Comorbidity Of Coronary Heart Disease Research Articles

Characteristics of COVID-19 patients with coronary artery disease comorbidity

Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease which is caused by the SARS-CoV-2 virus. Coronary heart disease is a disease caused by plaque build-up in artery walls which supply blood to the heart and other body parts. Coronary heart disease is amongst the most severe COVID-19 comorbidities. Objective: To determine the patient profile of COVID-19 patients with coronary heart disease comorbidity Methods: Literature study with a systematic review that uses previous research as a reference to generate conclusions. Results: Based on the 24 journals used in this literature review, 11 journals discuss the topic of age, 9 journals discuss the topic of gender, and 8 journals discuss the topic of the prognosis of COVID-19 patients with coronary heart disease comorbidity. Conclusion: The mean age of COVID-19 patients with coronary heart disease comorbidity is 63,4 years old. The gender in this case is 64,7% males dan 34,3% females. The rates for prognosis are 47,6% of patients need to go to the ICU, 32,8% of patients died, 51,75% of patients recovered and 36,5% of patients need further treatment.

Incidence of heart failure in patients with coronary heart disease and stroke in a large Chinese cohort study

Abstract Background Heart failure (HF) is associated with remarkably elevated mortality and cardiovascular disease (CVD) is a leading cause of HF. Many studies have reported the prevalence of comorbidity of coronary heart disease (CHD) and HF or short-term incidence using registry or cross-sectional data, the long-term incidence of HF among patients after the first cardiovascular event is quite limited, particularly in patients with stroke. Updated incidence estimates are crucial to understanding the burden of illness of HF and developing effective preventive strategies. Purpose To compare the long-term incidence of HF among different subtypes of CVD, i.e. CHD or stroke (with or without hypertension at baseline), under a consistent framework using large-scale population-based data. Methods Using data from the CHERRY study, a population-based cohort study linked with electronic health records in China, we identified all patients≥18 years and newly diagnosed CHD or stroke during 2010-2016, and sex- and age-matched controls without prior CVD in a 1:5 ratio. All patients and controls were followed up until incident HF (at least 1 inpatient HF claim or at least 2 outpatient HF claims or 2 prescriptions with digoxin), non-HF death or end of follow-up (31st May 2021). Crude incidence of HF was compared among patients and controls by sex or age. The cumulative incidence rate of HF was calculated with non-HF death as a competing event. Incidence rate ratios (IRRs) were calculated using Poisson regression adjusted for sex and age. Results We finally identified 14,682 CVD patients (mean [SD] age 71.0[12.4] years, 54.0% men, 3730 CHD and 11,238 stroke cases) and 73,410 controls. During the follow-up (median 4.46 years for patients and 8.96 years for controls), the incidence rate of HF was 27.90(95%CI: 26.6-29.2) per 1000 person-years for CVD patients, 22.36(95%CI:21.03-23.74) for stroke, 45.10(95%CI:41.91-48.48)for CHD and 45.20(95%CI:37.92-53.47)for MI, significantly greater than 8.10(95%CI:7.87-8.33) for controls. The incidence rate was similar in men and women and increased proportionally with age (P for trend <0.05). Considering the competing risk, the 10-year cumulative incidence was 15.49% for CVD patients, 12.48% for stroke, 25.02 % for CHD, and 21.34% for patients with MI. Moreover, 81.3% of CHD patients and 79.3% of stroke patients had a history of hypertension at baseline and higher IRRs than those without hypertension, respectively. Although stroke patients were at relatively lower risk of HF among CVD subtypes, hypertension diagnosis would increase the risk by 60% (IRRs, 1.66, 95%CI:1.36-2.02). Conclusion The incidence of HF varied among patients with different subtypes of CVD, with the highest in those with CHD. Stroke patients had a higher risk of HF than the general population, and comorbidity of hypertension might add an additional risk of HF, highlighting the significance of blood pressure management in preventing heart failure.Incidence rate for patients and controlsIncidence rate of HF by disease status

DYNAMICS OF CHARACTERISTICS OF THE GLYCEMICAL PROFILE OF PATIENTS WITH CORONARY HEART DISEASE AND OBESITY AFTER TREATMENT

Introduction. Cardiovascular diseases (CVD) have the status of an epidemic, as they have high levels of prevalence and are the main cause of disability and mortality both in Ukraine and in the world and cause a significant increase in health care costs. Among all CVDs, coronary heart disease (CHD) ranks first. Many studies confirm a high percentage of CHD among all CVDs, especially in comorbidity with hyperlipidemia and obesity. Therefore, when treating CHD disease with obesity, it is necessary to take into account the effectiveness of the applied pharmacological agents and determine the dynamics of pharmacological intervention.
 The aim. To determine the dynamics of indicators of the glycemic profile in the comorbid course of CHD and obesity after the treatment.
 Materials and methods. It was conducted a randomized controlled single-center prospective study case-control, which is based on the analysis of the results of 130 people aged 25–85 were examined, who were divided into 3 groups: 70 persons (main group) with CHD on the background of obesity and 35 people with isolated coronary artery disease (comparison group) and control group (25 practically healthy people). The studied groups were randomized by age and gender.
 Results. Before treatment, a probable predominance of daily glucose levels was determined in patients main group to the patients comparison group and controls. According to the results of the glucose tolerance test (GTT), an improbable excess of fasting glucose levels and after a glucose load was determined in CHD with obesity (respectively 5.64±1.92 and 7.08±2.25 mmol/l) compared to the isolated of CHD (respectively 5, 15±2.22 (p=0.791) and 6.20±3.15 (p=0.403) mmol/l) and control group (respectively 5.32±0.49 (p=0.685) and 5.42±0, 51 (p<0.001) mmol/l). After treatment, recovery of blood glucose levels was determined.
 Conclusions. It was established that the characteristics of the dynamics of glucose metabolism indicators can be used as an indicator of the effectiveness of the treatment in the comorbidity of obesity and CHD. The obtained results indicate that the characteristics of glucose metabolism in the comorbidity of CHD and obesity must be taken into account to ensure therapeutic and preventive measures.

Correlated interdependences of characteristics of carbohydrate metabolism and lipid profile and batokines levels in patients with coronary heart disease and obesity

Research of comorbid coronary heart disease (CHD) and obesity in recent years often rely on the study of inflammatory mediators, among which the first and foremost are batokines, in particular on fibroblast growth factor (FGF-21) and vascular endothelial growth factor A (VEGFa). The aim of our study was to determine the correlational interdependencies of indicators of carbohydrate metabolism and lipid profile and levels of batokines in the comorbidity of CHD and obesity. 70 people aged from 25 to 85 were examined with CHD on the background of obesity. The average age was (63.6±8.8) years. The research do not violate the principles of bioethics, which is confirmed by the conclusion of the Bioethics Committee of the Kharkiv National Medical University. All patients who participated in the study signed an informed voluntary consent. Based on the results of research probable direct strong correlations of total cholesterol (TC) with low-density lipoprotein (LDL) were determined (ρ=0.889; p=0.000); triglycerides (TG) with very low-density lipoprotein (VLDL) (ρ=0.810; p=0.000). The average strength of correlation was determined: glycosylated hemoglobin (HbA1c) with vascular endothelial growth factor A (VEGFA) (ρ=0.374; p=0.001); TC and LDL and AI (respectively ρ=0.615; p=0.000, and ρ=0.648; p=0.000); VLDL with atherogenic index (AI) (ρ=0.367; p=0.002). Probable direct weak correlations of blood glucose levels with TG (ρ=0.253; p=0.034) and VLDL (ρ=0.277; p=0.020) and VEGFA (ρ=0.225; p=0.061) were found; TG and VLDL with VEGFA (ρ=0.256; p=0.032 and ρ = 0.273; p = 0.022, respectively). Inverse interdependencies were recorded: medium strength – high-density lipoprotein (HDL) and AI (ρ=-0.583; p=0.000) and weak – hemoglobin levels with HDL (ρ=-0.251; p=0.036); HbA1c with LDL (ρ=-0.241; p=0.044); HDL with VLDL (ρ=-0.293; p=0.014). Keywords: comorbidity of coronary heart disease and obesity, batokines, FGF21, VEGFA.

Comparison of thoracolumbar versus non-thoracolumbar osteoporotic vertebral compression fractures in risk factors, vertebral compression degree and pre-hospital back pain

BackgroundThoracolumbar spine is at high risk of osteoporotic vertebral compression fractures (OVCF). This study aimed to identify the differences in risk factors, vertebral compression degree and back pain characteristics of thoracolumbar OVCF (TL-OVCF) and non-thoracolumbar OVCF (nTL-OVCF).MethodsOVCF patients hospitalized in a spine center between June 2016 and October 2020 were retrospectively studied. Demographics, comorbidity, spine trauma, bone mineral density, duration of pre-hospital back pain, extent of vertebral marrow edema, and degree of vertebral compression of patients with nTL-OVCF were summarized and compared to those with TL-OVCF.ResultsA total of 944 patients with acute single-segment OVCF were included. There were 708 (75.0%) TL-OVCF located in T11-L2 and 236 (25.0%) nTL-OVCF in lower lumbar (L3-L5) and middle thoracic (T5-T10) spine. The female-male ratio was 4.1 in nTL-OVCF and differed not significantly from TL-OVCF. The middle thoracic OVCF were older and had higher comorbidity of coronary heart disease (21.3%) and cerebral infarction (36.3%) than TL-OVCF (12.1% and 20.6%). In nTL-OVCF the ratio of apparent spine trauma (44.9%) and pre-hospital back pain ≤ 1 week (47.5%) was lower than in TL-OVCF (66.9% and 62.6%). The T-score value of lumbar spine was − 2.99 ± 1.11, − 3.24 ± 1.14, − 3.05 ± 1.40 in < 70, 70–80, > 80 years old TL-OVCF and differed not significantly from nTL-OVCF. The lower lumbar OVCF had more cranial type of vertebral marrow edema (21.8%) and fewer concurrent lumbodorsal fasciitis (30.8%) than TL-OVCF (16.8% and 43.4%). In TL-OVCF the anterior–posterior vertebral height ratio was lower with back pain for > 4 weeks than for ≤ 1, 1–2, and 2–4 weeks. In nTL-OVCF the degree of vertebral compression differed not significantly with pre-hospital back pain for ≤ 1, 1–2, 2–4, and > 4 weeks.ConclusionsThoracolumbar spine has 2-folds higher risk of OVCF than non-thoracolumbar spine. Non-thoracolumbar OVCF are not associated with female gender, apparent spine trauma or poor bone mineral density, but tend to maintain the degree of vertebral compression and cause longer duration of pre-hospital back pain.

Внесок деяких біологічно активних речовин жирової тканини в розвиток серцево-судинних ускладнень у коморбідних пацієнтів

The contribution of some biologically active substances of adipose tissue to the development of cardiovascular complications in comorbid patients. Adipose tissue hormones — adipokines — vaspin and omentin, which control homeostasis, lipid and glucose metabolism, have attracted scientific interest in recent years. The purpose of the study was to determine the contribution of some hormones of adipose tissue, namely, vaspin and omentin, in the development of obesity in patients with coronary heart disease with concomitant obesity. Materials and methods. A comprehensive examination of 38 patients with coronary heart disease in combination with obesity (average age: 64±1.9 years), men and women in equal numbers, was conducted; the comparison group consisted of 40 patients with coronary artery disease without obesity. Control group: 20 practically healthy individuals without coronary heart disease and with normal body weight, average age 58.2±1.4 years. Conclusions: The comorbidity of coronary heart disease and obesity leads to the activation of the pro-inflammatory hormone of adipose tissue — vaspin and insufficient circulation of omentin, which leads to an increase in body weight. The development of obesity in patients with coronary heart disease depends on the dysfunction of adipose tissue, the manifestations of which are an imbalance in the levels of vaspin and omentin.

PREDICTION OF THE RISKS OF THE DEVELOPMENT OF COMORBIDITY OF CORONARY HEART DISEASE AND OBESITY IN THE BACKGROUND OF MILITARY ACTIONS.

The aim: Study of prognostic possibilities of batokine complexes (fibroblast growth factor (FGF-21) and vascular endothelial growth factor A (VEGF-A)) in determining the risks of developing coronary heart disease (CHD) and obesity (especially in case of their comorbidity). Materials and methods: 105 patients aged 25-85 were examined: 70 (main group) -with CHD on the background of obesity and 35 - with isolated CHD (comparison group). Results: Probable associations with increased risks of comorbidity of CHD and obesity were: increased systolic blood pressure (SBP) (OR = 0.844 [95.0% CI 0.735-0.970], p = 0.017), FGF-21 (OR = 1.701 [95.0 % CI 1.219-2.375], p = 0.002), VEGF-A (OR = 1.725 [95.0% CI 1.213-2.372], p = 0.005), low-density lipoprotein (LDL) (OR = 4.419 [95.0% CI 1.351-14.469], p = 0.014). Probable associations were also established for lesions of the left anterior descending artery (LADA) (OR = 1.117 [95.0% CI 0.987-1.263], p = 0.078), intermediate branch of the left coronary artery (IBLCA) (OR = 1.336 [95.0% CI 1.099-1.624], p = 0.004). Conclusions: The values of the characteristics of batokine metabolism (FGF-21 and VEGF-A levels) can be used as a significant predictor of the development of obesity in CHD. Increased levels of FGF-21 and VEGF-A in blood serum characterize a significant relationship with the development of such comorbidity, which indicates a significant influence of batokine complexes on the pathogenesis of comorbidity of CHD and obesity.

The hemoglobin glycation index predicts the risk of adverse cardiovascular events in coronary heart disease patients with type 2 diabetes mellitus.

Previous studies have shown that the hemoglobin glycation index (HGI) can be used as a predictor of diabetic complications. However, limited information is currently available to indicate the correlation between HGI and comorbidity of coronary heart disease (CHD) and diabetes. This study aimed to evaluate the potential of HGI to predict major adverse cardiovascular events (MACEs) in CHD patients with type 2 diabetes mellitus (T2DM) undergoing percutaneous coronary intervention (PCI). A total of 918 CHD patients with T2DM were enrolled in a 3-year retrospective cohort study, from December 2017 to December 2020 at the First Affiliated Hospital of Zhengzhou University. Data including fasting blood glucose (FPG/FBG) and glycated hemoglobin A1c (HbA1c) were collected. HGI was calculated as actual measured HbA1c minus predicted HbA1c. Three groups were further divided based on the levels of HGI, including low, medium, and high levels. Kaplan Meier analysis indicated that elevated HGI was strongly associated with the occurence of MACE (log-rank P < 0.001). Multivariate Cox regression analysis revealed that elevated HGI was an independent risk factor for incident MACE in CHD patients with T2DM [adjusted hazard ratio (HR): 1.473; 95% confidence interval (CI): 1.365-1.589, P < 0.001]. Hemoglobin glycation index is an independent predictor of MACE events in CHD patients with T2DM. High HGI indicates a higher risk of MACE occurrence.

Insulin Therapy Increases the Risk of Hypokalemia and Arrhythmia in Diabetic Patients with Coronary Heart Disease: A Retrospective Study in Wahidin Sudirohusodo General Hospital

Background: Cardiovascular disease is the most common cause of morbidity and mortality in diabetic patients. Patients with Diabetes Mellitus (DM) often require insulin therapy to control hyperglycemia, yet, it is associated with the risk of hypokalemia and dysrhythmia. Objectives: To evaluate the prevalence and the risk of hypokalemia and arrhythmia due to insulin therapy in DM patients with Coronary Heart Disease (CHD) comorbidity. Material and Methods: The study was conducted retrospectively based on medical record data from January 2021 to December 2021 in Wahidin Sudirohusodo general hospital. The inclusion criteria include the out-hospital patients diagnosed with DM with CHD comorbidity. The patients were divided into 2 groups, those who received insulin and those who received oral antidiabetic drugs (OAD). Hypokalemia was defined if an electrolyte characterized by a low serum potassium concentration with a normal range of 3.5 – 5.0 mEq/L. Arrhythmia was defined if abnormal changes in a regular heartbeat, including an irregular heartbeat, a skipped heartbeat, a fast heart rate (tachycardia), or a slow heart rate (bradycardia). Results: The data were obtained from 322 patients’ medical record, 161 was treated with insulin, and 161 received OAD. The insulin-treated patients had a significantly lower blood potassium level compared to the OAD group. The insulin group had 63,40% incidents of hypokalemia, while in the OAD group only 16,80% experienced hypokalemia (p&lt;0.05). The presence of arrhythmia was detected in 63,40 % of insulin-treated patients, while only 29,80% had arrhythmia in the OAD group (p&lt;0,05). Conclusions: Insulin Therapy in DM patients with coronary heart disease can increase the incidence of hypokalemia, which may result in arrhythmia in patients with coronary heart disease.

Incidence of Diabetic Nephropathy and Its Predictors among Type 2 Diabetes Mellitus Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

Background Although the rate of diabetic nephropathy which is the leading cause of end-stage renal disease (ESRD) continues to rise, there is limited information about the problem. This study aimed to assess the incidence and predictors of diabetic nephropathy among type 2 DM patients. Methods Institution-based retrospective follow-up study was conducted at UGCSH with 462 newly diagnosed type 2 DM patients from January 2001 to February 2016, and the data were collected by reviewing their records. The Schoenfeld residuals test was used to check proportional hazard assumption. The best model was selected by using Akaike information criteria (AIC). Hazard ratios (HR) with its respective 95% confidence interval were reported to show significance and strength of association. Results The incidence rate of diabetic nephropathy was 14 (95% CI 10.8–17.7) cases per 10,000 patient-month observation. In addition, 63 (13.6%) DM patients developed diabetic nephropathy. The median time to develop diabetic nephropathy was 94.9 months with interquartile range (IOR) of (64.1–127.4) months. Type 2 DM patients who had coronary heart disease (AHR = 2.69, 95% CI 1.42–5.13) and anemia (AHR = 1.94, 95% CI 0.97–3.87) were at higher hazard for developing diabetic nephropathy. Besides this, having a long duration (>10 years) (AHR = 0.24, 95% CI 0.11–0.56) and being female (AHR = 0.44, 95% CI 0.26–0.73) was found to be protective against diabetic nephropathy. Conclusion The incidence of diabetic nephropathy among type 2 diabetes patients remains a significant public health problem. Duration of diabetes >10 years and female sex reduced the risk of diabetic nephropathy. Coronary heart disease and anemia increased the risk of diabetic nephropathy among type 2 DM patients. In light of these findings, early screening for diabetes complication is needed, and health professionals should give targeted intervention for type 2 DM patients with coronary heart disease comorbidity and anemia.

Iron Metabolism Contributes to Prognosis in Coronary Artery Disease: Prognostic Value of the Soluble Transferrin Receptor Within the AtheroGene Study.

BackgroundCoronary heart disease is a leading cause of mortality worldwide. Iron deficiency, a frequent comorbidity of coronary heart disease, causes an increased expression of transferrin receptor and soluble transferrin receptor levels (sTfR) levels, while iron repletion returns sTfR levels to the normal physiological range. Recently, sTfR levels were proposed as a potential new marker of iron metabolism in cardiovascular diseases. Therefore, we aimed to evaluate the prognostic value of circulating sTfR levels in a large cohort of patients with coronary heart disease.Methods and ResultsThe disease cohort comprised 3423 subjects who had angiographically documented coronary heart disease and who participated in the AtheroGene study. Serum levels of sTfR were determined at baseline using an automated immunoassay (Roche Cobas Integra 400). Two main outcomes were considered: a combined end point of myocardial infarction and cardiovascular death and cardiovascular death alone. During a median follow‐up of 4.0 years, 10.3% of the patients experienced an end point. In Cox regression analyses for sTfR levels, the hazard ratio (HR) for future cardiovascular death and/or myocardial infarction was 1.27 (95% CI, 1.11–1.44, P<0.001) after adjustment for sex and age. This association remained significant (HR, 1.23; 95% CI, 1.03–1.46, P=0.02) after additional adjustment for body mass index, smoking status, hypertension, diabetes mellitus, dyslipidemia, C‐reactive protein, and surrogates of cardiac function, size of myocardial necrosis (hs‐Tnl), and hemoglobin levels.ConclusionsIn this large cohort study, sTfR levels were strongly associated with future myocardial infarction and cardiovascular death. This implicates a role for sTfR in secondary cardiovascular risk prediction.

VOLEMIC AND HEMODYNAMIC STATUS OF PATIENTS WITH COMORBIDITY OF CORONARY HEART DISEASE AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE BEFORE AND AFTER MYOCARDIAL REVASCULARIZATION

Introduction . The comorbidity of chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) significantly worsens the clinical course of these pathologies, which determines the need for careful hemodynamic monitoring during coronary artery bypass grafting (CABG). Aim. To evaluate the parameters of central and pulmonary hemodynamics during the performance of CABG under conditions of cardiopulmonary bypass (CPB) in patients with comorbidity of IHD and COPD. Materials and methods. Two groups of patients with IHD before and after CABG were examined. The first group included 11 patients with coronary heart disease in combination with COPD II-III severity without exacerbation, the second group included 29 patients with coronary heart disease without pulmonary pathology. Volumetric and hemodynamic parameters were measured by transpulmonary thermodilution using a Drager Delta XL monitor and the Pulsion PiCCO Plus module (Germany) at three stages of the study: after the start of artificial lung ventilation; completion of the CPB procedure; 24 hours after IR. Results. For patients with comorbidity of coronary heart disease and COPD, a specific set of volumic and hemodynamic parameters was characteristic that distinguishes them from persons with coronary artery disease without pulmonary pathology. In the early postoperative period, this was manifested by the formation of a hypokinetic type of blood circulation, an increase in systemic vascular resistance, a less noticeable decrease in the global final diastolic volume, intrathoracic and pulmonary blood volumes. In addition, in patients with cardio-respiratory comorbidity, the maximum values of the indices of extravascular water in the lungs and permeability of the pulmonary vessels were recorded. Timely diagnosis of these disorders contributed to the restoration of pulmonary hemodynamics and water balance. Conclusion. When conducting CABG in patients with comorbidity of IHD and COPD, it is advisable to use the method of transpulmonary thermodilution, which provides more accurate control of hemodynamics and a personalized approach to correcting its disorders.

Alterations of irisin, adropin, preptin and BDNF concentrations in coronary heart disease patients comorbid with depression.

Depression is a well-known co-morbidity of coronary heart disease (CHD) and these two diseases share common risk mechanisms. Here, the aim of this study was to investigate the possible link between energy homeostasis regulation and CHD patients comorbid with depression. Two hundred and nine CHD patients and 101 matched healthy individuals were included. Demographic, clinical data were collected, serum irisin, adropin, preptin and brain-derived neurotrophic factor (BDNF) levels were determined by a double-antibody sandwich enzyme-linked immunosorbent assay (DAS-ELISA), and the depression was scored by Patient Health Questionnaire-9 (PHQ-9). Correlation analysis as well as multiple linear regression was used to assess the relationship between the three peptides, BDNF serum levels and PHQ-9 scores. Irisin serum level was significantly lower in CHD patients without depression as compared with healthy controls (P=0.002), as well as adropin (P=0.000), preptin (P=0.000) and BDNF (P=0.000). Furthermore, similar trends were observed in CHD patients with depression in terms of irisin, adropin and BDNF as compared with CHD patients without depression (P=0.006; P=0.003; P=0.002; respectively). Multiple logistic regression results confirmed the contribution of irisin and BDNF to the occurrence of depression in CHD. Interestingly, correlations analysis revealed significant negative correlations between PHQ-9 scores and irisin, adropin, BDNF level (r=-0.43, P<0.01; r=-0.29, P<0.05; r=-0.45, P<0.001 respectively), and irisin serum level was positively correlated with BDNF (r=0.38, P<0.01). Our study firstly identified the role of energy homeostasis in the susceptibility to depression in CHD patients, and the interaction between irisin and BDNF could trigger the imbalance of energy homeostasis that occurs in depression of CHD patients.

Chaihu-Shugan-San and absorbed meranzin hydrate induce anti-atherosclerosis and behavioral improvements in high-fat diet ApoE-/- mice via anti-inflammatory and BDNF-TrkB pathway

The comorbidity of coronary heart disease (CHD) and depression in patients is extremely prevalent, with a rate from 20 to 50%, while depression-like behaviors exist in a larger percentage of patients. Therefore, the study of comorbidities is particularly urgent. Chaihu-Shugan-San (CSS), a classical traditional Chinese medicine formula, has been used to treat CHD with depression for hundreds of years. However, the mechanism of its action on comorbidities remains unclear. Here, we focused on the behavioral changes in ApoE−/− mice fed a high-fat diet (HFD) and elucidated the mechanism of CSS and its main absorbed component, meranzin hydrate (MH), as an anti-atherosclerosis and anti-depression agent. In the present study, mice were fed an HFD for 16 weeks and were intragastrically administered high and low doses of CSS and MH. Depressive-like behaviors were evaluated by the sucrose preference test, the open-field test, the light-dark test and the tail-suspension test, after which atherosclerotic plaques, plasma lipids, inflammatory cytokine levels and the expression of BDNF/TrkB were measured. We demonstrated that the atherosclerosis model group exhibited significant depressant behaviors. Moreover, CSS inhibited depressive-like behavioral changes, reduced atherosclerotic plaque areas, plasma total cholesterol, triglycerides, LDL-cholesterol levels and inflammatory cytokines including TNF-α, IL-1β, and IL-6 in plasma and hippocampi, increased the protein and mRNA expression of BDNF and TrkB in the aorta and the hippocampus. Interestingly, MH, the main component in CSS that is absorbed in the plasma and hippocampus, exerted effects similar to those of CSS. In addition, MH increased the protein and mRNA expression of BDNF and TrkB in human umbilical vein endothelial cells (HUVECs) induced by LPS. Collectively, these results suggest that MH represents the CSS decoction, induces anti-atherosclerosis effects and improves depression-like behaviors in HFD-fed ApoE−/− mice. Moreover, the regulation of proinflammatory factors and BDNF-TrkB signaling are possibly involved in this process. Our findings indicate that MH is a potential phytochemical compound for the prevention of the comorbidity of atherosclerosis and depression.

Mechanisms of formation of the gastroesophageal reflux disease and coronary heart disease comorbidity

Objective — to identify possible transnosological mechanisms for the formation of comorbidity of gastroesophageal reflux disease (GERD) and coronary heart disease (CHD).Materials and methods. The study involved patients (n = 65) with GERD in combination with CHD: 54 men (83.08 %) and 11 women (16.92 %) aged 32 to 89 years; the mean age 61.57 ± 11.37 years. The laboratory-biochemical, clinical-instrumental and statistical methods were used during the study.Results. According to the anamnesis history, GERD duration varied 0.5 to 11 years (the mean duration 4.12 ± 2.25 years; median — 4 years); CHD duration ranged from 1 to 21 years; the average — 7.07 ± 4.61 years; the central trend (Me) — 6 years. All patients were divided into two groups: group I (n = 21; 32.31 %) consisted of subjects with non-erosive GERD and CHD; group II (n = 44; 67.69 %) included patients with erosive GERD and CHD. In both groups, women had an average lower cardiovascular risk (CVR) on different scales than men, and a higher percentage of associated 10-year survival, associated with modified risk factors (smoking, alcohol, body mass index, unhealthy diet, low physical activity, lipid metabolism). The dependence of severity obstructive sleep apnea (OSA) syndrome on the endoscopic form GERD (p = 0.0007) and dependence of level sleep disorders on clinical and morphological manifestations GERD (p = 0.0498) have been determined. The obtained data indicated the important transnosological mechanisms of formation of the GERD and CHD comorbidity: increased CVR and comorbidity level, changes in lipid spectrum and synthesis neurohormones, the presence of cardiac («cardiac mask») and pulmonary («pulmonary mask») manifestations, depressive and sleep disorders.Conclusions. The obstructive sleep apnea (OSA), as an insomnia variant, was established as a factor of the adverse course of GERD and CHD comorbidity. This is one of transnosological mechanisms that promotes the emergence of numerous organic and functional systematic violations.At the GERD and CHD comorbidity, the severity of insomnia and depression depends on the patient’s age, the CHD duration and level of body mass index (p &lt; 0.05); at different forms GERD there are differences in the main diagnostic parameters of severity OSA; the OSA severity was associated with the endoscopic GERD form (p = 0.0007); there is a dependence degree of sleep disorders on the clinical and morphological GERD manifestations (p = 0.0498). The increase in the comorbidity degree is proportional to the higher probability of mortality (r = 0.782; p &lt; 0.001); correction of the comorbidity indexes with CVR indexes allowed to determine more correctly the remote prognosis of combined disease and significantly improve the effectiveness of therapeutic and prophylactic actions.

A Literature Review of Antithrombotic Therapy for Patients of Venous Thromboembolic Events with Comorbidity of Coronary Heart Disease.

Patients with venous thromboembolism (VTE) and concurrent coronary heart disease (CHD) are not rare in clinic. The main challenge in the treatment for these patients is that the antithrombotic therapies for VTE and CHD are different from each other, but the combination of the two therapeutic strategies would increase the risk of bleeding. There is a need to optimize the antithrombotic therapeutic scheme on the basis of individual conditional, in order to balance the therapeutic effects and the bleeding risk. This article discussed the appropriate antithrombotic therapy when balancing the effectiveness and the risk in different circumstance of concurrence of VTE and CHD, such as combining anticoagulation therapy, dual antiplatelet therapy (DAPT), triple antithrombotic therapy (TAT), thrombolytic therapy and extending therapy, in order to provide safe, standard and effective therapeutic schemes for the clinical management of these patients. In the meantime, this article also provides perspectives regarding the application of novel non-vitamin K anticoagulants (NOACs) and the assessment tools of bleeding risk.

Co-morbid pathology: coronary heart disease and gastroesophageal reflux disease

The article presents data of domestic and foreign authors illustrating current views of mechanisms underlying development, pathogenesis, and difficulties of differential diagnostics of coronary heart disease (CHD) concurrent with gastroesophageal reflux disease (GERD). High prevalence of both conditions and their common risk factors are responsible for frequent occurrence of co-morbidity. The available data suggest positive effect of treatment with proton pump inhibitors (decreased frequency of myocardial ischemia and heart arrhythmia). Co-morbidity of CHD and GERD requires long-term treatment and the use of safe medications having no adverse effects on the course of CHD.

INFLUENCE OF SOMATIC COMORBIDITY ON THE COURSE OF CORONARY HEART DISEASE

Aim. To assess the life quality and clinical-laboratory parameters of the stable coronary heart disease (CHD) patients comorbid with diabetes type 2 (DM) and chronic obstructive pulmonary disease (COPD). Material and methods. Totally, 67 patients included, age 39-69 y.o. All patients were selected to 3 groups: CHD (group 1, n=21, mean age 55,4±6,8 y.o., males/ females 16/5), CHD and DM (group 2, n=21, 58,8±8,9 y.o., M/F 18/6), and CHD and COPD (group 3, n=22, 59,2±5,2 y.o., M/F 16/6). Clinical and anamnestic, as biochemical and hemodynamic parameters were evaluated, and the life quality with EQ-5D score. Results. In the CHD group with or none DM there was high rate of obesity, but in COPD group mean body mass index was lower than 29 kg/m2 . By EQ-5D, life quality decrease in CHD and DM, at most was determined by the units as “dyscomfort”, “everyday activities” and “anxiety/depression”. In CHD patients with comorbid COPD maximum was collected in the points related to “mobility”, “anxiety/ depression”. In the absence of significant dilation of the left ventricle (LV), in the patients of groups 2 and 3 there were relatively low values of ejection fraction (EF) comparing to CHD only patients. Also, in COPD and CHD patients there were signs of the left atrium overload, as the Doppler digns of pulmonary hypertension. Comorbidity of CHD and DM was followed by increased plasma urea and more significant dyslipidemia. Conclusion. Comorbid DM and COPD contribute on the worsening of CHD patients parameters with following decline in life quality, increased plasma urea and more significant dyslipidemia.

Comorbidity of depressive disorders and coronary heart disease: general aspects of pathogenesis

The high level of comorbidity of coronary heart disease (CHD) and depressive disorders and general aspects of their pathogenesis is an actual problem of modern research. Authors studied the content of cholesterol, platelet serotonin, platelet aggregation, activity of pro-inflammatory markers in CHD patients with comorbid depressive disorders. The study included 76 patients with CAD. The diagnosis of depressive disorder was set according to ICD-10, The Hamilton depression scales was used. Depressive disorders in CHD patients were associated with an increase in the activity of pro-inflammatory markers (IL-6 and TNF-α), and with high levels of low density lipoproteins. In patients with CAD and depressive disorders with high contents of platelet serotonin, the level of cholesterol was higher compared to those with low contents of serotonin. No significant differences in the functional platelet activity were identified in patients with CAD and comorbid depression compared to patients without mood disorders.

Abstract P1-13-04: A comparison of cardiovascular outcomes in postmenopausal women treated with aromatase inhibitors versus tamoxifen in breast cancer

Abstract OBJECTIVE: Breast cancer treatment Phase III studies show that Aromatase Inhibitors (AI) provide a longer disease free survival period compared to tamoxifen although overall survival is not consistently improved. This suggests an increase in a competing risk. The purpose of this study is to determine if there is an increase in cardiovascular morbidity and mortality in postmenopausal women treated with AI versus those treated with tamoxifen. METHODS: Using a retrospective cohort study design all postmenopausal women with breast cancer from January 1, 2002 to December 31, 2010 were identified from the Manitoba Cancer Registry (MCR). Data from these patients was requested from the Manitoba Health administrative databases for exposure, comorbidity, and outcome variables. Specifically, Drug Program Information Network (DPIN) data from 2002 to the most recent data available to determine prescriptions filled for tamoxifen and AI as a measure of exposure to these drugs. Hospital separation abstracts, physician claims data, and DPIN were used to determine comorbidity as well as new events for cardiovascular disease. Four specific groups were identified for comparison with respect to the outcomes of interest: tamoxifen exposed, AI exposed, exposure to both and no exposure. The primary end point was cardiovascular outcomes, including incident coronary heart disease and stroke. RESULTS: There were 4729 postmenopausal women diagnosed with Stage I – III breast cancer within previously defined years. The numbers for those treated with AI, Tamoxifen or both were 1590, 1015 and 607 respectively. Excluding women with preexisting comorbidity of coronary heart disease (CHD) and stroke, a competing risk regression model found that tamoxifen at 1 year of use had a statistically significantly lower rate of CHD endpoints compared to AI (p 0.040). There was no difference in stroke incidence between the two groups. CONCLUSION: Tamoxifen appears to provide a protective affect against CHD. Aromatase Inhibitors may lead to an increase in cardiovascular morbidity and mortality which may explain the lack of overall survival benefits with it's use. In the future, Tamoxifen may be preferentially used in women with a significant cardiac history. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-13-04.