Coronary Artery Disease In People Research Articles

Insulin sensitivity estimates and their longitudinal association with coronary artery disease in type 1 diabetes. Does it matter?

BackgroundInsulin resistance and chronic kidney disease are both associated with increased coronary artery disease risk. Many formulae estimating glucose disposal rate in type 1 diabetes infer insulin sensitivity from clinical data. We compare associations and performance relative to traditional risk factors and kidney disease severity between three formulae estimating the glucose disposal rate and coronary artery disease in people with type 1 diabetes.MethodsThe baseline glucose disposal rate was estimated by three (Williams, Duca, and Januszewski) formulae in FinnDiane Study participants and related to subsequent incidence of coronary artery disease, by baseline kidney status.ResultsIn 3517 adults with type 1 diabetes, during median (IQR) 19.3 (14.6, 21.4) years, 539 (15.3%) experienced a coronary artery disease event, with higher rates with worsening baseline kidney status. Correlations between the three formulae estimating the glucose disposal rate were weak, but the lowest quartile of each formula was associated with higher incidence of coronary artery disease. Importantly, only the glucose disposal rate estimation by Williams showed a linear association with coronary artery disease risk in all analyses. Of the three formulae, Williams was the strongest predictor of coronary artery disease. Only age and diabetes duration were stronger predictors. The strength of associations between estimated glucose disposal rate and CAD incidence varied by formula and kidney status.ConclusionsIn type 1 diabetes, estimated glucose disposal rates are associated with subsequent coronary artery disease, modulated by kidney disease severity. Future research is merited regarding the clinical usefulness of estimating the glucose disposal rate as a coronary artery disease risk factor and potential therapeutic target.

Increased Risk of Coronary Artery Disease in People with Diagnosis of Neuromuscular Disorders: A Nationwide Retrospective Population-Based Case-Control Study.

The existing literature has explored carpal tunnel syndrome (CTS) and determined that it could be a risk for coronary artery disease (CAD), but there has been little research comparing the relevance of CAD with other neuromuscular disorders (NMDs) to CTS. This case-control study explored the association between CTS, stenosing tenosynovitis (ST), and ulnar side NMDs and CAD. The study utilized data from Taiwan's National Health Insurance Research Database, focusing on health insurance claims. Between January 2000 and December 2011, we employed the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes to identify 64,025 CAD patients as the case group. The control group consisted of an equal number of individuals without CAD, matched for age, sex, and index year of CAD. Logistic regression analysis was employed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for each variable. Multivariate analysis, after adjusting for sociodemographic factors and comorbidities, revealed a significantly higher likelihood of a previous diagnosis of CTS in the CAD group compared to the comparison control group. However, neither ST nor the ulnar side NMDs had any statistical significance. These results indicated that median nerve injury, rather than other NMDs, may uniquely serve as a predisposing factor of CAD.

Gut Microbiota Alterations and Circulating Imidazole Propionate Levels Are Associated With Obstructive Coronary Artery Disease in People With HIV.

The impact of gut microbiota and its metabolites on coronary artery disease (CAD) in people with human immunodeficiency virus (PWH) is unknown. Emerging evidence suggests that imidazole propionate (ImP), a microbial metabolite, is linked with cardiometabolic diseases. Fecal samples from participants of the Copenhagen Comorbidity in HIV infection (COCOMO) study were processed for 16S rRNA sequencing and ImP measured with liquid chromatography-tandem mass spectrometry. CAD severity was investigated by coronary computed tomography-angiography, and participants grouped according to obstructive CAD (n = 60), nonobstructive CAD (n = 80), or no CAD (n = 114). Participants with obstructive CAD had a gut microbiota with lower diversity and distinct compositional shift, with increased abundance of Rumiococcus gnavus and Veillonella, known producers of ImP. ImP plasma levels were associated with this dysbiosis, and significantly elevated in participants with obstructive CAD. However, gut dysbiosis but not plasma ImP was independently associated with obstructive CAD after adjustment for traditional and HIV-related risk factors (adjusted odds ratio, 2.7; 95% confidence interval, 1.1-7.2; P = .048). PWH with obstructive CAD displays a distinct gut microbiota profile and increased circulating ImP plasma levels. Future studies should determine whether gut dysbiosis and related metabolites such as ImP are predictive of incident cardiovascular events.

Estimation of Risk and Proportion of Coronary Artery Disease in People Living with HIV/AIDS in Indian Setting: A Pilot Study

Abstract Objective: The objective of this study was to assess the Framingham Risk Score as well as the prevalence of coronary artery disease (CAD) in people living with HIV/AIDS (PLHA) male patients, in an Indian setting. Design: This descriptive pilot study was conducted in a multispecialty hospital which is a reference center for HIV/AIDS. Materials and Methods: The study included 50 HIV-positive male patients who underwent basic biochemical analysis, namely lipid profile, blood sugar (fasting), electrocardiogram, CD4 count along with basic personal history (including smoking habits and lifestyle), course of disease progression, and drug history. All were subjected to a two-dimensional echocardiogram and treadmill test (TMT). Subjects with a positive TMT underwent a confirmatory stress thallium/coronary angiography. Framingham Risk Scores were calculated, using standard scoring charts. Standard protocol forms were made for each patient. Results: The median diagnosed duration of HIV disease was 2.8 years (range: 0.5–7 years). The median 10-year risk of CAD (as calculated from the Framingham scores) was 1%. Major contributing risk factors were dyslipidemia, diabetes, and hypertension and were found to be greater as compared to published literature. Four patients had positive TMT, but all four had a negative, coronary angiogram. Conclusions: Biological plausibility suggests that CAD may be more common in PLHA due to the chronic inflammatory nature of the disease and the effects of the dyslipidemia effect of ART; however, our pilot study with the limitations could not substantiate this.

463-P: Risk Stratification of Coronary Artery Disease (CAD) according to LDL-C, HDL-C Levels, and Glucose Status

Whereas elevated LDL-C is a major risk factor for CAD, the inverse association between HDL-C levels and risk of CAD is well-known. Although insulin resistance, and glucose intolerance are associated with low HDL-C levels, it is not clear whether the association of LDL-C with CAD differs depending on glucose status and HDL-C values. We examined associations of LDL-C with the incidence of CAD according to HDL-C and glucose status using a nationwide claims database on 1,524,289 individuals during 2008-2019 with no history of CAD or familial hypercholesterolemia. Cox proportional hazards model identified risks of CAD events among combinations of 3 levels of HDL-C and 7 levels of LDL-C according to glucose status. During a mean follow-up period of 5.5 years, 8,301 CAD events occurred. CAD risk increased from lower LDL-C levels accompanied by lower HDL-C levels regardless of glucose status (Table). Even in people with LDL-C <80mg/dl, HDL-C <40mg/dl conferred 2.5-fold increased risk of CAD all glucose status. HDL-C and LDL-C values had a synergistic effect on the incidence of CAD in people with normoglycemia, whereas an addictive effect in people with prediabetes and diabetes. Although more strict LDL-C target need to be achieved as worsening of glucose status, results demonstrated that the necessity of modulating the LDL-C target according to HDL-C levels is not affected by glucose status. Disclosure M.H.Yamada: None. M.Iwanaga: None. T.Yamada: None. S.Kodama: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. T.Osawa: None. M.Kitazawa: None. Y.Yaguchi: None. T.Sato: None. Y.Mitsuma: None. M.Yamamoto: None. Y.Matsubayashi: None.

Abstract P626: Associations of Supervised and Home-Based Exercise With Serious Adverse Event Rates During Exercise Interventions for Peripheral Artery Disease: A Meta-Analysis of Five Randomized Clinical Trials

Background: Supervised or home-based walking exercise therapy (ET) are guideline recommended to improve walking performance in people with peripheral artery disease (PAD). This study compared serious adverse event (SAE) rates associated with home-based compared to supervised exercise in people randomized into clinical trials of ET for PAD. Methods: Data from five randomized clinical trials of ET for PAD were combined. In three trials (GOALS, HONOR, and LITE), participants were randomized to home-based ET or control. In two trials (PROPEL and TELEX), participants were randomized to supervised ET or control. The primary outcome in all trials was change in six-minute walk. SAEs consisted of hospitalization or death and were identified from participants, family members, and medical records. In post-hoc analyses, a meta-analysis compared associations of supervised ET and home-based ET on odds of a SAE or death. Control groups from the trials of supervised and home-based ET were not combined. Results: 867 unique participants were included (mean age + SD: 69 ±10 years, 47% female, 57 % Black, mean + SD ABI 0.66 ±0.15). Results are shown in the Table. Conclusion: In clinical trials of home-based ET, rates of coronary revascularizations and cardiovascular events were significantly higher in participants randomized to exercise, compared to control. However, there were no significant differences in rates of coronary revascularizations or cardiovascular events between participants randomized to home-based, compared to supervised ET. Improved walking performance from home-based exercise may precipitate symptoms from underlying coronary artery disease in people with PAD.

Assessment of Association of ITLN1 SNPs rs2274907A>T and rs2274908 G>A with Coronary Artery Disease in People from Punjab

The objectives of the present study were to determine the genotype and allele frequency distributions of rs2274907 and rs2274908 SNPs of the ITLN1 gene in CAD cases (n=206) and controls (n=206) inhabiting the state of Punjab in northwest India and to seek association, if any, of these SNPs with CAD. Age, lifestyle patterns, dietary habits and various biochemical traits (CHOL, TG, HDL, LDL and VLDL) were examined for possible association with the studied SNP genotypes in CAD cases. Statistically significant differences were found between CAD cases and controls in physical activity (OR=0.27, p<0.0001), alcohol intake (OR=0.67, p=0.04), smoking (OR=1.93, p=0.001), diet type (OR=1.76, p=0.011) and fruit intake (OR=2.62, p<0.0001). All biochemical trait differences were also found to be highly statistically significant (p<0.0001). The present case-control study revealed that both the SNPs at ITLN1 locus were statistically significantly associated with the occurrence of CAD in the people of Punjab.

Factors associated with the development of coronary artery disease in people with HIV.

People living with HIV (PLHIV) are at increased risk for coronary artery disease (CAD). This study aimed to describe the features associated with CAD in PLHIV. A case ([n =160] PLHIV with CAD) control ([n =317] PLHIV matched by age and sex without CAD) study was performed at the Alfred Hospital, Melbourne, Australia (January 1996 and December 2018). Data collected included CAD risk factors, duration of HIV infection, nadir and at-event CD4+ T-cell counts, CD4:CD8 ratio, HIV viral load, and antiretroviral therapy exposure. Participants were predominantly male (n =465 [97.4%]), with a mean age of 53years. Traditional risk factors associated with CAD in univariate analysis included hypertension (OR 11.4 [95%CI 5.01, 26.33], P <0.001), current cigarette smoking (OR 2.5 [95% CI 1.22, 5.09], P =0.012), and lower high-density lipoprotein cholesterol (OR 0.14 [95%CI 0.05, 0.37], P <0.001). There was no association between duration of HIV infection, nadir or current CD4 cell count. However, current and ever exposure to abacavir (cases: 55 [34.4%]; controls: 79 [24.9%], P =0.023 and cases: 92 [57.5%]; controls: 154 [48.6%], P =0.048, respectively) was associated with CAD. In conditional logistic regression analysis, current abacavir use, current smoking, and hypertension remained significantly associated (aOR=1.87 [CI=1.14, 3.07], aOR=2.31 [1.32, 4.04], and aOR=10.30 [5.25, 20.20] respectively). Traditional cardiovascular risk factors and exposure to abacavir were associated with CAD in PLHIV. This study highlights that aggressive management of cardiovascular risk factors remains critical for reducing risk in PLHIV.

ODP174 Correlation of Advanced Fibrosis and Coronary Artery Disease Risk Scores in People With Type 2 Diabetes in a Tertiary Care Centre

Abstract Nonalcoholic fatty liver disease (NAFLD) and Type 2 diabetes mellitus (T2DM) are common conditions that often coexist and can act synergistically to cause adverse effects. The presence of both NAFLD and T2DM increases the likelihood of developing diabetes complications (including both macro and microvascular complications), and enhances the risk of cirrhosis, hepatocellular carcinoma and death. NAFLD screening is often neglected in routine clinical practice. Fibro scan is a more sensitive modality for diagnosis of liver fibrosis and scarring. Liver stiffness measurements predict advanced fibrosis in people with diabetes The current study aims to correlate liver stiffness measurements and coronary artery disease risk scores in people with type 2 diabetes in a tertiary care centre Material and Methods: - A total of 181 people with diabetes coming for the first time at our centre underwent liver stiffness measurements using fibro scan after taking consent, people on prior lipid-lowering therapy and thiazolidinedione therapy were excluded from the study. We used the risk score model for the assessment of coronary artery disease in asymptomatic patients with type 2 diabetes [ https://paperpile.com/c/XKqsdv/PpmxP 1 ] because it was easy to use, specific for Asian population and validated with coronary computed tomographic angiography (CCTA) in asymptomatic people with type 2 diabetes. Out of the total of 181 subjects 51% were males and 49% were females, mean age was 50.2 years, duration of diabetes was 7.6years, Hba1c values ranged from 6. 0%-15%(mean 8.5%), median stiffness ranged from 2.3kpa to 34.8kpa (median of 8. 0kpa).50 out of 181(27.62%) had advanced fibrosis(liver stiffness measurements(LSM values of &amp;gt;9. 0). Advanced fibrosis had a significant(p&amp;lt;. 001) correlation with coronary artery risk scores with a correlation coefficient of 0.570. Advanced fibrosis is associated with increased risk of coronary artery disease in people with type 2 diabetes BIBLIOGRAPHY 1. http://paperpile.com/b/XKqsdv/PpmxP. Park G-M, An H, Lee S-W, Cho Y-R, Gil EH, Her SH, et al. Risk Score Model for the Assessment of Coronary Artery Disease in Asymptomatic Patients With Type 2 Diabetes. Medicine [Internet]. 2015 Jan [cited 2020 Oct 14];94(4): e508. Available from: https://journals.lww.com/md-journal/Fulltext/2015/01040/Risk_Score_Model_for_the_Assessment_of_Coronary.44.aspx Presentation: No date and time listed

Cytomegalovirus Immunoglobulin G (IgG) Titer and Coronary Artery Disease in People With Human Immunodeficiency Virus (HIV).

Cytomegalovirus (CMV) infection is thought to result in increased immune activation in people with human immunodeficiency virus (HIV, PWH). Although some data have linked asymptomatic CMV infection to cardiovascular disease among PWH, it remains unknown whether CMV is associated with increased or high-risk coronary plaque. The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) enrolled PWH aged 40-75 years on stable antiretroviral therapy (ART) with low-to-moderate atherosclerotic cardiovascular disease (ASCVD) risk. Among a subset of US REPRIEVE participants, coronary plaque was assessed by coronary computed tomography angiography. Here, we assessed the relationship between CMV immunoglobulin G (IgG) titer and (1) levels of immune activation, (2) inflammatory biomarkers, and (3) coronary plaque phenotypes at study entry. Of 672 participants, mean age was 51 years, 83% were men, median ASCVD risk score was 4.5%, and 66% had current CD4+ T-cell count ≥500 cells/mm3. Higher CMV IgG quartile group was associated with older age and lower current and nadir CD4+ T-cell counts. CMV IgG titer was associated with specific inflammatory biomarkers (sCD163, MCP-1, interleukin [IL]-6, hsCRP) in univariate analysis, but not after controlling for HIV-specific factors. In contrast, CMV IgG titer was not associated with coronary artery disease indexes, including presence of plaque, coronary artery calcium (CAC) score >0, vulnerable plaque presence, or Leaman score >5. No meaningful association was seen between CMV IgG titer and coronary artery disease indexes among ART-treated PWH at study enrollment. Longitudinal assessments in REPRIEVE will determine the relationship of CMV IgG titer to plaque progression and cardiovascular events. NCT02344290.

Oxidative and antioxidant changes in blood of young people with premature coronary artery disease and abdominal obesity

Aim. To study the oxidative and antioxidant blood profile in young people with premature coronary artery disease (CAD) and abdominal obesity (AO).Material and methods. The study included 169 people. The main group consisted of 47 patients diagnosed with premature (&lt;45 years of age) CAD, while 22 of them with AO and 25 without AO. The control group included 122 people without CAD, comparable with the main group in sex, age and body mass index. Among them, there are 67 people with AO and 55 people without AO. In all examined patients, the blood levels of total cholesterol, triglycerides, high-density lipoprotein cholesterol, MDA-modified oxidized high-density lipoprotein, superoxide dismutase (SOD), glutathione peroxidase 1, and whole blood total antioxidant capacity (TAC) were determined. Statistical processing was carried out in the SPSS 13.0 program.Results. The blood TAC was 2,3 times lower in persons with CAD than in those without CAD, and amounted to 1,58 mmol of trolox. The blood level of SOD in patients with CAD was 1,16 times higher than in the group of people without CAD. The relative odds of premature CAD were associated with decreased TAC (B=-2,855; Exp(B)=0,058; 95% confidence interval (CI), 0,008-0,392; p=0,004) and increased level of SOD (B=0,105; Exp(B)=1,076; 95% CI, 1,031-1,196; p=0,006), regardless of sex, age, risk factors. Conclusion. Thus, an increased SOD and reduced TAC can be potential biomarkers for premature CAD in people under 45 years of age.

Proteomic Signature of Subclinical Coronary Artery Disease in People With HIV: Analysis of the REPRIEVE Mechanistic Substudy.

People with HIV (PWH) have subclinical coronary artery disease (CAD) despite low traditional atherosclerotic cardiovascular disease (ASCVD) risk scores. Coronary plaque in PWH presents as a unique phenotype, but little is known about the contributions of specific inflammatory pathways to plaque phenotypes in PWH. The REPRIEVE Mechanistic Substudy enrolled PWH on ART without known cardiovascular disease. We used a targeted discovery proteomics approach to evaluate 246 unique proteins representing cardiovascular, inflammatory, and immune pathways. Proteomic signatures were determined for presence of coronary artery calcium (CAC > 0) and presence of coronary plaque. Data were available for 662 participants (aged 51 [SD 6] years, ASCVD risk score 4.9% [SD 3.1%]). Among 12 proteins associated with both CAC and presence of coronary plaque, independent of ASCVD risk score, the odds ratios were highest for NRP1: 5.1 (95% confidence interval [CI], 2.3-11.4) for CAC and 2.9 (95% CI, 1.4-6.1) for presence of plaque. Proteins uniquely related to presence of plaque were CST3, LTBR, MEPE, PLC, SERPINA5, and TNFSF13B; in contrast, DCN, IL-6RA, OSMR, ST2, and VCAM1 were only related to CAC. Distinct immune and inflammatory pathways are differentially associated with subclinical CAD phenotypes among PWH. This comprehensive set of targets should be further investigated to reduce atherosclerosis and ASCVD in PWH. NCT02344290.

Coronary Artery Disease in People Living with Human Immunodeficiency Virus

Abstract People living with HIV live longer now due to highly active antiretroviral therapy. Due to their increased life expectancy, they have an increased cardiovascular risk cause by the traditional risk factors (smoking, use of ilicit drugs, obesity/lipodystrophy, dyslipidemia, diabetes, hypertension) and particular risk factors (endothelial dysfunction, inflammation, coagulation abnormalities, viral coinfections and antiretroviral therapy. The pathophysiology of accelerated atherosclerosis is complex. Coronary artery disease become an important cause of mortality in these patients. The incidence of coronary artery disease and especially of acute myocardial infarction is generally low among HIV patients, but it may by twice as high as in patients with the similar characteristics. Medical treatment for coronary disease in these patients has no special particularities comparing to general population, but possible drug interactions must be considered. Indication for coronary revascularization, either angioplasty, or aorto-coronary by-pass follows general indications for general population.

Current management and screening of peripheral and coronary artery disease in people with diabetes mellitus in Europe. The PADDIA/CADDIA survey

AimsThis survey aimed to evaluate the current management and screening of coronary artery disease and peripheral artery disease in people with type 2 diabetes mellitus (T2DM) in Europe, utilizing the 2013 ESC/EASD (European Society of Cardiology/European Association for the Study of Diabetes) guidelines as a benchmark. MethodsThe PADDIA/CADDIA survey is a European medical research collaboration targeting cardiologists, vascular physicians, diabetologists and general practitioners from Austria, Belgium, France, Germany, Italy, Netherlands and United Kingdom. ResultsThe questionnaire was completed by sixty-three physicians, of whom 75% declared assessing the cardiovascular risk of people with T2DM mostly without using a risk score (59%). More than 90% of the panel, check HbA1c, blood pressure and low-density lipoprotein cholesterol targets in their patients with T2DM and coronary or peripheral artery disease. For 94% the presence of T2DM influence their patients’ management, by optimizing blood glucose, blood pressure and low-density lipoprotein cholesterol control. Only 37% considered screening for lower extremity peripheral artery disease among their T2DM patients and 35% among those with cardiovascular disease. ConclusionsPhysicians mostly follow the ESC/EASD 2013 guidelines, but when it comes to screening for additional conditions including coronary artery disease or peripheral artery disease, or intensifying the antithrombotic regimen there is need for better guidance.

Analysis of Coronary Artery Lesion Degree and Related Risk Factors in Patients with Coronary Heart Disease Based on Computer-Aided Diagnosis of Coronary Angiography.

A combination of various risk factors results in the development of coronary heart disease. The earlier that one identifies and deals with reversible risk factors for coronary heart disease, the greater the chance of recovery. The main goal of this research is to learn whether risk variables are associated with greater extent of coronary artery disease in people with coronary heart disease. This article selects 290 patients who had had coronary angiography in our hospital from September 2018 to March 2019 using a retrospective research and analytic methodology. Coronary angiography split the patients into two groups: those with coronary heart disease and those without. To determine the correlation between risk factors and a score related to heart disease, computer-aided statistical analysis of data about the differences in those risk factors was performed. The results were analyzed using the Spearman correlation and partial correlation, and the relationship between risk factors and Gensini score was analyzed by multiple linear regression. For the analysis, binary logistic regression was used to calculate the correlation between the risk factors of coronary heart disease and the probability of developing coronary heart disease. The findings concluded that increased age, smoking, elevated hs-CRP, HbA1c, hypertension, diabetes, and hyperuricemia are all contributors to coronary heart disease. Coronary heart disease is an independent risk factor for this condition. Many of the factors that play a role in the long-term development of the severity of coronary artery disease, such as hypertension, diabetes, smoking, elevated hs-CRP, decreased HDL-C, raised LDL-C, and TG, are commonly found in men. hs-CRP is the primary risk factor for the degree of coronary artery stenosis and could contribute to the progression of the condition by playing a major role in creating more stenosis.

The effect of preventative cardiovascular therapies on coronary artery disease in people with and without type 2 diabetes: a propensity-matched score study

BackgroundAlthough it is known that patients with Type 2 Diabetes Mellitus (T2DM) are at an increased risk of coronary artery disease (CAD), the actual coronary artery burden of atherosclerotic disease in patients with and without T2DM in a real-world setting and its possible modification by preventative therapies has not been extensively documented.MethodsMerged coronary angiography and hospital discharge data between 2013 and 2019 were obtained for analysis and a random sub-sample of patient charts were reviewed for medication use. Propensity scores were estimated using logistic regression models and used to match patients, looking at the effect of severity of CAD over time in years in an ordinal logistic regression model. A separate propensity score was estimated and used to inverse probability weight the ordinal logistic regression looking at the effect of medication use on CAD severity in patients with and without T2DM.ResultsFrom 3,016 patients in the coronary angiography database, 1421 with T2DM and 1421 without T2DM were matched on propensity score. T2DM patients had more extensive CAD in 2018 compared to 2013 ((adjusted odds ratio) adjOR: 2.06 95% C.I. 1.38, 2.07), but this risk appeared to be attenuated in 2019. In contrast, there was no effect of time on CAD burden in patients without diabetes. In the sub-sample of 760 patients who underwent a chart review of their medication use, there were 367 (48%) with T2DM. For patients with T2DM 69.8% reported taking statins, 64.0% RAS inhibitors and 64.0% anti-platelet drugs. This was significantly higher than patients without diabetes of whom 46.6% reported taking statins, 49.0% RAS inhibitors and 49.9% anti-platelet drugs. As in the full matched sample, patients with diabetes had more extensive CAD (adjOR: 1.32 95% CI: 1.01, 1.74). However, after adjustment for the use of RAS inhibitors, statins and anticoagulants there was no difference in extent of CAD between patients with and without diabetes (adjOR: 1.14 95% CI: 0.85, 1.53).ConclusionsAlthough patients with diabetes have a greater extent of CAD in comparison to those without T2DM, preventative medication use decreases this CAD burden significantly.

In Type 2 Diabetes Mellitus Patients, the Atherogenic Index of Plasma as a Marker of Coronary Artery Diseases

One-third of all deaths globally are caused by cardiovascular disease (CVD), and this percentage is predicted to climb as CVD risk factors become more widespread. Primary prevention of risk factors is the most fundamental duty in dealing with the CVD epidemic. The link between atherogenic index of plasma (AIP) and other CVD risks among university workers was investigated among study participants in order to demonstrate that AIP, not lipid profile, is a better predictor of CVDs. They discovered a link between AIP and CVD risk variables (body mass index, visceral fat, body fat, total cholesterol, low density lipoprotein cholesterol, triglyceride, glucose, and high density lipoprotein cholesterol) in people with type 2 diabetes. This comparative study was carried out in Cardiology Department, Zagazig University Hospitals. This study included 140 type 2 diabetes mellitus patients. They were classified into 2 main groups: Group 1: 70 patients with type 2 diabetes who had coronary artery disease (CAD). Group (2): 70 type 2 diabetes individuals with no indicators of CAD (admitted complaining of symptoms of angina or CA showing no significant stenotic lesions). Regarding study explained it has showed that AIP outperforms standard lipid indicators in predicting the likelihood ofdeveloping CADs in people with type 2 diabetes. In addition, the value of AIP in diabetic and prediabetic patients for predicting future CVD is being investigated. They came to the conclusion that AIP is an excellent predictor of future CVD in those with diabetes and those who are prediabetic.

Wearable Devices: A Future Useful Tool for Detection of Silent Ischemia in Patients with Diabetes?

As smartphone health care technology continues to evolve, many wearable devices are equipped with Electrocardiographic (ECG) recording. Recently, studies examining the possibility of various wearable devices for continuous ECG recording showed their ability to detect ST-segment alterations. It is known that in almost a quarter of people with diabetes, the presentation of an acute coronary syndrome may be atypical or even asymptomatic (“silent”), and it has been associated with adverse prognosis. The precise mechanisms behind the lack of pain in patients suffering from silent myocardial ischemia remain unknown. The attractive hypothesis that clinicians could use a wearable ECG recording to detect and treat earlier patients suffering from silent myocardial ischemia might change the adverse prognosis of those patients. However, before their clinical application, several obstacles should be overcome in order the physicians to obtain an additional powerful tool in the fight against coronary artery disease in people with diabetes.

Screening for Asymptomatic Coronary Artery Disease in People With Type2 Diabetes Mellitus in a Tertiary Care Center

Cardiovascular disease is the biggest driver of mortality in people with diabetes. Cardiovascular disease and diabetes share the same risk factors, the so-called “common soil” hypothesis. Asians and more specifically Indians are predisposed to cardiovascular disease, that too at an earlier age. The cost of management of cardiovascular disease in India is prohibitive. Thus, screening for asymptomatic coronary artery disease in people with type 2 diabetes and referring them for further evaluation will go a long way in preventing cardiovascular mortality. 560 consenting previously diagnosed people with type 2 diabetes, undergoing treatment for type 2 diabetes at our center, were recruited in the study. We used the risk score model for the assessment of coronary artery disease in asymptomatic patients with type 2 diabetes (1) because it was easy to use, specific for Asian population and validated with coronary computed tomographic angiography in asymptomatic people with type 2 diabetes. Questions regarding smoking, past history of stroke and duration of diabetes were recorded as per the risk score and accordingly the subjects were labelled low, intermediate and high risk. Anthropometric measurements were recorded, lipid profile was measured, neuropathy assessment was done using the DNS score. Results: 48.9%subjects were females,51.1% were males, mean duration of diabetes was 3.5 years, mean HbA1c was 8.5%, mean BMI 26.5kg/m2, mean age was 51.4 years, mean CAD score was 4.1 44.2% of the subjects were in a low risk category, 44.9% were in the intermediate risk category and 10.9% in the high-risk category. The maximum people had intermediate to high risk and were in the age group of 50–60 years (21.3%), followed by 13% in the 60–70 age group. Surprisingly, 12.6% people in the 40-50year age group had an intermediate to high risk score for ASCVD. The high prevalence of intermediate to high risk in relatively younger populations with shorter duration of diabetes (mean duration of diabetes 3.5 years) mandates universal screening for asymptomatic coronary artery disease in all people with type 2 diabetes mellitus. Our study highlights the importance of identifying asymptomatic coronary artery disease using locally relevant risk models and their timely referral to prevent excessive cardiovascular mortality in people with type 2 diabetes mellitus. This would ensure optimum utilization and prioritization of scarce resources in resource crunch situations. Keywords: Screening, asymptomatic CAD, type 2 diabetes mellitus.

Association of apolipoprotein C3 with insulin resistance and coronary artery calcium in patients with type 1 diabetes

Apolipoprotein C3 (APOC3) is a risk factor for incident coronary artery disease in people with type 1 diabetes (T1D). The pathways that link elevated APOC3 levels to an increased risk of incident cardiovascular disease in people with T1D are not understood. To explore potential mechanisms, we investigated the association of APOC3 with insulin resistance and coronary artery calcium (CAC). In a random subcohort of participants with T1D from Coronary Artery Calcification in Type 1 Diabetes (n=134), serum APOC3, high-density lipoprotein (HDL)-associated APOC3, and retinol binding protein 4 (RBP4; a potential marker of insulin resistance) were measured by targeted mass spectrometry. We used linear regression to evaluate associations of serum APOC3 and HDL-APOC3 with APOB, non-HDL cholesterol, serum- and HDL-associated RBP4, and estimated insulin sensitivity and logistic regression to evaluate association with presence of CAC, adjusted for age, sex, and diabetes duration. Serum APOC3 correlated positively with APOB and non-HDL cholesterol and was associated with increased odds of CAC (odds ratio: 1.68, P=.024). Estimated insulin sensitivity was not associated with serum- or HDL-RBP4 but was negatively associated with serum APOC3 in men (ß estimate: -0.318, P=.0040) and decreased odds of CAC (odds ratio: 0.434, P=.0023). Serum APOC3 associates with increased insulin resistance and CAC in T1D.