a low Framingham risk score

Background — Individual risk factors and, more importantly, global risk assessment tools such as the Framingham risk score have been used successfully for risk prediction especially in older patients. However, there is paucity of data about the coronary heart disease prediction in premature coronary artery disease patients with a low Framingham risk score.Methods and results — We recruited 102 consecutive young patients without hypertension and diabetes mellitus in the study. All subjects had had chest pain and underwent coronary angiography since non-invasive diagnostic test results suggested ischaemia. Forty-five patients having at least one coronary lesion independent of severity were included in the study group.The remaining fifty-seven subjects without any coronary lesion were used as control group. Conventional and non-conventional risk factors were evaluated both in patients and control subjects. Framingham risk score and absolute 10-year hard CHD events risk were also calculated for each individual.The coronary heart disease group had a significantly higher smoking frequency as compared to the control group. They also had higher plasma levels of triglycerides, apolipoprotein B and apo B/A1 ratio but a smaller LDL particle size.We failed to find any independent CHD predictor after logistic regression analysis. However, individual ROC curve analysis of risk factors revealed that apolipoprotein B, triglycerides and apo B/A1 ratio have the highest area under the curve for coronary artery disease prediction.Conclusions — The Framingham risk score may underestimate the true risk of an individual. Incorporating non-conventional risk factors such as apolipoprotein B and apo B/apo A1 ratio may provide valuable information in these patients.

Hs-CRP and oxidative stress in young CAD patients: A pilot study

Premature coronary artery disease (CAD) is common in India. We, therefore, studied oxidative stress, dyslipidemia, and high sensitivity-C reactive protein (hs-CRP) levels in young CAD patients. Present study consisted of male CAD patients below 40 years and age and sex matched healthy controls (n=30 each). Fasting blood samples were analyzed for serum lipid profile, malondialdehyde, antioxidant enzymes and hs-CRP levels. Dyslipidemia was observed in 90% of the young CAD patients, of which 72.2% showed increased serum triglycerides and decreased HDL-cholesterol. LDL-cholesterol levels were high in 77.8%. Serum malondialdehyde and hs-CRP levels were increased significantly (p<0.0001) as compared to controls. hs-CRP levels were in high risk range in all the young patients. However, glutathione peroxidase activity was reduced significantly (p<0.05). Our data suggests that elevated hs-CRP levels along with dyslipidemia and oxidative stress adds to the predictive value of premature CAD in young Indians.

RAS gene polymorphisms, classical risk factors and the advent of coronary artery disease in the Portuguese population

BackgroundSeveral polymorphisms within the renin-angiotensin system cluster of genes have been associated with the advent of coronary artery disease (CAD) or related pathologies. We investigated the distribution of 5 of these polymorphisms in order to find any association with CAD development and distinguish if any of the biochemical and behavioural factors interact with genetic polymorphisms in the advent of the disease.MethodsACE I/D (rs4340), ACE A11860G (rs4343), AT1R A1166C (rs5186), AGT T174M (rs4762) and AGT M235T (rs699) gene polymorphisms were PCR-RFLP analysed in 298 CAD patients and 510 controls from Portugal. Several biochemical and behavioural markers were obtained.ResultsACE I/D DD and ACE11860 GG genotypes are risk factors for CAD in this population. The simultaneous presence of ACE I/D I and ACE11860 A alleles corresponds to a significant trend towards a decrease in CAD incidence. We found several synergistic effects between the studied polymorphisms and classical risk factors such as hypertension, obesity, diabetes and dyslipidaemia: the presence of the DD genotype of ACE I/D (and also ACE11860 GG) increases the odds of developing CAD when associated to each one of these classical risk factors, particularly when considering the male and early onset CAD subgroup analysis; AGT235 TT also increases the CAD risk in the presence of hypertension and dyslipidaemia, and AT1R1166 interacts positively with hypertension, smoking and obesity.ConclusionACE polymorphisms were shown to play a major role in individual susceptibility to develop CAD. There is also a clear interaction between RAS predisposing genes and some biochemical/environmental risk factors in CAD onset, demonstrating a significant enhancement of classical markers particularly by ACE I/D and ACE11860.