Coronary Artery Disease In Persons Research Articles

434-P: Urinary Proteome Classifiers in Prediabetes Clusters

Objective: Patients with prediabetes have recently been classified into 6 prediabetes clusters, that stratify the risk of diabetes and complications. Cluster 1, 2 and 4 are low risk-clusters while cluster 3, 5 and 6 are high-risk clusters. Of notice, especially patients of cluster 6 have an elevated risk of nephropathy despite their low diabetes risk. To investigate if differences across clusters can be captured from urine peptidome, we studied differences in pre-specified urinary peptidome classifiers across age and sex matched participants from 6 prediabetes clusters (n=249, median age 46 (IQR 39 - 54) years, BMI 30.4 (26.9 - 39.4) kg/m², HbA1c 5.5 (5.3 - 5.8) %). Methods: Peptides in spot urine samples collected at the University Hospital Tuebingen from 11/2004 to 11/2012 were investigated using capillary electrophoresis coupled mass spectroscopy. The following classifiers based on multiple urine peptides had been developed to detect different conditions and were assessed: CKD273 (chronic kidney disease, CKD), validated in a large clinical cohort), HF1 and HF2 (heart failure), CAD238 (coronary artery disease, CAD), Col_death (collagen type-1 turnover), solid_tumor (solid tumor). Matsuda index and NEFA insulin sensitivity index (ISI) were used for estimation of insulin sensitivity. Results: The urinary peptidome classifiers CKD273, HF2 and CAD238 were significantly different between prediabetes clusters, with elevated values in cluster 6 compared to the healthiest cluster 2. These classifiers also correlated with Matsuda index and NEFA ISI. Classifiers HF1, Col_death and solid_tumor did not associate with prediabetes clusters or insulin sensitivity indices. Conclusions: Beyond corroboration of a previously described increased risk of CKD, urinary peptidome classifiers suggest elevated risk of heart failure and coronary artery disease in persons of the prediabetes cluster 6. This could underlie increased mortality in this group, independent of diabetes development. Disclosure A.Schork: None. A.L.Birkenfeld: None. R.Wagner: Advisory Panel; Daiichi Sankyo, Speaker's Bureau; Novo Nordisk, Sanofi. A.Fritsche: Advisory Panel; Novo Nordisk, Lilly, Sanofi, Boehringer-Ingelheim, Speaker's Bureau; AstraZeneca, SYNLAB Holding Deutschland GmbH. E.D.Schleicher: None. A.Peter: None. M.Heni: Advisory Panel; Boehringer-Ingelheim, Sanofi, Research Support; Boehringer Ingelheim Inc., Speaker's Bureau; Lilly, Bayer Inc., Sanofi, Boehringer-Ingelheim, Novo Nordisk, Amryt Pharma Plc. N.Stefan: Advisory Panel; Pfizer Inc., Research Support; Sanofi, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Lilly Diabetes, Novo Nordisk, Sanofi-Aventis Deutschland GmbH. R.Jumpertz von schwartzenberg: Other Relationship; Sanofi, Amgen Inc., Lilly, Novo Nordisk. H.Mischak: Stock/Shareholder; Mosaiques Diagnostics. J.Siwy: Employee; Mosaiques-Diagnostics GmbH.

Coronary Artery Disease in Persons With Human Immunodeficiency Virus Without Detectable Viral Replication.

We aimed to determine the prevalence of coronary artery disease (CAD) in persons with human immunodeficiency virus (HIV; PWH) and investigate whether inflammatory markers, including interleukin 6, IL-1β, and high-sensitivity C-reactive protein (hsCRP), were associated with CAD. From the Copenhagen Comorbidity in HIV Infection (COCOMO) study, we included virologically suppressed PWH who underwent coronary computed tomographic (CT) angiography. Any atherosclerosis was defined as >0% stenosis, and obstructive CAD as ≥50% stenosis. Among 669 participants (mean age [standard deviation], 51 [11] years; 89% male), 300 (45%) had atherosclerosis, and 119 (18%) had obstructive CAD. The following risk factors were associated with any atherosclerosis and with obstructive CAD: age, male sex, hypertension, diabetes, smoking, dyslipidemia, time with HIV, and current protease inhibitor use. Interleukin 6 (IL-6) and hsCRP levels >2 mg/L were associated with any atherosclerosis and with obstructive CAD in univariable analyses but not after adjustment for traditional risk factors. IL-1β was not associated with CAD. In a large population of PWH without viral replication, almost half had angiographically verified atherosclerosis. High concentrations of IL-6 and hsCRP were associated with CAD in univariable analyses, but adjustment for cardiovascular risk factors attenuated the association, suggesting that inflammation may mediate the association between traditional risk factors and CAD.

Ideal cardiovascular health, biomarkers, and coronary artery disease in persons with HIV.

To investigate relationships between Life's Simple 7 (LS7), an assessment of cardiovascular health (CVH), and coronary plaque among people with HIV (PWH). Cross-sectional. Coronary computed tomography angiography, immune/inflammatory biomarkers, and characterization of LS7 were collected among a subset of ART-treated PWH enrolled in REPRIEVE, a primary prevention trial. Analyses adjusted for cardiovascular disease risk (ASCVD score). Median age of the 735 participants was 51(±6) years, 16% female, and median (Q1-Q3) CVD risk was 4.5% (2.6-6.9). Forty percent had poor (≤2 ideal components), 51% had intermediate (three or four ideal components), and only 9% had ideal CVH (≥5). Coronary plaque was present in 357 (49%); 167 (23%) had one or more vulnerable plaque features, 293 (40%) had noncalcified plaque, and 242 (35%) had a coronary artery calcium score >0. All three phenotypes were increasingly more prevalent with poorer CVH and these relationships remained after adjusting for ASCVD risk. Poor CVH was associated with higher high-sensitivity C-reactive protein, oxidized low-density cholesterol, and interleukin-6. The relationship of LS7 to plaque remained after adjusting for these biomarkers. Among PWH, poor CVH as measured by LS7 was associated with coronary plaque presence, vulnerable features, and calcification. LS7 was also associated with selected biomarkers; adjustment for these and ASCVD score reduced but did not eliminate LS7's association with plaque, suggesting the possibility of additional protective mechanisms against atherogenesis and plaque remodeling. Clinical use of LS7 and further exploration of its relationships with coronary artery disease may enhance efforts to reduce cardiovascular morbidity and mortality in PWH. NCT02344290.

What is the accuracy of thallium stress tests for detecting coronary artery disease in persons with chest pain?

What is the accuracy of thallium stress tests for detecting coronary artery disease in persons with chest pain?

The expanding sphere of primary prevention for coronary artery disease in persons with erectile dysfunction.

To the Editor, Erectile dysfunction (ED) is a condition of multifactorial causes. Recently, Schwatrz and Kloner published an article on ED and heart disease that brought to light the cardiovascular implications of ED.1 The relation of ED as an early clinical sign of cardiovascular disease is indeed worth future investigation considering the fact that ED occurs 3-5 years prior to the initial acute coronary event. The second Princeton Consensus Conference in 2004 recognised ED as an early sign of cardiovascular disease and classified patients into low, intermediate and high risk groups. They also provided algorithms for approach and management of these patients.2 Recently, a meta-analysis of cohort studies showed that the presence of ED increased the risk for CAD (relative risk: 1.48, 95% CI: 1.25-1.74; p<0.001).3 This has great significance for those involved in prevention - both at primary and secondary levels. We would therefore, like to highlight the role of exercise training in primary and secondary prevention of coronary artery disease (CAD) among those with ED and also the role of the urologist in aiding prevention of CAD. ED has been associated with CAD in both diabetics,2 and also in the general population.4 Various factors like type 2 diabetes mellitus, atherosclerosis, smoking, and sedentary lifestyle have been attributed to ED.5 Elevated inflammatory markers, endothelial dysfunction, lack of physical activity, and obesity have been found to lead to ED.5,6 Therefore, it can be hypothesized that prevention of these factors could not only prevent ED but also in the long run, CAD. La Vignera et al. recently published a review with one of their aims being to sensitize health practitioners to the role of physical activity in ED.6 They highlighted the importance of physical activity and exercise training on inflammatory markers, endothelial function and obesity and how they affected ED. They also reported moderate physical activity (>150 minutes/week) was sufficient for maintaining proper erectile function. Data from studies on exercise training have shown that exercise training increased the number of endothelial progenitor cells and increased the levels of total testosterone. The levels of testosterone were, however, dependent on the duration of exercise.6 This suggests that individuals with ED, in whom nonvascular causes have been excluded, are likely to benefit from exercise training. However, more research is required with regard to the intensity, duration, and the long term benefits of exercise on ED and its role of in preventing CAD among those with vasculogenic ED. Other strategies like lifestyle modifications also play a vital role in improving sexual function thereby also controlling the risk factors for CAD.7 Growing evidence suggests that lifestyle modifications are equally effective as pharmacological interventions for cardiovascular risk factors in improving erectile function (standardized difference in means of International Index of Erectile Dysfunction are 2.40 (95% CI, 1.19-3.61) vs. 3.07 (95% CI, 1.84-4.30) for lifestyle modifications and pharmacotherapy respectively).8 This cycle of ED leading onto CAD brings to light a new frontier for primary prevention. Therefore, the need for screening for vasculogenic ED in the community would probably be the next step in primary prevention of CAD. This has been supported in a recent population based study among diabetics, in which it was seen that screening for ED along with the traditional risk factors for cardiovascular disease could improve the identification CAD.9 Early diagnosis and referral of patients with vasculogenic ED to cardiologists and exercise specialists for further evaluation and exercise training is therefore the need of the hour. Integration of specialists like urologists will also be required for the general screening. Large scale population studies will be needed to identify the risk factors for ED and CAD in the community and strategies will need to be adopted for promoting preventive strategies and exercise training in these patients.

Diagnosis of Coronary Artery Disease in Persons with Diabetes Mellitus

Coronary heart disease (CHD) is the leading cause of morbidity and mortality in patients with diabetes. Asymptomatic CHD in these patients is elusive and carries a poor prognosis given the fact that an unheralded acute myocardial infarction or sudden cardiac death frequently constitutes its first presentation. Because effective screening for asymptomatic patients with type 2 diabetes for both the presence and severity of CHD is intuitively appealing, we have summarized the utility and prognostic value of various diagnostic modalities (both functionally and anatomically) in enhancing risk stratification and leading to improved and more aggressive management of the risk factors. There exist some evidence and recommendations for screening of asymptomatic persons with diabetes using certain modalities. More research is needed to define potential subsets of patients with diabetes who may benefit from additional testing for asymptomatic CHD.

Coronial deaths in auckland due to atherosclerotic coronary artery disease in persons ≤40 years: a retrospective study 2000–2007

<h3>Aims</h3> To identify the demographic distribution, frequency and circumstances of coronial deaths in Auckland due to coronary artery atherosclerotic disease (CAD) in persons ≤40 years. To review the associated autopsy findings and cardiovascular risk factors (CVRF). <h3>Method</h3> A computerised search for coronial deaths due to CAD in persons ≤40 years from 2000 to 2007 was conducted using the Forensic Pathology Department database at Auckland City Hospital. The police reports and autopsy reports were reviewed to record the demographic detail, to determine the circumstances preceding death and to summarise the pathological findings. The main CVRF were analysed. <h3>Results</h3> A total of 89 coronial deaths due to CAD in persons ≤40 years were identified. There were Caucasian 23 (25.8%), Maori 33 (37.1%), Polynesian 26 (29.2%), Indian descent 3 (3.4%), Asian except Indian 1 (1.1%). Maori was the predominant ethnic group represented in this study and combined with the Polynesian group, made up 66.3% of cases. <h3>Conclusion</h3> This autopsy-based study revealed that in Auckland, Maori and Pacific people require an early screening (≤40 years of age) for CVRF assessment and management.

Review: Aspirin reduces the incidence of coronary artery disease in persons at risk

Review: Aspirin reduces the incidence of coronary artery disease in persons at risk

Sympathetic overactivity in hypertension: a risk factor for cardiovascular disease.

Numerous prospective studies have shown that high heart rate is related to the development of hypertension, atherosclerosis, and incidence of cardiovascular events. Experimental studies in monkeys have shown that high heart rate has direct atherogenic effects on the arteries as a result of increased wall stress. However, clustering of several risk factors for coronary artery disease in persons with high heart rate suggests that sympathetic overactivity also accounts for part of the increased cardiovascular morbidity that is observed in persons with tachycardia. Indeed, experimental studies have shown that heightened sympathetic tone can cause obesity, hyperinsulinemia, and insulin resistance, which in the long term can promote the development of atherosclerosis. Through its interaction with plasma insulin, sympathetic overactivity can promote the development of left ventricular hypertrophy. Sympathetic activation can also increase hematocrit and precipitate a procoagulant state. Angiotensin II has an effect both on the central nervous system, enhancing sympathetic outflow, and on the peripheral sympathetic nerves. Among the angiotensin II receptor antagonists, eprosartan showed a particular ability to block presynaptic angiotensin II receptor 1 (AT(1)) receptors at neuro-effector junctions in the sympathetic nervous system, as well as AT(1) receptors in blood vessels. This dual action may represent an important advance in treatment of elevated blood pressure.

Prevalence of coronary artery disease in a general population without suspicion of coronary artery disease: angiographic analysis of subjects aged 40 to 70 years referred for catheter ablation therapy.

The prevalence of coronary vessel wall alterations in the general population is not known. Therefore, the aim of our study was to determine the prevalence of coronary artery disease in persons in whom the underlying disease was not related to coronary artery disease and could therefore be regarded as a near normal population. We included 331 consecutive patients (173 men, 158 women, aged between 40 and 70 years) who were referred for catheter ablation of an accessory pathway (67.4% ) or atrioventricular-node modification (32.6%) and who underwent coronary angiography as part of their routine baseline evaluation before radiofrequency current application. Most of the patients (79%) of this cohort were free of symptoms of coronary artery disease. Based on visual inspection of coronary angiograms in multiple projections, patients were classified to have one-, two- or three-vessel disease if stenoses greater than 50% of lumen diameter were present. In addition, diffuse vessel wall alterations were assessed using two different score systems. The prevalence of coronary artery disease in this near normal population was 7.3%, with a significant difference in coronary asymptomatic (3.8%) vs symptomatic patients (17.1%). Mean levels of total cholesterol and other risk factors were not significantly different in patients with coronary artery disease compared to those without. But levels of low-density lipoprotein (LDL) cholesterol and lipoprotein(a) were significantly higher and high-density (HDL) cholesterol lower in patients with a stenosis or extent score higher than zero compared to a score of zero. The values of all vessel scores evaluating the extent of critical and diffuse coronary vessel alterations were very low in patients affected with coronary artery disease, indicating a low degree of diffuse alteration of the vessel wall. The prevalence of coronary artery disease with at least one critical stenosis in subjects aged 40-70 years with an average cholesterol level of 238+/-42 mg. dl(-1)is 7.3%.

Comparison of outcome after coronary angioplasty and coronary surgery for multivessel coronary artery disease in persons with diabetes

Comparison of outcome after coronary angioplasty and coronary surgery for multivessel coronary artery disease in persons with diabetes

Comparison of outcome after coronary angioplasty and coronary surgery for multivessel coronary artery disease in persons with diabetes

Comparison of outcome after coronary angioplasty and coronary surgery for multivessel coronary artery disease in persons with diabetes