Coronary Artery Disease Patients Research Articles

Nε-carboxymethyl-lysine and inflammatory cytokines, markers and mediators of coronary artery disease progression in diabetes

This editorial refers to the article “Comparative analysis of Nε-carboxymethyl-lysine and inflammatory markers in diabetic and non-diabetic coronary artery disease patients”, published in the recent issue of the World Journal of Diabetes 2023 is based on glucose metabolism, advanced glycation end products (AGEs), inflammation and adiposity on diabetes and coronary artery disease (CAD). This study has included CAD patients who were stratified according to glycosylated hemoglobin higher than 6.5 and sex-matched. A higher prevalence of hypertension, dyslipidemia, and non-vegetarian diet were found in the diabetic group. These risk factors might influence body weight and adiposity and explain the increment of the left atrium. Although this data was not supported by the study. The diet can also explain the non-enzymatic reactions on lipids, proteins, or nucleic acids and consequently an increment of AGEs. These molecules can emit fluorescence. However, one of the non-fluorescent and most abundant AGEs is Nε-carboxymethyl-lysine (CML). Its association with coronary artery stenosis and severity in the diabetic group might suggest its role as a player in CAD progression. Thus, CML, after binding with its receptor (RAGE), can induce calcification cascade through reactive oxygen species and mitogen-activated protein kinase. Moreover, this interaction AGE-RAGE can cause activation of the transcription nuclear factor-kb and induce inflammatory cytokines. It might explain the relationship between CML and pro-inflammatory cytokines in diabetic and CAD patients. Although this is a population from one center, the determination of CML and inflammatory cytokines might improve the diagnosis of severe and progressive CAD. Future and comparative studies among glycosylated hemoglobin, CML, and other AGE levels according to diagnosis and prognosis value might modify the clinical practice. Although these molecules are irreversible, they can act through a specific receptor inducing a signal transduction that might be modu-lated by inhibitors, antibodies, or siRNA. Further mechanistic studies might improve the development of future preventive therapies for diabetic patients.

Evaluation of Single/Multiple Joint Effects of Lipid Profiles on Hypertension, Diabetes Mellitus and Obesity Accompanying Coronary Artery Disease

Abstract
 Background: Although cardiovascular diseases are among the most prominent causes of mortality/morbidity in the world, they are even more important together with comorbidities. This study aims to reveal the single/multiple effects of total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), and triglyceride (TG) on hypertension (HT), type 2 diabetes mellitus (T2DM) and obesity accompanying coronary artery disease (CAD).
 Methods: The data were retrospectively achieved from the records of CAD patients undergoing coronary bypass surgery at the Department of Cardiovascular Surgery, … Medical Center, … University. The medical knowledge discovery process (MKDP) was applied to the data concerning HT, DM, obesity, TC, HDL-C, LDL-C, and TG variables. Different methods were used to determine the optimal cut-off points of lipid profiles. Logistic regression analysis (LRA) was examined the single/multiple effects of lipid profiles on HT, T2DM, and obesity.
 Results: TC, LDL-C, TG, and HDL-C lipid profiles categorized according to the cut-off points determined in the current study were analyzed with LRA models. LDL-C (>117 mg/dL)*TC (>191 mg/dL)*HDL-C (>37.2 mg/dL) in HT and TC (>190 mg/dL)*TG (>197) mg/dL)*HDL-C (>36.3 mg/dL) in T2DM interaction terms had a moderate effect size. LDL-C (>115 mg/dL)*TG (>197 mg/dL)*HDL-C (>36.3 mg/dL) interaction terms in T2DM and TC (>192 mg/dL)*LDL-C (>117 mg/dL)*HDL-C (>36.8 mg/dL), TK (>192 mg/dL)*TG (>193 mg/dL)*HDL-C (>36.8 mg/dL) and LDL-C (>117 mg/dL)*TG (>193 mg/dL)*HDL-C (>36.8 mg/dL) interaction terms in obesity were reported as having a high effect size.
 Conclusion: In conclusion, it is recommended to use the approach that analyzes the cut-off points proposed in this study for lipid profiles in predicting HT, T2DM, and obesity.

Matrix metallopeptidase 9 contributes to the beginning of plaque and is a potential biomarker for the early identification of atherosclerosis in asymptomatic patients with diabetes

AimsTo determine the roles of matrix metallopeptidase-9 (MMP9) on human coronary artery smooth muscle cells (HCASMCs) in vitro, early beginning of atherosclerosis in vivo in diabetic mice, and drug naïve patients with diabetes.MethodsActive human MMP9 (act-hMMP9) was added to HCASMCs and the expressions of MCP-1, ICAM-1, and VCAM-1 were measured. Act-hMMP9 (n=16) or placebo (n=15) was administered to diabetic KK.Cg-Ay/J (KK) mice. Carotid artery inflammation and atherosclerosis measurements were made at 2 and 10 weeks after treatment. An observational study of newly diagnosed drug naïve patients with type 2 diabetes mellitus (T2DM n=234) and healthy matched controls (n=41) was performed and patients had ultrasound of carotid arteries and some had coronary computed tomography angiogram for the assessment of atherosclerosis. Serum MMP9 was measured and its correlation with carotid artery or coronary artery plaques was determined.ResultsIn vitro, act-hMMP9 increased gene and protein expressions of MCP-1, ICAM-1, VCAM-1, and enhanced macrophage adhesion. Exogenous act-hMMP9 increased inflammation and initiated atherosclerosis in KK mice at 2 and 10 weeks: increased vessel wall thickness, lipid accumulation, and Galectin-3+ macrophage infiltration into the carotid arteries. In newly diagnosed T2DM patients, serum MMP9 correlated with carotid artery plaque size with a possible threshold cutoff point. In addition, serum MMP9 correlated with number of mixed plaques and grade of lumen stenosis in coronary arteries of patients with drug naïve T2DM.ConclusionMMP9 may contribute to the initiation of atherosclerosis and may be a potential biomarker for the early identification of atherosclerosis in patients with diabetes.Clinical trial registrationhttps://clinicaltrials.gov, identifier NCT04424706.

The role of coronary artery disease in lung transplantation: a propensity-matched analysis.

Candidate selection for lung transplantation (LuTx) is pivotal to ensure individual patient benefit as well as optimal donor organ allocation. The impact of coronary artery disease (CAD) on post-transplant outcomes remains controversial. We provide comprehensive data on the relevance of CAD for short- and long-term outcomes following LuTx and identify risk factors for mortality. We retrospectively analyzed all adult patients (≥ 18years) undergoing primary and isolated LuTx between January 2000 and August 2021 at the LMU University Hospital transplant center. Using 1:1 propensity score matching, 98 corresponding pairs of LuTx patients with and without relevant CAD were identified. Among 1,003 patients having undergone LuTx, 104 (10.4%) had relevant CAD at baseline. There were no significant differences in in-hospital mortality (8.2% vs. 8.2%, p > 0.999) as well as overall survival (HR 0.90, 95%CI [0.61, 1.32], p = 0.800) between matched CAD and non-CAD patients. Similarly, cardiovascular events such as myocardial infarction (7.1% CAD vs. 2.0% non-CAD, p = 0.170), revascularization by percutaneous coronary intervention (5.1% vs. 1.0%, p = 0.212), and stroke (2.0% vs. 6.1%, p = 0.279), did not differ statistically between both matched groups. 7.1% in the CAD group and 2.0% in the non-CAD group (p = 0.078) died from cardiovascular causes. Cox regression analysis identified age at transplantation (HR 1.02, 95%CI [1.01, 1.04], p < 0.001), elevated bilirubin (HR 1.33, 95%CI [1.15, 1.54], p < 0.001), obstructive lung disease (HR 1.43, 95%CI [1.01, 2.02], p = 0.041), decreased forced vital capacity (HR 0.99, 95%CI [0.99, 1.00], p = 0.042), necessity of reoperation (HR 3.51, 95%CI [2.97, 4.14], p < 0.001) and early transplantation time (HR 0.97, 95%CI [0.95, 0.99], p = 0.001) as risk factors for all-cause mortality, but not relevant CAD (HR 0.96, 95%CI [0.71, 1.29], p = 0.788). Double lung transplant was associated with lower all-cause mortality (HR 0.65, 95%CI [0.52, 0.80], p < 0.001), but higher in-hospital mortality (OR 2.04, 95%CI [1.04, 4.01], p = 0.039). In this cohort, relevant CAD was not associated with worse outcomes and should therefore not be considered a contraindication for LuTx. Nonetheless, cardiovascular events in CAD patients highlight the necessity of control of cardiovascular risk factors and a structured cardiac follow-up.

Increased epicardial adipose tissue thickness as a sign of subclinical atherosclerosis in patients with rheumatoid arthritis and ıts relationship with disease activity ındices.

Epicardial adipose tissue is a novel cardiometabolic risk factor and indicator of subclinical atherosclerosis. We aimed to evaluate the epicardial adipose tissue thickness in rheumatoid arthritis (RA) patients and its association with disease activity scores. A total of 81 rheumatoid arthritis patients and 70 age- and sex-matched healthy individuals were recruited for this cross-sectional study. Epicardial adipose tissue thickness (EATT) was measured by transthoracic two-dimensional echocardiography. Tender and swollen joint counts were recorded at the time of inclusion. The laboratory tests included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor, anti-citrullinated protein antibodies, and serum lipid levels. Disease activity was calculated based on Disease Activity Scores for 28 joints (DAS-28) ESR and CRP, the Simple Disease Activity Index (SDAI), and the Clinical Disease Activity Index (CDAI). Epicardial adipose tissue thickness was significantly higher in the RA patients compared to the healthy controls (p < 0.001). We found statistically significant correlations of EATT with all disease activity indices (p < 0.001) and CRP (p = 0.002). According to a cut-off value of 6.4mm determined for epicardial adipose tissue thickness, the RA patients with thickness ≥ 6.4mm had higher disease activity scores and CRP levels. In the multivariable regression analysis, only SDAI score was found as an independent risk factor for increased EATT (OR, (95%CI), 13.70 (3.88-48.43), p < 0.001). Epicardial adipose tissue thickness measurement by echocardiography is a reliable method for assessing subclinical atherosclerosis in rheumatoid arthritis patients, and a higher disease activity score is an independent risk factor for coronary artery disease.

A Comparative Analysis of the Serum Paraoxonase (PON1) Activity and the Concentration of Parameters of Lipid Profile after 3 Months of Statin Therapy

Background: Human serum paraoxonase (PON1) residing on HDL can prevent the oxidation of low densitylipoprotein (LDL), the initiating factor in atherosclerosis. Statins are commonly used to treat dyslipidemia,aknown risk factor for coronary artery disease (CAD).The aim of the studyis to evaluate the alterations in theconcentrationof PON1 along with that of other parameters of lipid profile in patients of CAD before and after 3 months of statin therapy.Materials and Methods: The study included 30 new patients who were put on statin therapy following thediagnosis of acute coronary syndrome. The activity of PON1 (units-IU/L) and the concentration of lipid profileparameters (units-mg/dl) were estimated before starting statin therapy and again after three months. Patients with co-morbidities like diabetes, kidney disease, liver disease and other cardiac diseases of infectious aetiology were excluded.Results and Analysis: As expected, both PON1 and HDL have increased after 3 months. There was a statistically significant increase in both PON1 (p&lt;0.05)and HDL (p&lt;0.001) and a decrease (p &lt;0.05, also statistically significant)in LDL after 3 months of statin therapy.Conclusion: This knowledge may be exploited in the follow up CAD patients. The increase in PONI and thesimilar increase in HDL after 3 months of statin therapy may be exploited in the follow-up of cardiac patients.

Clinical and psychological associations and coping strategies for personality type D and depression in patients with coronary artery disease

The comorbidity of manifestations of psychological distress and cardiovascular diseases is complex. The degree of impact of psychological stress on the patient depends on the possibilities of the adaptive potential of the individual in the environment.Aim: To study the cognitive assessment of stress, coping strategies and clinical and psychological associations in personality type D and depression in patients with coronary artery disease (CAD).Material and Methods. The study included 112 CAD patients. The DS-14 questionnaire was used to determine personality type D.To determine the level of depression the hospital scale HADS (Hospital Anxiety and Depression Scale). To assess coping strategies, the questionnaires “Methods of Coping Behavior” and “Indicator of Stress Coping Strategies” were used. Difficult life situation (DLS) assessment was determined using the “Cognitive Assessment of DLS” methodology. The questionnaire “Types of Orientations in Difficult Situations” was used to study orientations in DLS.Results. Patients were divided into groups based on manifestations of psychological distress: with type D (n = 40), without type D (n = 72); with depression (n = 48) without depression (n = 82). In type D, there was a more frequent assessment of the situation as out of control (12.0 ± 4.6 points versus 11.0 ± 4.6 points, p = 0.049) and orientation towards losses in difficult situations (17.0 ± 4.1 points 15.5 ± 5.1, points, p = 0.016). In depression, less pronounced desire for difficulties (19.0 ± 5.0 points versus 23.0 ± 5.9 points, p = 0.006), orientation towards opportunities (15.5 ± 3.2 points versus 18.0 ± 3.5 points, p &lt; 0.001). In type D, the strategies “Escape-avoidance” (p = 0.05) and “Self-control” (p = 0.04) were used more often. In depression, the strategies “Problem resolution” (p = 0.02), “Search for social support” (p &lt; 0.001) and “Avoidance” (p = 0.02) were more often used, less often – “Confrontational coping” (p = 0.001).Conclusion. Differences in cognitive assessment and coping strategies were revealed in patients with coronary artery disease in personality type D and the development of depression symptoms. This study emphasizes the need for individualized behavioral interventions for patients with coronary artery disease with manifestations of psychological distress.

Colchicine for the Prevention of Cardiovascular Disease: Potential Global Implementation.

Targeting traditional cardiovascular risk factors is effective in reducing recurrent cardiovascular events, yet the presence of residual cardiovascular risk due to underlying systemic inflammation is a largely unaddressed opportunity. This review aims to comprehensively assess the evolving role of colchicine as a therapeutic approach targeting residual inflammatory risk in the context of those with coronary artery disease (CAD). Inflammation plays a significant role in promoting atherosclerosis, and targeting anti-inflammatory pathways has the potential to decrease cardiovascular events. Low-dose colchicine (0.5mg/day orally), when added to guideline-directed medical care for CAD, safely decreases major adverse cardiovascular events (MACE) by 31% in stable atherosclerosis patients and 23% in those after recent myocardial infarctions. Meta-analyses of recent randomized control trials further support both the efficacy and safety of colchicine, particularly when added to other standard cardiovascular therapies, including statin therapy. The European Society of Cardiology and other national guidelines endorse the use of low-dose colchicine in patients across the spectrum of CAD. Recently, colchicine was FDA-approved in the United States as the first anti-inflammatory therapy for the reduction of cardiovascular events. In a period of a rising incidence of CAD across the globe, colchicine represents a unique opportunity to decrease MACE due to its large magnitude of benefits and general affordability. However, challenges with drug interactions must be addressed, especially in those regions where HIV, hepatitis, and tuberculosis are prevalent. Colchicine is safe and effective at reducing cardiovascular events across a broad spectrum of coronary syndromes. The ability to simultaneously target traditional risk factors and mitigate residual inflammatory risk marks a substantial advancement in cardiovascular prevention strategies, heralding a new era in the global battle against CAD.

Learned high-resolution cardiac CT imaging from ultra-high-resolution PCD-CT.

Coronary computed tomography angiography (cCTA) is a widely used non-invasive diagnostic exam for patients with coronary artery disease (CAD). However, most clinical CT scanners are limited in spatial resolution from use of energy-integrating detectors (EIDs). Radiological evaluation of CAD is challenging, as coronary arteries are small (3-4 mm diameter) and calcifications within them are highly attenuating, leading to blooming artifacts. As such, this is a task well suited for high spatial resolution. Recently, photon-counting-detector (PCD) CT became commercially available, allowing for ultra-high resolution (UHR) data acquisition. However, PCD-CTs are costly, restricting widespread accessibility. To address this problem, we propose a super resolution convolutional neural network (CNN): ILUMENATE (Improved LUMEN visualization through Artificial super-resoluTion imagEs), creating a high resolution (HR) image simulating UHR PCD-CT. The network was trained and validated using patches extracted from 8 patients with a modified U-Net architecture. Training input and labels consisted of UHR PCD-CT images reconstructed with a smooth kernel degrading resolution (LR input) and sharp kernel (HR label). The network learned the resolution difference and was tested on 5 unseen LR patients. We evaluated network performance quantitatively and qualitatively through visual inspection, line profiles to assess spatial resolution improvements, ROIs for CT number stability and noise assessment, structural similarity index (SSIM), and percent diameter luminal stenosis. Overall, ILUMENATE improved images quantitatively and qualitatively, creating sharper edges more closely resembling reconstructed HR reference images, maintained stable CT numbers with less than 4% difference, reduced noise by 28%, maintained structural similarity (average SSIM = 0.70), and reduced percent diameter stenosis with respect to input images. ILUMENATE demonstrates potential impact for CAD patient management, improving the quality of LR CT images bringing them closer to UHR PCD-CT images.

Predictive effect of estimated glomerular filtrate rate by creatinine or cystatin C on mortality in patients with coronary artery disease

Background Renal dysfunction leads to poor prognosis of patients with coronary artery disease (CAD). Current studies have reported the prognosis or mortality of various diseases using different estimated glomerular filtrate rate (eGFR) formulas, while the performance of these equations is unclear in CAD patients. We aim to evaluate the predict effect of creatinine-based eGFR (eGFRcr), cystatin C-based eGFR (eGFRcys), and both creatinine and cystatin C-based eGFR (eGFRcr-cys) in CAD patients. Methods A total of 23,178 patients with CAD were included from CIN-II cohort study. The association of eGFRcr, eGFRcys and eGFRcr-cys with cardiovascular and all-cause mortality was detected by Cox regression analysis. The predictive effect of eGFRcr, eGFRcys and eGFRcr-cys on mortality was assessed. Results During a median follow up of 4.3 years, totally 2051 patients (8.8%) experience all-cause mortality, of which 1427 patients (6.2%) died of cardiovascular disease. For the detection of cardiovascular mortality among CAD patients, eGFRcr-cys had high discriminatory capacity with area under the curve (AUC) in receiver operator characteristic analysis of 0.730, which was significantly better than eGFRcr (AUC = 0.707, p < 0.001) and eGFRcys (AUC = 0.719, p < 0.001). Similar results were observed in all-cause mortality. Restricted cubic spline showed a U-shaped association between eGFRcr and all outcomes in patients with both reduced and supranormal eGFR levels, while a L-shaped association in eGFRcys and eGFRcr-cys. Conclusions Estimated GFR based on both creatinine and cystatin C has highest predictive effect for cardiovascular and all-cause mortality among CAD patients. Meanwhile, supranormal eGFRcr may indicate a higher risk of mortality.

Triglyceride to high-density lipoprotein cholesterol ratio associated with long-term adverse clinical outcomes in patients deferred revascularization following fractional flow reserve

BackgroundGuidelines on coronary intermediate lesions strongly recommend deferred revascularization after detecting a normal fractional flow reserve (FFR). Researches about triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) on cardiovascular diseases has also been well conducted. However, the association of TG/HDL-C and long-term adverse clinical outcomes remains unknown for patients deferred revascularization following FFR.MethodsThis study retrospectively included 374 coronary artery disease (CAD) patients with non-significant coronary lesions diagnosed by coronary angiography (CAG) and FFR. The main outcome measure was the combination of major adverse cardiovascular and cerebrovascular events (MACCEs). All patients were categorized into three subgroups in terms of TG/HDL-C tertiles (T1 < 0.96, 0.96 ≤ T2 < 1.58, T3 ≥ 1.58). Three different Cox regression models were utilized to reveal the association between TG/HDL-C and prevalence of MACCEs.Results47 MACCEs were recorded throughout a median monitoring period of 6.6 years. The Kaplan-Meier survival curves showed a higher MACCEs rate occurred in the higher TG/HDL-C group (5.6% vs. 12.9% vs. 19.4%, log-rank P < 0.01). After adjustment, patients in T3 suffered a 2.6-fold risk compared to the T1 group (T3 vs. T1: HR 2.55, 95% CI 1.05–6.21, P = 0.038; T2 vs. T1: HR 1.71, 95% CI 0.65–4.49, P = 0.075; P for trend = 0.001). The restricted cubic spline (RCS) analysis demonstrated that the HR for MACCEs rose as TG/HDL-C increased. Both the receiver operating characteristic (ROC) and time-dependent ROC proved the excellent predictive ability of TG/HDL-C.ConclusionThe study illustrates that TG/HDL-C correlates with the risk of MACCEs in CAD patients deferred revascularization following FFR. TG/HDL-C could serve as a dependable predictor of cardiovascular events over the long term in this population.

Study some biochemical parameters in patients with Coronary artery disease with and without Type 2 diabetes

Background: Impaired lipid metabolism are well recognized factors for Coronary artery disease (CAD) which is the major reason of mortality and morbidity all over world. The incident of CAD with type 2 diabetes mellitus (T2DM) is growing.&#x0D; Aim: The current study aimed to study some biochemical variables (vitamin D3, lipid profile, Insulin, FBG and HbA1C) in patients with diabetes and coronary heart disease and compare them with healthy people.&#x0D; Subjects and Methods: The study was conducted in human beings (apparently healthy and patients). It is statistically considered as [case- control study], the voluntaries were divided as following: 40 apparently healthy persons (40 male) were recruited through advertisement among laboratories and hospital staff in the three medical centers previously mentioned and from friends in Baghdad. 40 voluntaries patients with T2DM were taken, of them (40 male) were recruited from the specialized center for endocrinology and diabetes. 55 voluntaries patients who had CAD (55 male), 55 patients who have had T2DM with CAD (55 male).&#x0D; Results: the results evaluating the BMI of participant revealed that 16.3% had normal BMI, 55.8% were overweight and 27.9% were obese. 65.3% had vitamin D. insufficiency and 16.8% had vitamin D deficiency. The glycemic control evaluation shows that 37.4% had good glycemic control and 16.8% had poor control and 45.8% had excellent control. All participant had insulin resistance in which 31.6% had early resistance. Otherwise, a statistical significant difference in mean level of BMI, vitamin D, insulin level, HOMA-IR, FBS and HbA1c between the 4 groups. For lipid profile, Control group participant had significant lower total cholesterol level in compare to the other groups. Control group participant had significant lower TG level in compare to the other groups. Control group participant had significant higher HDL in compare in CAD group and CAD with DM group. Control group participant had significant lower LDL in compare in CAD group and CAD with DM group.&#x0D; Conclusions: Based on the results of the current study, it was found that there is a strong association between low vitamin D and cardiovascular disease, and it was also found that insulin resistance, which mainly causes type 2 diabetes, has increased health problems in CAD patients. On the other hand, the current study demonstrated that high levels of LDL and cholesterol were closely associated with events and increased risk of CAD.

Plasma amino acids spectrum and Holter ECG monitoring indexes in coronary artery disease patients with atrial fibrillation

The research was conducted with the aim of establishing a connection between plasma amino acid peculiarities and Holter ECG monitoring indexes in Coronary Artery Disease (CAD) and Atrial Fibrillation (AF) patients. 300 patients were examined divided into 3 groups: I – 149 patients with CAD without arrhythmias, II – 124 patients with CAD and AF paroxysm, and the Control Group (CG) – 27 patients without CAD and arrhythmias. Holter ECG monitoring was performed for the patients with AF within 24 hours after sinus rhythm restoration, and for the patients without AF on the first day of observation. Plasma AA level was detected by the method of ion exchange liquid column chromatography. It was established that there is a significant increase glutamate and Branched-Chain Amino Acids (BCAA) levels in patients of the II group, and significant depletion in glycine levels comparison with the I group patients (p&lt;0.05). In the II group patients, an increase in SupraVentricular (SVE) and Ventricular Extrasystoles (VE) was checked in comparison with the I group patients (p&lt;0.05). Total SVE was significantly correlated with threonine (r=-0.316), serine (r=-0.336), glycine (r=-0.397), isoleucine (r=0.317), BCAA (r=0.356), and glycine+serine sum (r=-0.302), p&lt;0.05. AF paroxysm was significantly correlated with taurine (r=-0.302), serine (r=-0.328), glycine (r=-0.311), glutamine (r=-0.304), and glycine+serine sum (r=-0.379), p&lt;0.05. Total VE was significantly correlated with glycine (r=-0.370) and tyrosine (r=0.325), p&lt;0.05. Changes in ST-segment were significantly correlated with tyrosine (r=0.307), phenylalanine (r=0.318), and Aromatic Amino Acids (AAA) (r=0.379), p&lt;0.05. We concluded that glycine, serine, and BCAA are significantly correlated with cardiac arrhythmias. Changes in ST segment are significantly correlated with AAA levels. Keywords: heart rhythm violations, ischemia, arrhythmia, metabolomics.

Association between C-Reactive Protein to Albumin Ratio and Multi-Vessel Coronary Artery Disease in Patients with Stable Coronary Artery Disease

Multivessel coronary artery disease (MV-CAD) remains a prevalent and serious health concern despite advances in treatment. Early identification and risk stratification are crucial for optimizing treatment. The CRP-to-albumin ratio (CAR) has emerged as a promising biomarker in various inflammatory diseases. This study investigated the potential of CAR as a marker for MV-CAD. We retrospectively analyzed 1360 patients with suspected CAD. Patients were divided into three groups based on CAR tertiles. Logistic regression analyses were carried out to estimate the association between MHR and MV-CAD. Elevated CAR levels were significantly associated with an increased prevalence of CAD (p &lt; 0.001), severe CAD (p &lt; 0.001), and MV-CAD (p &lt; 0.001). Patients with the highest CAR tertile had five times higher odds of MV-CAD compared to the lowest tertile (p &lt; 0.001). CAR demonstrated moderate accuracy in predicting MV-CAD (AUC: 0.644, 95% CI: 0.615–0.674, p &lt; 0.001). CAR holds promise as a tool for the early identification and risk stratification of multivessel CAD. Further research is warranted to validate its clinical utility and explore its potential to guide treatment decisions and improve outcomes in patients with this high-risk condition.

Diagnostic and prognostic role of serum interleukin-6 and carotid ultrasonography to detect subclinical atherosclerosis in patients with RA and ANCA-associated vasculitis.

ANCA-associated vasculitis (AAV) can affect multiple organs with severe life-threatening manifestations. Disease monitoring is difficult due to a lack of defined biomarkers. We aimed to assess the diagnostic role of serum interleukin-6 and vascular ultrasonography in AAV and subclinical atherosclerosis. The study included 20 AAV patients and two control groups of 34 patients with rheumatoid arthritis (RA) and 35 healthy controls. The levels of Il-6, carotid intima-media thickness test (CIMT), atherosclerotic plaque, and degree of stenosis were investigated. A GRACE-risk score was calculated for AAV and RA patients. The AAV patients had elevated levels of IL-6 (115 ± 23.96) compared to the RA patients (91.25 ± 42.63) and the healthy controls (15.65 ± 3.30), p < 0.001. IL-6 showed a diagnostic accuracy of 73% in distinguishing AAV from RA patients (AUC = 0.730; 95% CI 0.591 to 0834). In the AAV group, CIMT was 1.09, above the upper reference value of 0.90, p < 0.001. The AAV patients had a higher median GRACE risk score, and 60% of them had a high risk of cardiovascular events as compared to 35% of the RA patients. Sonography of extracranial vessels and serum levels of IL-6 can be used in daily clinical practice to diagnose and monitor patients with AAV.

Evaluation of Lipid Profile and Oxidative Stress of Workers in Fast Food Restaurants and The Risk of Atherosclerosis

Cooking fumes and biomass smoke pose significant threats to air degradation and human health, especially to people who work in this field on a daily basis, due to the large amounts of hazardous pollutants released from grilling activities. Chronic exposure to these fumes is associated with a risk of inflammation and oxidative stress, which can increase the risk of atherosclerosis. In this study, the lipid profile Glutathion (GSH) and Malondialdehyde (MDA) of workers in fast food restaurants and patients with atherosclerosis were evaluated. The study included 40 Atherosclerosis patients, 40 fast food workers, and 40 healthy individuals as a control group, the ages ranges of (20-40) years. The obtained results indicated a significant increase in cholesterol, triglycerides, LDL, and VLDL and a decrease in HDL (p &lt; 0.01) in patients and fast-food workers compared to control group. The results also indicated a significant increase in the level of MDA, and a significant decrease in the level of GSH for patients and fast-food workers compared to the control. In conclusion, it appears that fast food workers experience oxidative stress and disruption in lipid metabolism that may increase the risk of atherosclerosis. Therefore, safety and quality control measures must be strengthened to reduce the occupational risks of fast-food restaurant workers.        

Role of Anemia and Leukocytosis as Severity Predictors of Coronary Artery Disease Stenosis : A Retrospective Cross-sectional Study

Background: Anemia and leukocytosis were found to be associated with conditions that higher the risk for the formation of atherosclerotic plaque which will develop into cardiovascular disease. Basic laboratory parameters such as anemia and leukocytosis are not routinely used to assess Coronary Artery Disease (CAD) severity based on its stenosis. This study aimed to analyze the role of simple laboratory examiantion anemia and leukocytosis as predictors of the severity of stenosis in CAD. Methods: Cross-sectional approach was used in this study. Secondary data on CAD patients treated at Sultan Agung Islamic Hospital Semarang in 2022 were analyzed. Anemia and leukocytosis are the main risk factors analyzed in this study. Other risk factors such as gender, age, smoking status, hypertension and diabetes mellitus (DM) were also included in the analysis of this study. We performed bivariate analysis and multivariate analysis to see the relationship between these risk factors and the CAD stenosis severity. Results: Bivariate analysis with chi-square showed that anemia had a significant relationship with CAD severity (P&lt;0.05). Multivariate analysis between anemia and smoking status reported that anemia was the most significant risk factor for the CAD stenosis severity (P&lt;0.05). Conclusion: No association found between leukocytosis and CAD severity.

Fecal short chain fatty acids role in atrial fibrillation paroxysm pathogenesis through coronary artery disease patients

gut microbiota composition and its metabolites is an essential part of human health. Short chain fatty acids (SCFA) are known gut microbiota metabolites. Lack of them is common for dyslipidemia and inflammatory changes. But their role in atrial fibrillation (AF) and coronary artery disease (CAD) pathogenesis is still uninvestigated. The aim: to estimate the fecal short chain fatty acids changes in patients with atrial fibrillation paroxysm and coronary artery disease and found their connections with known cardiometabolic risk factors. Materials and methods: 300 patients were investigated. We divided them into 3 groups: I group – 149 CAD patients without rhythm disorders, II group – 124 patients with CAD and AF paroxysm and control group (CG) – 27 patients without CAD and arrhythmias. Fecal SCFA was checked by gas chromatography with mass electron detection. Results: Fecal SCFA changes in patients with AF paroxysm and CAD were found in our investigation. Isocaproic and isobutyric fecal acids appears in CAD and AF patients’ samples in comparison with control group. In the patients with AF and CAD significant increasing of valeric (1128,43%) and decreasing butyric (78,75%), isovaleric (56,29%), caprylic (99,21%) acids, medium chain fatty acids (95,54%) and unsaturated fatty acids (38,76%) levels was revealed in comparison with CAD patients without arrhythmias (P&lt;0,05). The largest amount of correlations was between total amount of SCFA, medium chain fatty acids (total amount = 7), butyric acid (total number = 6) and cardiometabolic risk factors (P&lt;0,05). The acceptable role of total amount of short chain fatty acids (AUC = 0.7907) and butyric acid (AUC=0.7127) in AF paroxysm occurrence in CAD patients was proven by ROC-analysis. Conclusions: SCFA-synthesis violations were reveled in patients with atrial fibrillation paroxysm and coronary artery disease. To propose the new ways of gut microbiota and cardiometabolic risk factors correction will be interesting for future investigations.

Retinal Structural and Vascular Changes in Patients with Coronary Artery Disease: A Systematic Review and Meta-Analysis

Background: Retinal microvascular anomalies have been identified in patients with cardiovascular conditions such as arterial hypertension, diabetes mellitus, and carotid artery disease. We conducted a systematic review and meta-analysis (PROSPERO registration number CRD42024506589) to explore the potential of retinal vasculature as a biomarker for diagnosis and monitoring of patients with coronary artery disease (CAD) through optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Methods: We systematically examined original articles in the Pubmed, Embase, and Web of Science databases from their inception up to November 2023, comparing retinal microvascular features between patients with CAD and control groups. Studies were included if they reported sample mean with standard deviation or median with range and/or interquartile range (which were computed into mean and standard deviation). Review Manager 5.4 (The Cochrane Collaboration, 2020) software was used to calculate the pooled effect size with weighted mean difference and 95% confidence intervals (CI) by random-effects inverse variance method. Results: Eleven studies meeting the inclusion criteria were incorporated into the meta-analysis. The findings indicated a significant decrease in the retinal nerve fiber layer (WMD −3.11 [−6.06, −0.16]), subfoveal choroid (WMD −58.79 [−64.65, −52.93]), and overall retinal thickness (WMD −4.61 [−7.05, −2.17]) among patients with CAD compared to controls (p &lt; 0.05). Furthermore, vascular macular density was notably lower in CAD patients, particularly in the superficial capillary plexus (foveal vessel density WMD −2.19 [−3.02, −1.135], p &lt; 0.0001). Additionally, the foveal avascular zone area was statistically larger in CAD patients compared to the control group (WMD 52.73 [8.79, 96.67], p = 0.02). Heterogeneity was significant (I2 &gt; 50%) for most features except for subfoveal choroid thickness, retina thickness, and superficial foveal vessel density. Conclusion: The current meta-analysis suggests that retinal vascularization could function as a noninvasive biomarker, providing additional insights beyond standard routine examinations for assessing dysfunction in coronary arteries.

[Correlation between serum growth differentiation factor 11 level and severity of coronary artery disease in patients with acute myocardial infarction].

Objective: To investigate the correlation between serum growth differentiation factor 11 (GDF11) level and coronary artery lesions in patients with ST-segment elevation myocardial infarction (STEMI), and the predictive efficacy of nomogram risk prediction model based on GDF11 combined with traditional risk factors on the occurrence of STEMI. Methods: This study was a retrospective cross-sectional study. Patients hospitalized in the Department of Cardiology of the 904th Hospital of Joint Logistic Support Force of People's Liberation Army of China from 2016 to 2018 were selected and divided into control group and STEMI group. The demographic data, blood lipid level, laboratory indicators of blood and GDF11 level were collected. Logistic regression analysis screened out independent correlated factors for the occurrence of STEMI. Spearman correlation analysis clarified the correlation of each indicator with the SYNTAX or Gensini scores. A nomogram risk prediction model for the risk of STEMI occurrence and the receiver operating characteristic curve was used to compare the prediction efficiency of each model. Results: A total of 367 patients were enrolled, divided into control group (n=172) and STEMI group (n=195), age (66.5±11.8), male 222 (60.49%). The serum GDF11 level of STEMI group was significantly lower than that of the control group (36.20 (16.60, 70.75) μg/L vs. 85.00 (53.93, 117.10) μg/L, P<0.001). The results of multivariate logistic regression analysis showed serum GDF11(OR=0.98, 95%CI: 0.97-0.99) and traditional independent risk factors such as smoking, diabetes, C-reactive protein, homocysteine, lipoprotein (a) and apolipoprotein A1/B were independent correlate factors for the occurrence of STEMI (P<0.05). Spearman correlation analysis showed that serum GDF11 was negatively correlated with SYNTAX score and Gensini score (P<0.05). The nomogram model constructed by serum GDF11 combined with traditional independent risk factors (AUC=0.85, 95%CI: 0.81-0.89) had better predictive value for the occurrence of STEMI than the traditional nomogram model constructed by independent risk factors(AUC=0.80, 95%CI:0.75-0.84) or serum GDF11 (AUC=0.76, 95%CI: 0.72-0.81), all P<0.01. Conclusions: Serum GDF11 is an independent correlate factor in the occurrence of STEMI and is negatively correlated with the severity of coronary artery lesions in patients with STEMI. The nomogram model constructed based on GDF11 combined with traditional risk factors can be a good predictor for the occurrence of STEMI.