Coronary Artery Disease In Population Research Articles

Coronary artery disease and familial hypercholesterolaemia patients' eligibility for PCSK-9 inhibitors: who is to benefit from lower ldl thresholds?

Abstract Purpose High and very high cardiovascular risk patients are usually possible candidates for PCSK-9 inhibitors. Coronary artery disease (CAD) and Familial Hypercholesterolaemia (FH) patients belong to this group by definition, according to 2019 recent dyslipidaemia guidelines. The real contribution of each group to potential eligibility for PCSK-9 is to be investigated. Methods We enrolled 1892 inpatients prospectively for 12 months, diagnosed either with chronic CAD or with acute coronary syndrome (ACS). In order to test eligibility for PCSK-9 inhibitors, three different LDL thresholds were used in our model for very high and high risk groups: 55mg/dl and 70mg/dl, 70mg/dl and 100mg/dl, 100mg/dl and 130mg/dl, as recommended by the 2019 and 2016 ESC/EAS Guidelines for Dyslipidaemia and the National Health Care system, respectively. A proprietary software was developed and eligibility was determined by using patient clinical information and different criteria. Dutch Lipid Clinic Network criteria were used to determine heterozygous FH population. Results The eligible percentage for the three classifications was 18.6%, 7.7% and 1.8%, in the total CAD population respectively. Definite/ probable FH percentages among our population were 4.8%, 3.4%, 1.4%, respectively. Solely CAD eligible population was 13.8%, 4.3% and 0.4% respectively. The increase of the eligible percentages toward more recent guidelines was mostly attributed to the increasing number of coronary patients who become eligible as our criteria become stricter while the percentage of the eligible CAD/FH population only slightly increases. Conclusions FH is a significant cardiovascular risk factor but stricter criteria and LDL thresholds, favour solely CAD patients. Using real-world data and an adjustable model, we provide a realistic estimation of PCSK-9 eligibility among CAD patients. Funding Acknowledgement Type of funding sources: None. Subgroup analysis of eligible population

Genetically determined risk of mood swings and cardiometabolic diseases: mendelian randomization study

Abstract Background Mood swings is believed to associated with increased risk of Cardiometabolic Diseases (CMD). However, the roles of mood swings on CMD are controversial because of the bias of reverse causation and/or confounding in epidemiological studies. Hence, we use a two-sample MR approach to identify the causal association between genetically determined mood swings and CMD. Methods We obtained 33 independent single-nucleotide polymorphisms (SNPs) with genome-wide significant (P<5×10–8) associated with mood swings as instrumental variable in UK Biobank. Summary data of outcomes were extracted from the Coronary Artery Disease Genome-wide Replication and Meta-analysis plus the Coronary Artery Disease Genetics consortium, the Diabetes Genetics Replication and Meta-analysis consortium, the CKDGen consortium, and the International Stroke Genetics Consortium. Results The genetic instrument of 33 SNPs explained 4.8% of the variance in mood swings. Genetically determined mood swings was associated with an increased risk of coronary artery disease (CAD) (odds ratio 3.12, 95% confidence interval 1.92 to 5.08; P=4.32×10–6). However, mood swings had no effect on the other cardiometabolic outcomes. The above estimates were consistent across all three MR methods without significant heterogeneity. Also, there was no evidence of directional pleiotropy for each outcome except for large artery stroke. Conclusions Using MR approaches that are able draw causal inference, our results suggest that interventions aimed at improving mood swings in the population would lead to a reduction risk of CAD, which highlights the importance of mood management in high-risk CAD population. Funding Acknowledgement Type of funding sources: None.

PROGNOSTIC VALUE OF PET MPI MYOCARDIAL FLOW RESERVE IN CABG PATIENTS

<h3>BACKGROUND</h3> Positron emission tomography (PET) myocardial perfusion imaging (MPI) is a well-validated non-invasive imaging technique for the assessment of coronary artery disease (CAD). Amongst its many advantage, it permits quantitative, non-invasive assessment of myocardial blood flow (MBF) and myocardial flow reserve (MFR). While the diagnostic and prognostic value of MFR has been extensively validated in the general CAD population, only limited data is available when it comes to its prognostic value in patients with prior coronary artery bypass grafting (CABG). Our study aim was to evaluate if diminished MFR on 13N-Ammonia PET MPI is associated with increased risk of major adverse cardiovascular events (MACE) amongst patients with prior CABG. <h3>METHODS AND RESULTS</h3> A retrospective study was performed at the Montréal University Hospital Centre (CHUM) between February 2018 and September 2020. Patients (n=62) with prior CABG (at least 3 months) who had an 13N-Ammonia PET/CT scan performed were included. The main endpoint was to evaluate if myocardial perfusion values were associated with increased risk of MACE. MACE was defined as death, re-infarction, repeat revascularization or hospitalization for heart failure. In patients with multiple MACE, only the first event was considered for analysis. Our cohort was subdivided in two groups: patients with MACE and patients without MACE. The main indications for performing PET MPI are displayed in the figure. Baseline characteristics (table) were comparable between both groups except for the number of graft (3.0 [2.0,3.0] vs. 3.0 [3.0,4.0], p=0.005). Risk factors were similar between both groups except for presence of chronic kidney disease (CKD) (11 (55%) vs. 10 (23.8%), p=0.02). There was no difference between both groups regarding drug regimen. In patients with MACE as compared to no-MACE, both global MFR (1.8 ± 0.5 vs. 2.1 ± 0.5, p=0.03, respectively) and the global stress MBF (1.2 [0.9,1.4] vs. 1.4 [1.1,1.8] mL/min/g, p=0.049, respectively) were significantly lower. Sum Stress Score was higher in the MACE group (2.5 [1.0,10.0] vs. 0.0 [0.0,3.5], p=0.04). Low left ventricular ejection fraction (LVEF) reserve had no prognostic value in our study (p=0.20). <h3>CONCLUSION</h3> In patients with prior CABG, both reduced global MFR and global stress MBF were associated with increased risk of MACE. Therefore, PET MPI with flow quantification can help identifying patients at risk of MACE after CABG. Our findings need to be confirmed in a larger cohort of patients.

Are hypertensive patients with history of coronary artery disease at risk for silent lower extremity artery disease?

We aimed to investigate the association between hypertension and asymptomatic lower extremity artery disease (LEAD) in outpatients with known history of coronary artery disease (CAD). Patients with known history of CAD who have been undergone coronary angiography and have significant coronary artery stenosis (more than 60%) were included. LEAD was defined as ankle-brachial index (ABI)<0.9 in either leg. The risk of LEAD in hypertensive group was analyzed using chi-square test, and correlation between blood pressure (BP) and ABI was analyzed using Pearson correlation test in SPSS v.25. One hundred and four patients were included. 82.7% of patients were male. Mean age was 57.05±7.97. The prevalence of hypertension was 35.6%, and the prevalence of LEAD was 16.3%. A higher proportion of LEAD was found in hypertensive (18.9%) compared to non-hypertensive (14.9%), although not statistically significant (OR: 1.33; 95% CI: 0.46 to 3.85; p=0.598). There was an association between ABI and systolic BP (p=0.016), but not with diastolic BP (p=0.102). Our study showed that the prevalence of LEAD in hypertension, especially in the CAD population, is relatively high. There was no association between hypertension and LEAD, but a higher prevalence of LEAD was found in hypertensive patients. Nevertheless, LEAD screening is still recommended in hypertensive patients, especially in the CAD population, given the fact that outcomes of health and mortality are worse for those with concomitants of these diseases.

Clonal Hematopoiesis of Indeterminate Potential (CHIP) in Patients with Coronary Artery Disease and in Centenarians. Further Clues Linking Chip with Cardiovascular Risk

Background. Age-related clonal hematopoiesis of indeterminate potential (CHIP), a relatively common condition in elderly people, has been associated with an increased risk of hematological neoplasms, and, to a greater extent, of overall mortality. Earlier this year, Jaiswal and colleagues have suggested that excess mortality in subjects with CHIP is related to an increased risk of cardiovascular diseases, and provided a convincing model linking TET2 mutations to a pro-inflammatory state favoring the development of atherosclerotic plaques.Aims. We sought to replicate the recent findings of an increased prevalence of CHIP in patients with Coronary Artery Disease (CAD), by studying patients enrolled in the Verona Heart Study. We were also interested in studying a group of selected ultra-centenarians (mean age 105.6 ± 2.0 years), as the prevalence of CHIP has been previously reported to increase linearly with age until near 90 years, but no data have been produced until now in such a peculiar population of “super-controls”.Methods. We analyzed whole-exome sequencing (WES) data from peripheral-blood cells DNA in 99 patients with angiographically proven severe CAD, and 79 centenarians. The mean coverage varied from 30x to 100x (maximum in centenarians). We focused on somatic mutations predicted to alter the protein function in 6 genes (TET2, ASXL1, DNMT3A, JAK2, PPM1D, TP53) ,known to be key players in the development of CHIP.Results. The prevalence of CHIP in CAD patients was 18.2%, a figure reproducing the increased prevalence in other CAD populations recently reported by Jaiswal and colleagues. By contrast, the prevalence of CHIP in centenarians was only 2.5%, a figure in clear countertrend with respect to the linear increase of CHIP observed until the age of 90 years in previous studies. This suggested a kind of “survival bias” indirectly supporting the pathogenic role of age-related CHIP. Interestingly, the majority (85%) of the driver mutations in CAD patients occurred in TET2, consistently with the pro-atherosclerotic role of this gene in mouse models.Conclusions. Our results add further to the recent hypothesis that links CHIP to an increased risk of cardiovascular disease. DisclosuresMartinelli:CELGENE: Consultancy; PFIZER: Consultancy; ROCHE: Consultancy; JOHNSON & JOHNSON: Consultancy; ARIAD/INCYTE: Consultancy; AMGEN: Consultancy.

Safety and Efficacy of Colchicine in Patients with Stable CAD and ACS: A Systematic Review and Meta-analysis.

Evidence from recent trials has shown conflicting results in terms of the utility of colchicine in patients with coronary artery disease (CAD). Multiple databases were queried to identify all randomized controlled trials (RCTs) comparing the merits of colchicine in patients with acute coronary syndrome (ACS) or stable CAD. The pooled relative risk ratio (RR) of major adverse cardiovascular events (MACE), its components, and gastrointestinal (GI) adverse events were computed using a random-effect model. Ten RCTs comprising a total of 12,761 patients were identified. At a median follow-up of 12 months, there was a significantly lower risk of MACE [RR 0.66, 95% confidence interval (CI) 0.45-96], ACS (RR 0.66, 95% CI 0.45-0.96), ischemic stroke (RR 0.42, 95% CI 0.22-0.81), and need for revascularization (RR 0.61, 95% CI 0.42-90) in patients receiving colchicine compared with placebo. A subgroup analysis based on the clinical presentation showed that the significantly lower incidence of MACE and stroke were driven by the patients presenting with ACS. The use of colchicine in patients with stable CAD did not reduce the incidence of MACE (RR 0.55, 95% CI 0.28-1.09), ACS (RR 0.52, 95% CI 0.25-1.08), or stroke (RR 0.61, 95% CI 0.33-1.13). There was no significant difference in the relative risk of cardiac arrest, ACS, cardiovascular mortality, and all-cause mortality between the two groups in both ACS and stable CAD populations. The risk of GI adverse events was significantly higher in patients receiving colchicine (RR 2.10, 95% CI 1.12-3.95). In patients presenting with ACS, low-dose colchicine might reduce the incidence of MACE, stroke, and the need for revascularization at long follow-up durations. Colchicine might offer no benefits in reducing the risk of ischemic events in patients with stable angina.

Performance of PRECISE-DAPT Score for predicting upper gastrointestinal bleedings in patients with stable coronary artery disease on long-term antithrombotic therapy

Abstract Funding Acknowledgements Type of funding sources: None. Background PRECISE-DAPT score has become developed for predicting the risk of bleedings in patients treated with coronary stenting and subsequent 1-year dual antiplatelet therapy. The utility of PRECISE-DAPT score in the setting of all-comer CAD population with different regimes of long-term antithrombotic therapy remains unclear. Upper gastrointestinal bleeding (UGIB) is the predominant hemorrhagic complication in CAD patients; however, the PRECISE-DAPT capacity with respect to this type of bleeding has never been evaluated. Purpose to evaluate the role of PRECISE-DAPT score in the assessment of upper gastrointestinal bleeding risk in patients with stable coronary artery disease (CAD) receiving long-term antithrombotic therapy. Methods Data were obtained from single center prospective Registry of Long-term AnTithrombotic TherApy (REGATTA-1 NCT04347200). The PRECISE-DAPT score was calculated in a total of 434 patients with stable CAD (77,4% males, median age 61 [IQR 55-69] yrs). Most of the patients 93,6 % received DAPT due to recent PCI with a switch to aspirin monotherapy after 6 months. 1,4 % of patients received aspirin only, 22 (5,1%) of patients received oral anticoagulants because of concomitant atrial fibrillation. The primary outcome was any overt UGIB (BARC ≥2). Results In a total of 451 person-years of follow-up (median follow-up was 378 days, IQR 365-421), UGIB occurred 40 patients (incidence at 1 year 8.9 per 100 patients). The median time to first occurrence of UGIB was 55 [IQR 8-115] days. Median PRECISE-DAPT score was 12 points [IQR 6; 20]. The cut-off value for PRECISE-DAPT score to predict UGIB was 16 points (AUC = 0.732, p = 0.0001, 95% CI 0.367-0.827) that correspond to at least moderate bleeding risk according to original score discrimination. Kaplan-Meier bleeding rates were separated by score cut-off (Log-Rank p &amp;lt; 0,001) and the risk difference remains consisted in regression model (OR 2.79 [1.07-7.29]; p = 0.0348). Conclusion(s): PRECISE DAPT score demonstrated good discriminatory capacity (cut-off 16 points) with respect to UGIB in patients with stable CAD receiving long-term antithrombotic therapy.

Depressive Symptoms and Health-Related Quality of Life in Patients with Cardiovascular Diseases Attending a Tertiary Care Hospital, Puducherry-A Cross-Sectional Study.

Background Globally, coronary artery disease (CAD) was the leading cause of health losses. The emergence of revascularization has brought a major change in the management of CAD. Depression and cardiovascular diseases (CVD) are the two highly prevalent noncommunicable diseases (NCD), which lead to poor quality of life and high socio-economic loss for the patient. The rate of depressive episodes was higher in CAD population in comparison to population with other heart problems. Objectives The primary objective of the current study is to determine the proportion of those with depressive symptoms through Patient Health Questionnaire-9 (PHQ-9) among CAD patients in a tertiary care public hospital. Methods It was a cross-sectional analytical design, which assess the percentage of patients with depressive symptoms among CAD patients, using a pretested, semistructured questionnaire. The PHQ-9 and EuroQoL five-dimensional three-level (EQ-5D-3L) questionnaire, a quality-of-life instrument (five items), were used, which was validated in the Tamil version. Statistical Analysis Categorical variables was expressed as proportion. We used Chi-square as a statistical test to calculate the p value and risk estimation with 95% CI. Results Out of 541 patients, 159 (30%) patients had mild-to-moderate depressive symptoms, of which 144 (89%) participants were greater than 50 years. In EQ-5D-3L, around one-third of the participants reported pain or discomfort and anxiety or depression. Conclusion The study concludes that the assessment of health-related quality of life (HRQoL) is becoming increasingly important in the management of CAD patients. Studies have shown that depression predicts subsequent quality of life, while others have shown that HRQoL is a risk factor for ongoing depression. Treatment of depression may improve subsequent physical HRQoL; hence, it is vital to address both during their follow-up to improve outcomes among patients with CAD.

Coronary artery disease: differential expression of ceRNAs and interaction analyses.

BackgroundPrevious studies have demonstrated associations between cardiovascular disease and the expression of various messenger RNAs (mRNAs), microRNAs (miRNAs), and long non-coding RNAs (lncRNAs). This study aimed to investigate the differential expression of mRNAs, lncRNAs, and miRNAs between tissues from patients with coronary artery disease (CAD) and healthy controls, and to determine the interactions between these molecules in CAD.MethodsWe investigated the differential expression of competitive endogenous RNAs (ceRNAs) between patients with CAD and healthy controls by collecting data from Gene Expression Omnibus (GEO) microarrays. We also investigated the biological function of these differentially expressed ceRNAs by performing Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. We then created a protein-protein interaction (PPI) network to identify the hub genes. Biosystems and literature searches were also carried out to identify relevant signaling pathways and the potential function of the differentially expressed ceRNAs.ResultsWe identified 456 expression profiles for miRNAs, 16,325 mRNA expression profiles, and 2,869 lncRNA expression profiles. With regards to connectivity, GO and KEGG analyses (count ≥9) identified the top 11 PPI network nodes in rank order. We also identified the top 15 significant nodes for the ceRNAs identified according to degree centrality (DC) (P<0.05). Collectively, our analyses confirmed that the differential expression of certain ceRNAs, and their respective signaling pathways were associated with CAD.ConclusionsData arising from 11 GO and KEGG pathways, the top 15 PPI network nodes with the best connectivity rank, and the top 15 ceRNA network nodes, as determined by DC rank in CAD population, indicated that the differential expression of these ceRNAs plays a key role in the CAD. Our findings highlight new molecular mechanisms for CAD and provide new options for the development of therapeutic targets.

Comparative study of platelet indices in coronary artery diseases

Introduction: With urbanization and increase in sedentary lifestyle, prevalence of CAD (Coronary artery disease) is looming large as the new epidemic afflicting Indians. Altered platelet morphology and functions have been linked with the formation and propagation of thrombotic event. Platelet indices (Mean platelet volume - MPV, Platelet distribution width - PDW, Platelet large cell ratio - PLCR) are determinants of platelet functionality. Aims and Objectives: 1. To study platelet indices (MPV, PDW, P-LCR) in CAD; 2. To compare platelet indices in patients with myocardial infarction, stable CAD and control population. Material and Methods: A comparative and prospective study was conducted on 100 patients each of MI & stable CAD on antiplatelet therapy and 100 age and sex matched healthy individuals as controls. Platelet indices were measured using an Automated Blood Counter SYSMEX XN-1000. Troponin T and CK-MB levels were collected from clinical data in MI cases. Results: Platelet indices were significantly higher in MI patients in comparison to stable CAD and control groups. Stable CAD patients also showed significantly higher platelet indices in comparison to control groups. (p value Conclusion: The present study showed a significantly higher MPV, PDW and P-LCR in CAD patients in comparison to control group. Among CAD patients, MI patients had significantly higher platelet indices than stable CAD patients. Hence platelet indices can be used as simple and cost effective predictive parameters to predict CAD. Their use in a risk stratification system to predict MI and in response to intervention are worthy of consideration. Keywords: Coronary artery diseases, Platelet indices, Mean platelet volume, Platelet distribution width, Platelet large cell ratio.

Is There Any Association Between the MEF2A Gene Changes and Coronary Artery Disease?

Coronary artery disease (CAD) is a common multifactorial disease with a high rate of morbidity and mortality worldwide. The MEF2A gene transcription factor belongs to the myocyte enhancer factor-2 (MEF2) family and is involved in critical processes such as calcium-dependent signaling pathways and cardiac development. Although the variants of the MEF2A gene were studied in different CAD and myocardial infarction (MI) populations, the reality of this gene association with CAD is still unclear. This study reports the first in silico investigation on MEF2A variants. All reported variants in CAD/MI patients were collected from eleven countries. Their pathogenicity and variant position conservation were surveyed by online prediction tools, including Mutation-Taster, Polyphen-2, PROVEAN, SIFT, CADD, and GERP. In silico analysis did not confirm the pathogenic effect of 21-bp deletion, which was introduced as a monogenic cause of CAD. c.704C&gt;A (p.S235Y), c.812C&gt;G (p.P271R), c.836C&gt;T (p.P279L) and c.848G&gt;A (p.G283D) missenses, c.1315C&gt;T (p.R439X) nonsense, and seven out-of-frame deletions were predicted as disease-causing variants. Although some variants of the MEF2A gene affect protein structure, the MEF2A variation studies in CAD/MI patients and in silico analysis do not approve the association and pathogenicity of MEF2A variants in the familial/sporadic CAD. © 2020 Tehran University

Significant association between the endothelial lipase gene 584C/T polymorphism and coronary artery disease risk.

Several studies have investigated a potential association between the endothelial lipase gene (LIPG) 584C/T polymorphism and susceptibility to coronary artery disease (CAD), but a uniform conclusion is yet to be reached. To better evaluate the true relationship between the LIPG 584C/T polymorphism and the risk of CAD, a meta-analysis of 14 case–control studies with 9731 subjects was performed. Relevant articles published through August 2020 were searched in the CNKI, PubMed, Embase and Web of Science databases. Thirteen articles, including 14 eligible case–control studies with 4025 cases and 5706 controls, were enrolled in the present meta-analysis. The Newcastle–Ottawa Scale (NOS) scores of the case–control studies ranged from 6 to 8. The pooled results indicated that there is a significant association between the LIPG 584C/T polymorphism and CAD in the homozygote comparison model and the allelic comparison model. Subgroup analyses revealed that the LIPG 584C/T mutation significantly decreased the risk of CAD in the subgroups of African, CAD, hospital-based (HB), and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) populations in some genetic models. No publication bias was found in our meta-analysis, which certifies the robustness of the current meta-analysis. Trial sequential analysis (TSA) also confirmed the stability of our results. The results of our meta-analysis indicate that the LIPG 584C/T polymorphism plays a protective role in the incidence of CAD. More high-quality case–control studies on various ethnicities are needed to confirm our results.

Interaction between a haptoglobin genetic variant and coronary artery disease (CAD) risk factors on CAD severity in Singaporean Chinese population.

BackgroundHaptoglobin (Hp) is a plasma protein with strong anti‐inflammation and antioxidant activities. Its plasma level is known to be inversely associated with many inflammatory diseases, including cardiovascular diseases. However, the association of HP genetic variants with coronary artery disease (CAD) severity/mortality, and how they interact with common CAD risk factors are largely unknown.MethodsWe conducted the analysis in a Singaporean Chinese CAD population with Gensini severity scores (N = 582) and subsequently evaluated the significant findings in an independent cohort with cardiovascular mortality (excluding stroke) as outcome (917 cases and 19,093 controls). CAD risk factors were ascertained from questionnaires, and stenosis information from medical records. Mortality was identified through linkage with the nationwide registry of births and deaths in Singapore. Linear regression analysis between HP genetic variant (rs217181) and disease outcome were performed. Interaction analyses were performed by introducing an interaction term in the same regression models.ResultsAlthough rs217181 was not significantly associated with CAD severity and cardiovascular mortality (excluding stroke) in all subjects, when stratified by hypertension status, hypertensive individuals with the minor T allele have more severe CAD (β = 0.073, SE = 0.030, p = 0.015) and non‐hypertensive individuals with the T allele have lower risk for mortality (odds ratio = 0.771 (0.607–0.980), p = 0.033).Conclusion HP genetic variant is not associated with CAD severity and mortality in the general population. However, hypertensive individuals with the rs217181 T allele associated with higher Hp levels had more severe CAD while non‐hypertensive individuals with the same allele had lower risk for mortality in the Chinese population.

The relationship between coronary artery disease and clinical outcomes in COVID-19: a single-center retrospective analysis

Recent studies have reported evidence that coronavirus disease 2019 (COVID-19) has disproportionately affected patients with underlying comorbidities. Our study aims to evaluate the impact of both cardiac and noncardiac comorbidities on a high-risk population with COVID-19 infection and coronary artery disease (CAD) compared to those without CAD. This is a retrospective study of patients who tested COVID-19 positive via reverse transcriptase-PCR (RT-PCR) assay. We compared the characteristics and outcomes of patients with and without CAD. Population demographics, comorbidities and clinical outcomes were collected and analyzed. Multivariate logistic regression analysis was used to identify factors associated with inpatient mortality. A final sample population of 355 patients was identified, 77 of which had a known diagnosis of coronary artery disease. Our study population had a higher proportion of females, and those with CAD were significantly older. The rates of cardiovascular risk factors including hypertension, diabetes mellitus and chronic kidney disease, as well as heart failure and chronic obstructive pulmonary disease were significantly higher in the CAD population. Lactate dehydrogenase was the only inflammatory marker significantly lower in the CAD group, while troponin and brain natriuretic peptide were significantly higher in this population. Patients with CAD also had significantly higher inpatient mortality (31% vs 20%, P = 0.046) and need for renal replacement therapy (33% vs 11%, P < 0.0001) compared to the non-CAD group. However, only age [odds ratio 1.041 (1.017-1.066), P = 0.001] was significantly associated with mortality in the overall population after adjusting for demographics and comorbidities, while the presence of CAD was not independently associated with mortality. Patients with CAD and COVID-19 have higher rates of comorbidities, inpatient mortality and need for renal replacement therapy compared to their non-CAD counterparts. However, CAD in itself was not associated with mortality after adjusting for other covariates, suggesting that other factors may play a larger role in the increased mortality and poor outcomes in these patients.

Ischemia and Viability Testing in New-Onset Heart Failure.

To examine the utility and methods of coronary artery disease (CAD) assessment in patients with new-onset heart failure with reduced ejection fraction (HFrEF) of unclear etiology. Moreover, we sought to review the role and techniques of assessing myocardial viability to guide coronary revascularization in patients with established ischemic cardiomyopathy. Data indicates that surgical coronary revascularization in patients with HFrEF due to ischemic cardiomyopathy leads to lower long-term all-cause mortality and cardiovascular hospitalizations. Thus, identifying ischemic heart disease in patients with new-onset HFrEF is essential. In addition to invasive coronary angiography (ICA), radionuclide myocardial perfusion imaging, coronary CT angiography (CCTA), and cardiac magnetic resonance (CMR) imaging have emerged as effective non-invasive tools in the assessment of CAD in this population. Viability testing remains an area of particular interest and debate and its full potential has not been fully addressed. We propose stepwise algorithms for CAD and viability assessment in this patient population. Non-invasive testing with radionuclide myocardial perfusion imaging, CCTA, and CMR is an alternative to ICA for CAD assessment in patients with new-onset HFrEF of unclear etiology. Several non-invasive imaging modalities have proved to be effective in detecting viable myocardium in patients with ischemic cardiomyopathy. The use of viability imaging to guide coronary revascularization should be individualized.

Early Detection of Undiagnosed Abdominal Aortic Aneurysm and Sub-Aneurysmal Aortic Dilatations in Patients with High-Risk Coronary Artery Disease: The Value of Targetted Screening Programme.

IntroductionAbdominal aortic aneurysm (AAA) and coronary artery disease (CAD) share common risk factors. The objective of this study was to determine the prevalence of undiagnosed AAA in patients with angiographically diagnosed significant CAD.Patients and MethodsMale patients aged 50 years and above (including indigenous people) with angiographically diagnosed significant CAD in the recent one year were screened for AAA. Standard definition of abdominal aortic aneurysm and CAD was used. All new patients were followed up for six months for AAA events (ruptured AAA and AAA-related mortality).ResultsA total of 277 male patients were recruited into this study. The total prevalence of undiagnosed AAA in this study population was 1.1% (95% CI 0.2–3.1). In patients with high-risk CAD, the prevalence of undiagnosed AAA was 1.7% (95% CI 0.3–4.8). The detected aneurysms ranged in size from 35.0mm to 63.8mm. Obesity was a common factor in these patients. There were no AAA-related mortality or morbidity during the follow-up. Although the total prevalence of undiagnosed AAA is low in the studied population, the prevalence of sub-aneurysmal aortic dilatation in patients with significant CAD was high at 6.6% (95% CI 3.9–10.2), in which majority were within the younger age group than 65 years old.ConclusionThis was the first study on the prevalence of undiagnosed AAA in a significant CAD population involving indigenous people in the island of Borneo. Targeted screening of patients with high-risk CAD even though they are younger than 65 years old effectively discover potentially harmful asymptomatic AAA and sub-aneurysmal aortic dilatations.

Efficacy of psychological interventions on psychological outcomes in coronary artery disease: systematic review and meta-analysis.

The benefits of cognitive-behavioral treatment (CBT) and positive psychology therapy (PPT) in patients with cardiovascular disease are still not well defined. We assessed the efficacy of CBT and PPT on psychological outcomes in coronary artery disease (CAD) patients. Randomized controlled trials evaluating CBT or PPT in CAD patients published until May 2018 were systematically analyzed. Primary outcomes were depression, stress, anxiety, anger, happiness, and vital satisfaction. Random effects meta-analyses using the inverse variance method were performed. Effects were expressed as standardized mean difference (SMD) or mean differences (MD) with their 95% confidence intervals (CIs); risk of bias was assessed with the Cochrane tool. Nineteen trials were included (n = 1956); sixteen evaluated CBT (n = 1732), and three PPT (n = 224). Compared with control groups, depressive symptoms (13 trials; SMD -0.80; 95% CI -1.33 to -0.26), and anxiety (11 trials; SMD -1.26; 95% CI -2.11 to -0.41) improved after the PI, and depression (6 trials; SMD -2.08; 95% CI -3.22 to -0.94), anxiety (5 trials; SMD -1.33; 95% CI -2.38 to -0.29), and stress (3 trials; SMD -3.72; 95% CI -5.91 to -1.52) improved at the end of follow-up. Vital satisfaction was significantly increased at follow-up (MD 1.30, 0.27, 2.33). Non-significant effects on secondary outcomes were found. Subgroup analyses were consistent with overall analyses. CBT and PPT improve several psychological outcomes in CAD patients. Depression and anxiety improved immediately after the intervention while stress and vital satisfaction improve in the mid-term. Future research should assess the individual role of CBT and PPT in CAD populations.

Plasma Histamine Level as a Distinguishing Factor between Stable Coronary Artery Disease and Acute Coronary Syndrome

Background: Angina can be caused by atherosclerosis in Coronary Artery Disease (CAD) patients either in Stable Coronary Artery Disease (SCAD) or Acute Coronary Syndrome (ACS). Histamine as a mast cell-preformed mediator is suspected to play a role in atherosclerosis. However, its mechanism is yet to be established and there is a lack of these data in the CAD population. To confirm the distinctness of plasma histamine level in patients with Acute Coronary Syndrome and Stable Coronary Artery Disease Patients, this research was an observational analytic study with transversal design in 49 CAD patients by purposive sampling which consists of 25 ACS patients (72% men, mean age 55,6±9,66 years) and 24 SCAD patients (83,3% men, mean age 52,71±8,03 years). The level of plasma histamine was measured using a Histamine ELISA-Kit. Median values of plasma histamine level in ACS group and SCAD group were 30,79 ng/ml (5,85-36,09 ng/ml) and 26,42 ng/ml (0,30-41,39 ng/ml). Comparison analysis on the median value of plasma histamine level between two groups was done with Mann-Whitney U Test and showed a statistical difference between two groups (p=0,011). There are significant differences in plasma histamine level between Acute Coronary Syndrome and Stable Coronary Artery Disease Patients.

Economic burden of coronary artery disease or peripheral artery disease in patients at high risk of ischemic events in the French setting: a claims database analysis

Aims: Estimate the direct costs of high-risk patients presenting with coronary artery disease (CAD) or peripheral artery disease (PAD) in France.Materials and methods: This retrospective cohort study used a representative claims database, the “Echantillon Généraliste de Bénéficiaires” (EGB), to identify patients presenting with CAD or PAD between 2011 and 2016. Among those, patients meeting the COMPASS trial selection criteria were selected, as well as controls matched on age and sex. Direct costs (Euros 2016) were estimated in a societal perspective by comparing case and controls.Results: The adult population presenting with CAD or PAD in the EGB in 2016 was estimated at 29,888 individuals, representing a crude prevalence rate of 5.44%. After using the documented selection criteria of the COMPASS study, this population (COMPASS-like) was estimated at 17,369 individuals (58.1% of the CAD and/or PAD total population). Among them, a proportion of 11.5% presented with CAD + PAD. Compared with the original COMPASS population, patients were older (76.5 vs 68.2 years) and with a lower male predominance (60.0% vs 78.2% males). Compared with controls, the COMPASS-like population was characterized by a higher annual mortality (5.9% vs 3.5%) and the presence of more comorbidities on top of CAD and/or PAD. The annual per capita extra direct cost of the COMPASS-like population was estimated at €4,284, with a main contribution from inpatient care (58.9%). This extra cost was higher in the PAD ± CAD sub-group (€5,552) and the CAD + PAD sub-group (€8,067).Limitations: The EGB had limitations about several clinical features defining high-risk patients that may lead to bias in our estimates.Conclusions: Due to the high prevalence of CAD and/or PAD and the associated high unit costs, this population generates a significant economic burden, which is higher among patients with PAD and in those presenting simultaneously with both conditions.

The fasting plasma glucose is correlated to the prevalence and severity of coronary artery disease in population without diabetes history in Xinjiang, China

The aim of the study is to investigate the association of fasting plasma glucose (FPG) with the prevalence and severity of coronary artery disease (CAD) in different ethnic groups without diabetes history in Xinjiang. Patients without diabetes history, who had undergone coronary angiography, were obtained. The levels of FPG in different ethnics were analyzed. The Gensini score was explored to evaluate the degree of coronary artery stenosis, and the logistic regression analysis was adopted to explore the risk factors of the prevalence of CAD. A total of 1500 cases (men 71.2%; mean age 57.6 ± 10.6 years; 1095 cases of CAD) were included. The incidence rates of CAD were 76.8% in Han, 72.5% in Uyghur and 68.1% in Kazakh group, respectively (P = .009), while the Gensini scores in Kazahk group (36.63 ± 33.88) were lower than the other ethnic populations (P = .003). The FPG levels in patients with CAD were significant higher than that without in all the ethnic groups (P < .01). Furthermore, it was indicated that the FPG levels (OR = 1.22, 95%CI 1.07–1.39, P = .003), as well as the age, sex, smoking or hypertension history, were associated with the CAD risk. FPG level was an independent risk factor of the prevalence and severity of CAD in population in Xinjiang.