Coronary Artery Disease In Relation Research Articles

The relation between the atrial blood supply and the complexity of acute atrial fibrillation.

BackgroundPatients with a history of myocardial infarction and coronary artery disease (CAD) have a higher risk of developing AF. Conversely, patients with atrial fibrillation (AF) have a higher risk of developing myocardial infarction, suggesting a link in underlying pathophysiology. The aim of this study was to assess whether coronary angiographic parameters are associated with a substrate for AF in patients without a history of AF.MethodsDuring cardiac surgery in 62 patients (coronary artery bypass grafting (CABG;n = 47), aortic valve replacement (AVR;n = 9) or CABG + AVR (n = 6)) without a history of clinical AF (age 65.4 ± 8.5 years, 26.2% female), AF was induced by burst pacing. The preoperative coronary angiogram (CAG) was assessed for the severity of CAD, and the adequacy of atrial coronary blood supply as quantified by a novel scoring system including the location and severity of right coronary artery disease in relation to the right atrial branches. Epicardial mapping of the right atrium (256 unipolar electrodes) was used to assess the complexity of induced AF.ResultsThere was no association between the adequacy of right atrial coronary blood supply on preoperative CAG and AF complexity parameters. Multivariable analysis revealed that only increasing age (B0.232 (0.030;0.433),p = 0.03) and the presence of 3VD (B3.602 (0.187;7.018),p = 0.04) were independently associated with an increased maximal activation time difference.ConclusionsThe adequacy of epicardial right atrial blood supply is not associated with increased complexity of induced atrial fibrillation in patients without a history of clinical AF, while age and the extent of ventricular coronary artery disease are.

SERUM VISFATIN LEVEL IN RELATION TO THE SEVERITY OF CORONARY ARTERY DISEASE

Background: Visfatin is a novel adipocytokine which mainly found in visceral adipose tissue. Visfatin may be related to endothelial function, which is indispensable for coronary circulation, and may be an indicator of an inflammatory event in the coronary arteries. Objective: To evaluate the severity of Coronary Artery Disease in relation to serum visfatin level. Patients and Methods: This was a case-control study done at Bab El-Sharia University Hospital, Al-Azhar University, arranged to conduct 90 Egyptian patients underwent elective coronary angiography for suspected CAD. Patients were divided into 60 patients with CAD (patients group), and 30 patients with normal coronary angiography (control group).The severity of CAD was assessed using coronary angiography by estimating the number of vessels affected. Patients with CAD were divided equally to: diabetic patients with coronary artery disease and non-diabetic patients with coronary artery disease. Results: Visfatin was higher in patients group in comparison to control group; it was 16.68 ± 4.67 and 2.95 ± 0.87 respectively, and it was clear that the serum level of visfatin was significantly higher in groups with more vessels involvement. As the Mean ± SD of visfatin in one vessel group was 13.13 ± 2.77 and was 16.95 ± 2.89 and 21.99 ± 3.91 in two vessels and three vessels respectively. In comparison between diabetic and non-diabetic patients, visfatin was significantly higher in diabetic patients with coronary disease artery disease (Mean ± SD: 18.97 ± 4.54) than non-diabetic patients with coronary artery (Mean ± SD: 14.39 ± 3.59). Conclusion: Patients with CAD showed increased visfatin serum levels particularly diabetics. Moreover, high visfatin levels were significantly correlated with CAD severity.

SERUM VISFATIN LEVEL IN RELATION TO THE SEVERITY OF CORONARY ARTERY DISEASE

Background: Visfatin is a novel adipocytokine which mainly found in visceral adipose tissue. Visfatin may be related to endothelial function, which is indispensable for coronary circulation, and may be an indicator of an inflammatory event in the coronary arteries. Objective: To evaluate the severity of Coronary Artery Disease in relation to serum visfatin level. Patients and Methods: This was a case-control study done at Bab El-Sharia University Hospital, Al-Azhar University, arranged to conduct 90 Egyptian patients underwent elective coronary angiography for suspected CAD. Patients were divided into 60 patients with CAD (patients group), and 30 patients with normal coronary angiography (control group).The severity of CAD was assessed using coronary angiography by estimating the number of vessels affected. Patients with CAD were divided equally to: diabetic patients with coronary artery disease and non-diabetic patients with coronary artery disease. Results: Visfatin was higher in patients group in comparison to control group; it was 16.68 ± 4.67 and 2.95 ± 0.87 respectively, and it was clear that the serum level of visfatin was significantly higher in groups with more vessels involvement. As the Mean ± SD of visfatin in one vessel group was 13.13 ± 2.77 and was 16.95 ± 2.89 and 21.99 ± 3.91 in two vessels and three vessels respectively. In comparison between diabetic and non-diabetic patients, visfatin was significantly higher in diabetic patients with coronary disease artery disease (Mean ± SD: 18.97 ± 4.54) than non-diabetic patients with coronary artery (Mean ± SD: 14.39 ± 3.59). Conclusion: Patients with CAD showed increased visfatin serum levels particularly diabetics. Moreover, high visfatin levels were significantly correlated with CAD severity.

Determinants of serum aldosterone in Kemerovo Region

Aim. To determine the variability of serum aldosterone in patients with stable coronary artery disease in relation to arterial hypertension status, age, and gender. Materials and Methods. We recruited 176 consecutive patients with stable coronary artery disease and evaluated serum aldosterone by enzyme-linked immunosorbent assay, further comparing its levels with regards to age, gender, and presence of arterial hypertension. Results. Average serum aldosterone in patients with stable coronary artery disease was similar in Kemerovo Region and those reported in the literature. Age ≥ 60 years, female gender, and the presence of arterial hypertension were among the serum aldosterone determinants Conclusions. Females ≥ 60 years of age with a medical history of arterial hypertension have increased serum aldosterone.

Severity of atherosclerotic coronary artery disease in relation to glycated hemoglobin level in diabetic patients

Severity of atherosclerotic coronary artery disease in relation to glycated hemoglobin level in diabetic patients

Pattern of Pulsed Wave Tissue Doppler Imaging of Anterior Wall of Ascending Aorta in Patients with Premature Coronary Artery Disease in Relation to Aortic Stiffness Index Parameters

Atherosclerosis and arterial stiffening may coexist and the relations of these parameters in patients with premature coronary artery disease (CAD) have not been well elucidated. Tissue Doppler imaging of the ascending aorta may be used in the assessment of elastic properties. A number of studies pointed that increased aortic stiffness (AS) is considered as a predictor index of cardiovascular disease (CVD) morbidity and mortality. Besides, a genetic factor was proposed to play a role based on the finding that increased arterial stiffness was found to be more prevalent in individuals with positive family history of premature coronary artery disease. Our study hypothesize that there’s a correlation between CAD in males younger than 45 years old and females younger than 55 years old in one hand and the aortic wall velocities assessed by TDI echocardiography on the other hand.

Decreased serum levels of CTRP12/adipolin in patients with coronary artery disease in relation to inflammatory cytokines and insulin resistance

Coronary artery disease (CAD) is the leading cause of death worldwide. Atherosclerosis as the main underlying mechanism of CAD is associated with inflammation and adipose tissue dysfunction. C1q/TNF-related protein12 (CTRP12) is a newly discovered adipokine which is a paralog of adiponectin. CTRP12 has anti-inflammatory and insulin sensitizing effects. Circulating levels of this adipokine have been reported to be lower in patients with type 2 diabetes and women with polycystic ovarian syndrome. The present study was undertaken for the first time to evaluate serum levels of CTRP12 in CAD patients and its association with anthropometric and biochemical parameters.Serum levels of CTRP12 were measured using ELISA kit in 188 CAD patients (angiography confirmed) and 70 controls. The serum levels of adiponectin, TNF-α and IL-6 were measured using ELISA kits.Serum levels of CTRP12 were found to be lower in CAD patients (585.48 ± 201.67 pg/mL) than in the controls (814.86 ± 247.85 pg/mL; p < 0.001). CTRP12 also showed an independent association with the risk of CAD (OR [CI] = 0.998 [0.996–0.999]; p = 0.019). Moreover, it showed an inverse correlation with HOMA-IR (r = −0.298; p = 0.012) and TNF-α (r = −0.269; p = 0.023) and a positive correlation with adiponectin (r = 0.344; p = 0.003) in the controls. In CAD patients, CTRP12 was inversely correlated with BMI (r = −0.181, p = 0.013), HOMA-IR (r = -0.199; p = 0.006), TNF-α (r = -0.259; p < 0.001) and IL-6 (r = -320; p < 0.001) and a positive correlation with high density lipoprotein-cholesterol(r = 0.342; p < 0.001) and adiponectin (r = 0.398; p < 0.001).The present study showed for the first time that serum levels of CTRP12 are independently associated with CAD and that CTRP12 is associated with several CAD risk factors. The results suggest a possible link between CTRP12 and pathogenic mechanisms of atherosclerosis, such as inflammation and high density lipoprotein-cholesterol metabolism; however, more study is required in this regard.

Risk stratification of coronary artery disease using radionuclides. Current status of clinical practice.

A discussion is presented on the current use of radioisotopes for evaluation of coronary artery disease in relation to other available techniques. The review is focused on coronary artery disease risk stratification employing single photon emission computed tomography and positron emission tomography, as well as on ischaemic cardiomyopathy and myocardial viability applications. Concepts are presented regarding coronary blood flow reserve, diagnostic and prognostic values, criteria for its appropriate use, as well as current methods to reduce unnecessary patient irradiation, in order to optimise nuclear cardiology practice.

Risk stratification of coronary artery disease using radionuclides. Current status of clinical practice

A discussion is presented on the current use of radionuclides for evaluation of coronary artery disease in relation to other available techniques. The review is focused on coronary artery disease risk stratification employing single photon emission computed tomography and positron emission tomography, as well as on ischemic cardiomyopathy and myocardial viability applications.Concepts are presented regarding coronary blood flow reserve, diagnostic and prognostic values, criteria for its appropriate use, as well as current methods to reduce unnecessary patient irradiation, in order to optimize nuclear cardiology practice.

Reverse perfusion pattern in myocardial perfusion imaging using technetium-99m-sestamibi in patients with intermediate risk for coronary artery disease in relation to the time of acquisition and intensity of visceral uptake as artifactual causes.

With respect to the equivocal value of the reverse perfusion pattern (RPP) in technetium-99m (Tc)-sestamibi myocardial perfusion imaging, a study was carried out to evaluate this pattern in association with the presence or absence of coronary artery disease (CAD) and other underlying factors, mainly the time of acquisition and the presence of intense visceral uptake. We prospectively studied 102 patients with a moderate risk of CAD (41 men and 61 women, mean age: 56.5±9.2 years) without a previous history of documented CAD, myocardial infarction, or revascularization. Myocardial perfusion imaging was performed using a 2-day dual-phase protocol with the stress and rest images, each obtained 15, 120, and 180 min after an injection of 666-814 MBq Tc-MIBI. According to the time of image acquisition, the following five protocols were defined, A: 15/15 min, B: 15/180 min, C: 180/180 min, D: 180/15 min, and E: 120/120 min for stress/rest images, respectively. The odds of RPP were higher in the cases with more intense infradiaphragmatic visceral uptake on rest-phase images of the protocols A and D (odds ratios=1.2-7.8 and 1.2-7.5, respectively). Our results showed that RPP is related to incorrect normalization. Also, diabetes, sex, and CAD did not correlate with RPP. This study found no relationship between RPP and CAD, diabetes mellitus, and sex; however, an association was found between RPP and incorrect normalization because of the variation of visceral uptake intensity in relation to the time of acquisition at stress and rest phases favoring the artifactual base of this pattern.

Prognostic Value of Multidetector Coronary Computed Tomography Angiography in Relation to Exercise Electrocardiogram in Patients With Suspected Coronary Artery Disease

This study was designed to determine the prognostic value of multidetector coronary computed tomography angiography (CTA) in relation to exercise electrocardiography (XECG) findings. The prognostic usefulness of coronary CTA findings of coronary artery disease in relation to XECG findings has not been explored systematically. Patients with suspected coronary artery disease who had undergone both coronary CTA and XECG (<90 days between tests) from 2003 through 2009 were enrolled retrospectively. Coronary CTA results were classified according to the severity of maximal stenosis (normal, mild: <40% of luminal stenosis, moderate: 40% to 69%, severe: ≥70%), XECG results were categorized as positive and negative, and Duke XECG score was calculated. Clinical follow-up data were collected for major adverse cardiac events (MACE): cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and revascularization after 90 days from index coronary CTA. C-statistics were calculated to compare discriminatory values of each test. Among the 2,977 (58 ± 10 years) study patients, 12% demonstrated positive XECG results. By coronary CTA, patients were categorized as normal (56%) or having mild (26%), moderate (13%), or severe (5%) disease. During a median follow-up of 3.3 years (interquartile range: 2.3 to 4.6), 97 MACE were observed and the 5-year cumulative event rate was 3.6% (95% confidence interval: 3.0 to 4.3). Although both XECG (C-statistic: 0.790) and coronary CTA (C-statistic: 0.908) improved risk stratification beyond clinical risk factors (C-statistic: 0.746, p < 0.05 for all), XECG in addition to coronary CTA (C-statistic: 0.907) did not provide better discrimination than coronary CTA alone (p = 0.389). In subgroup analyses, coronary CTA stratified risk of MACE in groups with both positive and negative XECG results (all p < 0.001 for trend). However, positive XECG results predicted risk of MACE on coronary CTA only in the moderate stenosis group (hazard ratio: 2.58, 95% confidence interval: 1.29 to 5.19, p = 0.008) and severe stenosis group (hazard ratio: 2.28, 95% confidence interval: 1.19 to 4.38, p = 0.013). In patients with suspected coronary artery disease, coronary CTA discriminates future risk of MACE in patients independent of XECG results. Compared with coronary CTA, XECG has an additive prognostic value only in patients with moderate to severe stenosis on coronary CTA.

Association of GSTM1 and GSTT1 gene polymorphisms with coronary artery disease in relation to tobacco smoking

Recent studies suggest that the common variant in the glutathione S-transferase (GST) M1 (GSTM1) and T1 (GSTT1) gene is associated with the risk of smoking-related coronary artery disease (CAD). Intra-ethnic as well as inter-ethnic differences are known to impact the frequencies of GST gene polymorphisms, thus influencing its interactive effect with tobacco smoking on CAD risk. The aim of the present study was to evaluate the interaction of the genetic polymorphisms of GSTM1 and GSTT1 with cigarette smoking and the risk of CAD in a Chinese population. We conducted a study with 277 CAD patients and 277 controls matched by age and sex to examine the prevalence of GSTM1 and GSTT1 polymorphism in CAD. We found that homozygous deletion of GSTM1 had a frequency of 32.1% among patients with CAD and 21.3% among those without CAD (p=0.004). The frequency of the GSTT1(null) genotype was 27.8% among the patients with CAD and 19.1% among CAD-free subjects (p=0.016). Patients who smoked having both the wild-type genotypes of GSTM1 and GSTT1 were protected from developing coronary heart disease (p<0.001). Moreover, smokers with combined GSTM1(null)GSTT1(null) genotypes had a significantly higher number of stenosed vessels than those with the positive genotype (p=0.02). Our results suggest that GST polymorphisms may be a susceptibility factor to smoking-related CAD in the Chinese population.

The course of coronary artery disease in relation to personality traits and symptoms of depression in hospitalized male patients

Goalassessment of depressive symptomatology and personality traits in patients with coronary artery disease (CAD).Patientsforty-two males consecutively admitted to a cardiology unit due to an ICD-10 diagnosis of Acute Cardiac Syndrome (ACS). Twenty-two of them had unstable angina (UA) without myocardial infarction and 20 of them had confirmed myocardial infarction (MI).Methods:short questionnaire assessing the clinical course of heart disease, the Beck Depression Inventory (BDI) and the Cloninger Temperament and Character Inventory (TCI) were applied.Results:The mean BDI score in the whole group of patients was 20. The MI patients had higher BDI score than the UA patients without MI. The patients with more serious clinical course of heart disease and those who shorter suffered from ACS had significantly higher BDI score than the other patients. The whole group of ACS patients revealed more pronounced temperamental Harm Avoidance (HA) and less pronounced Reward Dependence dimension of the TCI. The patients with more serious clinical course of CAD had more evident HA features and than patients with mild clinical course of the disease. The patients with longer duration of CAD had more pronounced Self-Transcendence (a character dimension of the TCI) as compared to patients with shorter duration of the illness.Conclusions:Depressive symptoms are common and prominent in CAD patients particularly in those with shorter duration and more serious course of the illness. The relationships between temperamental and character dimensions of personality with the clinical course of CAD indicate multifactor and complex associations which need further studies.

Association Between IL-1β Gene Polymorphism and Myocardial Infarction

HomeArteriosclerosis, Thrombosis, and Vascular BiologyVol. 25, No. 4Association Between IL-1β Gene Polymorphism and Myocardial Infarction Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBAssociation Between IL-1β Gene Polymorphism and Myocardial Infarction Yukihiko Momiyama, Reiko Ohmori and Fumitaka Ohsuzu Yukihiko MomiyamaYukihiko Momiyama First Department of Internal Medicine, National Defense Medical College, Saitama, Japan Search for more papers by this author , Reiko OhmoriReiko Ohmori First Department of Internal Medicine, National Defense Medical College, Saitama, Japan Search for more papers by this author and Fumitaka OhsuzuFumitaka Ohsuzu First Department of Internal Medicine, National Defense Medical College, Saitama, Japan Search for more papers by this author Originally published1 Apr 2005https://doi.org/10.1161/01.ATV.0000159700.18731.d2Arteriosclerosis, Thrombosis, and Vascular Biology. 2005;25:e36To the Editor:We read with great interest the study by Iacoviello et al.1 They investigated IL-1β gene polymorphism (−511C/T) in 406 patients with myocardial infarction (MI) at young age and 419 controls and reported the TT genotype to be inversely associated with MI. Moreover, they demonstrated mononuclear cells with TT homozygote to show decreased IL-1β production compared with those with CC homozygote. They concluded that this polymorphism affects the risk of MI at young age.Inflammation plays an important role in atherosclerosis. Infectious agents, such as Chlamydia pneumoniae (CP), were often reported to be associated with MI. However, inflammatory responses to infection may vary from individual to individual, and only a small number of individuals develop MI. We previously investigated IL-1β (−511C/T) and IL-1Ra (a variable number repeat) gene polymorphisms and CP seropositivity in 292 patients undergoing coronary angiography.2 Notably, the IL-1 gene variants (IL-1β CC and/or IL-1Ra 2- or 3-repeat) were found to be associated with MI only in patients with CP seropositivity. Our report suggested that IL-1 gene polymorphisms modify the process of coronary artery disease (CAD) in patients with CP infection, leading to the development of MI. In the same line of evidence, the AtheroGene Group3 demonstrated that IL-6 (−174G/C) gene polymorphism was not a factor for CAD, but the association between infectious burden and CAD was modulated by IL-6 gene polymorphism.A recent large study4 investigated 112 polymorphisms in 4152 subjects. Only connexin (1019C/T), plasminogen activator inhibitor (PAI) (4G-668/5G), and stromelysin-1 (5A-1171/6A) gene polymorphisms were associated with MI, whereas IL-1β gene polymorphism was not.4 IL-1β gene polymorphism may not be a factor for MI in a general population, but it may play a role in the development of MI in certain individuals, such as in young subjects1 or subjects with CP infection.2 Large studies are important, but studies in certain subgroups, such as the study by Iacoviello et al1 and ours,2 will provide additional valuable information.1 Iacoviello L, Di Castelnuovo A, Gattone M, Pezzini A, Assanelli D, Lorenzet R, Del Zotto E, Colombo M, Napoleone E, Amore C, D’Orazio A, Padovani A, de Gaetano G, Giannuzzi P, Donati MB. Polymorphisms of the IL-1β gene affect the risk of myocardial infarction and ischemic stroke at young age and the response of mononuclear cells to stimulation in vitro. Arterioscler Thromb Vasc Biol. 2005; 25: 222–227.LinkGoogle Scholar2 Momiyama Y, Hirano R, Taniguchi H, Nakamura H, Ohsuzu F. Effects of interluekin-1 gene polymorphisms on the development of coronary artery disease associated with Chlamydia pneumoniae infection. J Am Coll Cardiol. 2001; 38: 712–727.CrossrefMedlineGoogle Scholar3 Georges JL, Rupprecht HJ, Blankenberg S, Poirier O, Bickel C, Hafner G, Nicaud V, Meyer J, Cambien F, Tiret L. Impact of pathogen burden in patients with coronary artery disease in relation to systemic inflammation and variation in genes encoding cytokines. Am J Cardiol. 2003; 92: 515–521.CrossrefMedlineGoogle Scholar4 Yamada Y, Izawa H, Ichihara S, Takatsu F, Ishihara H, Hirayama H, Sone T, Tanaka M, Yokota M. Prediction of the risk of myocardial infarction from polymorphisms in candidate genes. N Engl J Med. 2002; 347: 1916–1923.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Fang Y, Xie H and Lin Z (2018) Association between IL-1β + 3954C/T polymorphism and myocardial infarction risk, Medicine, 10.1097/MD.0000000000011645, 97:30, (e11645), Online publication date: 1-Jul-2018. Rios D, Cerqueira C, Bonfim-Silva R, Araújo L, Pereira J, Gadelha S and Barbosa A (2010) Interleukin-1 beta and interleukin-6 gene polymorphism associations with angiographically assessed coronary artery disease in Brazilians, Cytokine, 10.1016/j.cyto.2010.02.012, 50:3, (292-296), Online publication date: 1-Jun-2010. April 2005Vol 25, Issue 4 Advertisement Article InformationMetrics https://doi.org/10.1161/01.ATV.0000159700.18731.d2PMID: 15790937 Originally publishedApril 1, 2005 PDF download Advertisement

Are Anti–Oxidized Low-Density Lipoprotein Antibodies Pathogenic or Protective?

Despite a recent decline, atherosclerosis remains the most common cause of death in the Western world. The disease course of atherosclerosis is characterized by its chronicity, with progression in its initial stages being particularly insidious. Chronic inflammation is the pathological hallmark of atherosclerosis,1–4 and inflammatory processes are instrumental at all stages of this disease. Even before the development of detectable intimal lesions, the expression pattern of the endothelium has been shown to be inflammatory in nature, conforming to the response-to-injury hypothesis first postulated by the late Russell Ross.5 Thus, in lesion-prone sites of the arterial tree, the endothelial expression of adhesion molecules is upregulated, reflecting endothelial dysfunction secondary to unfavorable blood rheology6 and/or hypercholesterolemia.7–9 Atherosclerosis is known today to be associated with the burden of infection as well.10 The presence of infectious/inflammatory pathogeneses raises the autoimmune aspect of the condition.11–14 Anti–oxidized LDL (oxLDL) antibodies are exceptional among the autoantibodies prevalent in atherosclerosis: on the one hand, a correlation was found between the existence and titers of anti-oxLDL antibodies and the extent of atherosclerosis and cardiovascular disease (CVD) (Table 1). On the other hand, experimental data indicate that anti-oxLDL antibodies may be protective. View this table: TABLE 1. Correlation Between Titers of Anti-oxLDL Abs and Atherosclerosis and CVD oxLDL frequently presents in the sera of patients with autoimmune conditions, acute coronary syndrome, or stable coronary artery disease (CAD).15–18 OxLDL has been associated with both subclinical atherosclerosis and inflammatory variables.19 A large amount of oxLDL accumulates in atherosclerotic plaques,20–22 and the serum concentrations of circulating oxLDL may correlate with the severity of CAD23 and acute coronary syndrome.24 OxLDL seems to be an immunogenic molecule that stimulates the induction of anti-oxLDL antibodies. Thus, it is not surprising that an association was found between the presence …

Impact of pathogen burden in patients with coronary artery disease in relation to systemic inflammation and variation in genes encoding cytokines

The number of infectious pathogens to which an individual has been exposed (pathogen burden) has been linked to the development and the prognosis of coronary artery disease (CAD). The interaction among infection, genetic host susceptibility, and CAD remains unclear. This study was aimed at evaluating the modulation of the association between CAD and pathogen burden, by serum levels of inflammatory markers and polymorphisms of the interleukin (IL)-6 and tumor necrosis factor (TNF)-α genes. Immmunoglobulin (Ig) G or IgA antibodies to 8 pathogens were determined in 991 patients with CAD and 333 control subjects. Serum levels of high-sensitivity C-reactive protein, fibrinogen, IL-6, and TNF-α were also measured. All subjects were genotyped for the IL-6/G-174C, the TNF/C-851T, and the TNF/G-308A polymorphisms. Analysis of single pathogens demonstrated a positive relation to the presence of CAD for some ( Chlamydia pneumoniae, cytomegalovirus, Helicobacter pylori, and herpes virus simplex type 1), but not all pathogens. A strong association between increasing pathogen burden and CAD was confirmed, even after adjustment for risk factors. The prevalence of a high pathogen burden (≥4 pathogens) was 50% in patients and 21% in controls (p <0.0001). A high pathogen burden was associated with decreased high-density lipoprotein cholesterol levels (p <0.001). The association between CAD and pathogen burden was modulated by the IL6/G-174C polymorphism, the odds ratio being higher in heterozygotes than in both types of homozygotes (p <0.05). This interaction appeared to be mediated by variations in serum IL-6 levels. No such interaction was detected with any of the 2 TNF-α polymorphisms.

Differential effect of aspirin on platelet aggregation in patients with coronary artery disease in relation with associated risk factors.

Platelets play a key role in the pathogenesis of atherosclerosis and acute coronary syndromes and antiplatelet therapy offers a clinical benefit. Although aspirin is the most widely used agent, there are several conditions in which aspirin may fail to provide a full antithrombotic benefit. Furthermore, data concerning the relationship between platelet function, aspirin, and the associated risk factors are limited. In the present study. ADP and collagen-induced platelet aggregation of 200 consecutive patients with suspected coronary artery disease (CAD) who underwent coronary angiography were evaluated. The patients were classified into three groups according to the number of stenotic vessels. One hundred and eight patients were using 300 mg/day of aspirin. The associated cardiovascular risk factors were also considered. The collagen-induced platelet aggregation of smokers was significantly higher than non-smokers (P < 0.05). Although platelet aggregation was higher in diabetic and hypertensive patients, the difference was not statistically significant. No significant correlation was found between platelet aggregation and other risk factors. The collagen-induced platelet aggregation of the subjects with non-stenotic vessels was reduced by aspirin (P < 0.05). Aspirin did not sufficiently inhibit ADP and collagen-induced aggregation in patients with CAD. This finding supports the idea that the nonplatelet-mediated effects of aspirin could be more important than its antiplatelet effect in clinical use and the use of new potent antiplatelet drugs may complete its antiplatelet effect.

Serum N-acetyl-β- d-gulucosaminidase activity increases in association with insulin resistance in patients with coronary artery disease

N-acetyl-β- d-glucosaminidase (NAG) is released from lysosomes, but the clinical significance of its serum activity in the pathogenesis of coronary artery disease has not been well understood. We measured serum NAG activity by a colorimetric method in consecutive 168 patients suspected of having coronary artery disease who underwent diagnostic coronary angiography. In addition, we evaluated the relationship between the activity and severity of coronary artery disease, as well as various coronary risk factors. Serum NAG activity was higher in the multi-vessel disease group than in the no stenotic lesion group (9.2±2.3 vs. 7.8±1.8 U/l, P<0.01) and in the single-vessel disease group (vs. 8.2±2.2 U/l, P<0.05). In all patients, Gensini score was closely correlated with the serum NAG activity ( r=0.39, P<0.001). Multiple regression analysis showed that serum NAG activity was correlated with plasma insulin level ( r=0.49, P<0.01), but not correlated with other coronary risk factors. In 126 patients without apparent diabetes mellitus, serum NAG was also correlated with plasma insulin level ( r=0.37, P<0.01) and additionally with insulin resistance determined by homeostasis model assessment ( r=0.47, P<0.01). Our results suggested that serum NAG activity correlates with the severity of coronary artery disease in relation to plasma insulin level and insulin resistance, and thus can be an indicator of coronary artery disease based upon abnormalities of glucose metabolism.

Fibrinolytic Proteins and Progression of Coronary Artery Disease in Relation to Gemfibrozil Therapy

Impaired fibrinolytic function, mainly due to increased plasma plasminogen activator inhibitor-1 (PAI-1) activity, is common in patients with manifest coronary artery disease (CAD) and a predictor of recurrent cardiovascular events. We investigated the relationships of plasma tissue-type plasminogen activator (tPA) and PAI-1 antigen levels, plasma PAI-1 activity and PAI 4/5-guanosine (4G/5G) genotype to CAD progression in 203 middle-aged men participating in the Lopid Coronary Angiography Trial (LOCAT). A higher tPA antigen concentration, whether baseline or on-trial, was associated with a more severe global angiographic response (p < 0.05), an association mainly accounted for by progression of diffuse lesions in graft-affected segments (change in per-patient means of average diameters of segments haemodynamically related to bypass grafts). Plasma PAI-1 activity and mass concentration and 4G/5G PAI-1 genotype were unrelated to angiographic outcome measurements. tPA and PAI-1 antigen increased significantly in the gemfibrozil group (+11.3% and + 16.4%, respectively, p < 0.001), whereas there was no treatment effect on PAI-1 activity (median change 0.0%). It is concluded that fibrinolytic function does not substantially influence progression of CAD as assessed by angiography in middle-aged men. Furthermore, pronounced long-term lowering of serum triglycerides by gemfibrozil treatment does not significantly affect the plasma PAI-1 activity level but increases the plasma tPA and PAI-1 antigen concentrations.

Association of trans fatty acids (vegetable ghee) and clarified butter (Indian ghee) intake with higher risk of coronary artery disease in rural and urban populations with low fat consumption

These cross-sectional surveys included 1769 rural (894 men and 875 women) and 1806 urban (904 men and 902 women) randomly selected subjects between 25–64 years of age from Moradabad in North India. The total prevalence of coronary artery disease based on clinical history and electrocardiogram was significantly higher in urban compared to rural men (11.0 vs. 3.9%) and women (6.9 vs. 2.6%), respectively. Food consumption patterns showed that important differences in relation to coronary artery disease were higher intake of total visible fat, milk and milk products, meat, eggs, sugar and jaggery in urban compared to rural subjects. Prevalence of coronary artery disease in relation to visible fat intake showed a higher prevalence rate with higher visible fat intake in both sexes and the trend was significant for total prevalence rates both for rural and urban men and women. Subgroup analysis among urban (694 men and 694 women) and rural (442 men and 435 women) subjects consuming moderate to high fat diets showed that subjects eating trans fatty acids plus clarified butter or those consuming clarified butter as total visible fat had a significantly higher prevalence of coronary artery disease compared to those consuming clarified butter plus vegetable oils in both rural (9.8, 7.1 vs. 3.0%) and urban (16.2, 13.5 vs. 11.0%) men as well as in rural (9.2, 4.5 vs. 1.5%) and urban (10.7, 8.8 vs. 6.4%) women. Univariate and multivariate regression analysis with adjustment for age showed that sedentariness in women, body mass index in urban men and women, milk and clarified butter plus trans fatty acids in both rural and urban in both sexes were significantly associated with coronary artery disease. It is possible that lower intake of total visible fat (20 g/day), decreased intake of milk, increased physical activity and cessation of smoking may benefit some populations in the prevention of coronary artery disease.