Prognosis Of Coronary Heart Disease Research Articles

Independent Impact of Brain-Derived Neurotrophic Factor on Cardiovascular Prognosis in Coronary Heart Disease Patients: A Prospective Cohort Study

Abstract Objectives: Brain-derived neurotrophic factor (BDNF) as a biomarker of depressive symptoms manifests a novel role in the cardiovascular system. This study aims to indicate the association of BDNF levels between depressive symptoms and the cardiovascular prognosis in coronary heart disease (CHD) patients. Methods: Participants were recruited from hospitalized CHD patients between November 18, 2020 and November 26, 2021, in the First Affiliated Hospital of Shantou University Medical College. Serum BDNF levels were measured by the enzyme-linked immunosorbent assays. Depressive symptom was evaluated using Patient Health Questionnaire (PHQ-9). The cardiovascular events were the endpoint outcomes across the 12-month follow-up. Kaplan–Meier curves and Cox proportional hazards regression models were used to investigate the relationship of serum BDNF levels between depressive symptom and prognosis. Results: A total of 102 CHD patients (60.6 ± 10.4 year, 76% male) were enrolled. Based on the median serum BDNF levels, the participants were grouped into those “low BDNF (≤0.65 ng/mL)” versus “high BDNF (≥0.65 ng/mL).” CHD patients with low BDNF levels had a higher prevalence of depressive symptoms (PHQ–9 ≥10) compared with high BDNF levels. Within a median 540 days of follow-up, low serum BDNF increased the risk of cardiovascular events (adjusted hazard ratio = 3.26; 95% confidence interval = 1.18–9.02, P = 0.02) after adjustment for confounding factors. Conclusions: CHD patients with low serum BDNF levels were significantly associated with an increased risk of cardiovascular events, independently of depressive symptoms.

The causal effect of Helicobacter pylori infection on coronary heart disease is mediated by the body mass index: a Mendelian randomization study

The association between Helicobacter pylori (H. pylori) infection and coronary heart disease (CHD) remains controversial, with an unclear causal link. This study employed bidirectional Mendelian randomization (MR) method, using H. pylori infection as the exposure, to investigate its causal relationship with CHD diagnosis, prognosis, and potential pathogenesis. H. pylori infection exhibited a causal association with body mass index (BMI) (β = 0.022; 95% CI 0.008–0.036; p = 0.001). Conversely, there was no discernible connection between H. pylori infection and the diagnosis of CHD (OR = 0.991; 95% CI 0.904–1.078; p = 0.842; IEU database; OR = 1.049; 95% CI 0.980–1.118; p = 0.178; FinnGen database) or CHD prognosis (OR = 0.999; 95% CI 0.997–1.001; p = 0.391; IEU database; OR = 1.022; 95% CI 0.922–1.123; p = 0.663; FinnGen database). Reverse MR analysis showed no causal effect of CHD on H. pylori infection. Our findings further support that H. pylori infection exerts a causal effect on CHD incidence, mediated by BMI. Consequently, eradicating or preventing H. pylori infection may provide an indirect clinical benefit for patients with CHD.

Homocysteine and Lp-PLA2 levels: Diagnostic value in coronary heart disease.

Coronary heart disease (CHD) is the leading cause of mortality worldwide. Identifying effective diagnostic markers and understanding risk factors is crucial for prevention and management. This study aimed to investigate the levels of homocysteine (Hcy) and lipoprotein-associated phospholipase A2 (Lp-PLA2) in human plasma and their roles in the diagnosis and prognosis of CHD. A retrospective study was conducted on 232 patients with CHD, divided into Acute Myocardial Infarction, unstable angina pectoris, and stable angina pectoris groups, and a control group of 75 healthy adults. Blood samples were analyzed for serum Hcy and Lp-PLA2 levels using the cycling enzyme method and ELISA method, respectively. Statistical analyses were performed to evaluate the risk factors, and diagnostic efficacy was assessed using receiver operating characteristic (ROC) curves. No significant differences in age and sex were observed between the study and control groups, whereas marked disparities in risk factors such as obesity, hypertension, diabetes, and hyperlipidemia were noted. Significant differences in serum Hcy and Lp-PLA2 levels were identified among the CHD subgroups. Univariate and multivariate logistic regression analyses revealed that Hcy, Lp-PLA2, hypertension, and hyperlipidemia were significant risk factors for CHD. The combined diagnostic Area Under the Curve (AUC) for Hcy and Lp-PLA2 was found to be higher than that when using them individually. This study identified the elevation of Hcy and Lp-PLA2 levels as independent risk factors for CHD, and their conjoint analysis significantly enhanced clinical diagnostic efficacy. These findings provide valuable insights for CHD diagnosis, treatment, and prevention, highlighting the importance of these markers in CHD management.

Hemoglobin albumin lymphocyte and platelet score and all-cause mortality in coronary heart disease: a retrospective cohort study of NHANES database.

Anemia, inflammatory status, and malnutrition are all important factors in the prognosis of cardiovascular disease (CVD), and their interactions are also noteworthy. A recent scoring system, the hemoglobin albumin lymphocyte and platelet (HALP) score, combining multi-dimensional metrics, has been used in the prognoses of many diseases except coronary heart disease (CHD). Herein, this study aims to explore the association between HALP score and all-cause mortality in patients with CHD. Demographic and clinical data of adult patients with CHD were extracted from the National Health and Nutrition Examination Surveys (NHANES) database from 2003 to 2018 in this retrospective cohort study. Weighted univariate and multivariate COX proportional hazard models were used for covariates screening and exploration of the association between HALP score and all-cause mortality. The evaluation indexes were hazard ratios (ORs) and 95% confidence intervals (CIs). Kaplan-Meier (KM) curve and the receiver operator characteristic (ROC) curve were used to assess the predictive performance of HALP on CHD prognosis. In addition, subgroup analyses of age and congestive heart failure (CHF) were also performed. Among the eligible patients, 657 died of all-cause mortality. After adjusting for the covariates including age, education level, PIR, marital status, smoking, physical activity, total energy intake, CHF, stroke, hypertension, DM, CKD, cancer or malignancy, monocyte, drug for CVD, treatment for anemia, anticoagulants drug, and adrenal cortical steroids, we found that HALP score was negatively associated with the risk of all-cause mortality [HR = 0.83, 95% CI: (0.74-0.93)]. Compared with patients with high HALP scores, those who had lower HALP scores seemed to have a higher risk of all-cause mortality (all P < 0.05). HALP score has a potential predictive value on CHD prognosis with an area under the curve (AUC) of 0.61. Furthermore, in patients aged <65 years, with or without CHF, a lower HALP score was also associated with a higher risk of all-cause mortality (all P < 0.05). HALP score has a potential predictive value on CHD prognosis; however, the causal association between HALP score and mortality in patients with CHD needs further exploration.

Association between the triglyceride-glucose index and 1-year major adverse cardiovascular events in patients with coronary heart disease and hypertension

BackgroundThe triglyceride-glucose (TyG) index has been proposed as a potential predictor of adverse prognosis of coronary heart disease (CHD). However, its prognostic value in patients with CHD and hypertension remains unclear. This study aimed to evaluate the association between the TyG index and the 1-year risk of major adverse cardiovascular events (MACEs) in patients with CHD and hypertension.MethodsThe data for the study were taken from the Hospital Information System database in China-Japan Friendship Hospital which contained over 10,000 cardiovascular admissions from 2019 to 2022. The Boruta algorithm was performed for feature selection. The study used univariable analysis, multivariable logistic regression analysis, and restricted cubic spline (RCS) regression to evaluate the association between the TyG index and the 1-year risk of MACEs in patients with CHD and hypertension.ResultsAfter applying inclusion and exclusion criteria, a total of 810 patients with CHD and hypertension were included in the study with a median TyG index of 8.85 (8.48, 9.18). Using the lowest TyG index quartile as the reference, the fully adjusted ORs (95% CIs) for 1-year MACEs for TyG index Q2, Q3, and Q4 were 1.001 (0.986 ~ 1.016), 1.047 (1.032 ~ 1.062), and 1.760 (1.268 ~ 2.444), respectively. After adjusting for all confounders, we found that those with the highest TyG index had a 47.0% increased risk of MACEs over the 1-year follow-up (OR 1.470, 95% CI 1.071 ~ 2.018). The results in the subgroup analysis were similar to the main analyses. RCS model suggested that the TyG index was nonlinearly associated with the 1-year risk of MACEs (P for nonlinear < 0.001).ConclusionThis study shows that the elevated TyG index is a potential marker of adverse prognosis among patients with CHD and hypertension and informs the development of clinical decisions to improve outcomes.

Triglyceride-glucose index is associated with recurrent revascularization in patients with type 2 diabetes mellitus after percutaneous coronary intervention

BackgroundThe Triglyceride-glucose (TyG) index, as a surrogate marker of insulin resistance, is independently associated with the severity of coronary artery lesions and the prognosis of coronary heart disease. The investigation aimed to explore the relationship between the TyG index and recurrent revascularization in individuals with type 2 diabetes mellitus (T2DM) resulting from the progression of lesions or in-stent restenosis (ISR) after percutaneous coronary intervention (PCI).MethodA total of 633 patients who met the inclusion and exclusion criteria were enrolled and divided into three groups based on the tertiles of the TyG index. The primary endpoint was recurrent revascularization resulting from the progression of lesions or ISR. All-cause death was considered as the competing risk event. Competing risk analysis and Cox regression analysis for predicting recurrent revascularization after PCI were conducted stepwise. Variables were standardized to make the hazard ratio (HR), subdistribution hazard ratio (SHR) and corresponding 95% CI more consistent prior to being used for fitting the multivariate risk model. The predictive ability of the TyG index was evaluated using several measures, including the ROC curve, likelihood ratio test, Akaike’s information criteria, category-free continuous net reclassification improvement (cNRI > 0), and integrated discrimination improvement (IDI). Internal validation was conducted through bootstrapping with 1000 resamples.ResultsDuring a median follow-up period of 18.33 months, a total of 64 (10.11%) patients experienced recurrent revascularization, including 55 cases of lesion progression and 9 cases of in-stent restenosis. After controlling for competitive risk events, the TyG index was independently associated with a higher risk of recurrent revascularization [SHR:1.4345, (95% CI 1.1458–1.7959), P = 0.002]. The likelihood ratio test and Akaike’s information criteria showed that the TyG index significantly improves the prognostic ability. Additionally, adding the TyG index improved the ability of the established risk model in predicting recurrent revascularization, indicated by a C-index of 0.759 (95% CI 0.724–0.792, P < 0.01), with a cNRI > 0 of 0.170 (95% CI 0.023–0.287, P < 0.05), and an IDI of 0.024 (95% CI 0.009–0.039, P = 0.002). These results remained consistent when the models containing TyG index were confirmed using an internal bootstrap validation method.ConclusionThe findings highlight the potential of the TyG index as a predictor of recurrent revascularization. Lesion progression emerged as the primary contributor to recurrent revascularization instead of in-stent restenosis. The incorporation of the TyG index into risk prediction models is likely to be beneficial for accurate risk stratification in order to improve prognosis.

The combination of CYP2C19 polymorphism and inflammatory cell ratios in prognosis cardiac adverse events after acute coronary syndrome

BackgroundCYP2C19 gene polymorphism combination with inflammatory cell ratios was significant in the prognosis of coronary heart disease. Materials and methodsA cross-sectional analysis study, with 6 months follow-up on 142 patients with acute coronary syndrome. Patients were analyzed for CYP2C19 gene polymorphisms by real-time polymerase chain reaction (PCR) and complete blood count to determine inflammatory cell ratios and recorded cardiovascular events (CEs) after following up to 6 months. ResultsFor 90-day CEs, CYP2C19 gene polymorphism (Hazard Ratio (HR): 1.965, 95 % Confidence Interval (CI): 1.012–3.814), the combination of a neutrophil and lymphocyte ratio (NLR) ≥ 2.982 (HR: 13.001, 95 % CI: 1.37–97.304) or a platelet to lymphocyte ratio (PLR) ≥ 162.42 (HR: 2.878, 95 % CI: 1.212–6.835) was independent predictors of CEs. For 180-day CEs, CYP2C19 gene polymorphism combination with NLR ≥3.02 (HR: 13.946, 95 % CI: 1.833–106.121) or PLR ≥160.38 (HR: 5.349, 95 % CI: 1.379–20.745) or monocyte to lymphocyte ratio (MLR) ≥ 0.3 (HR: 4.699, 95 % CI: 1.032–31.393) were independent predictors of CEs. ConclusionNLR, PLR or MLR combined with CYP2C19 gene polymorphism were stronger independent predictors of cardiovascular events in patients with acute coronary syndromes compared to CYP2C19 gene polymorphism and inflammatory cell ratios separately. CYP2C19 polymorphism and high NLR was the strongest predictor of both CEs at 90 days and 180 days.

Role of speckle-tracking echocardiography in diagnosis and further prognosis of coronary heart disease

Echocardiography is one of the first-line methods of detection and evaluation of coronary artery disease, which helps clinicians in the diagnostic and prognostic evaluation of this disease. However, visual assessment of abnormal left ventricular myocardial wall motion is not always appropriate in detecting less severe or transient myocardial ischemia and in making an accurate differential diagnosis. Speckle-tracking echocardiography is a widely available non-invasive tool that can easily and quickly provide clarifying information and significantly extend the standard echocardiographic study, as the method allows you to identify subtle myocardial damage and local areas of ischemia that correspond to the pattern of coronary disease, and obtain an objective report in the form of simple visual scheme, very easy to use for differential diagnosis and treatment. Therefore, this method, which is increasingly used in various manifestations of coronary insufficiency and is convenient to use both at rest and with stress echocardiography, has proved efficient results in terms of predicting coronary heart disease, quantitative interpretation of emerging or persistent ischemia, assessment of the clinical course and outcome, and left ventricular remodeling. In this review, we have attempted to reflect the currently available findings that demonstrate the significance of speckle-tracking echocardiography for the evaluation and follow-up of coronary heart disease, including some congenital anomalies of the coronary arteries, and to touch on the main achievements and discoveries in the use of two-dimensional and three-dimensional deformation parameters and their potential application for a wider introduction into clinical practice.

Clinical and psychological correlations with type D personality in patients with chronic coronary syndrome

Recently, it has become common to identify type D personality, which is predisposed to the development of psychological distress. Negative behavioral characteristics of individuals with type D personality contribute not only to the development of cardiovascular diseases, but also to other comorbid pathologies that can influence the progression and prognosis of coronary heart disease. The aim of the study. To identify clinical and psychological correlations with type D personality in patients with chronic coronary syndrome. Methods. The study included 113 patients (68 men and 45 women; median age – 64 years) admitted for planned percutaneous coronary intervention at the Research Institute for Complex Issues of Cardiovascular Diseases (Kemerovo, Russian Federation). Based on the results of the DS-14 test, patients were divided into two groups: patients with type D personality (n = 40) and patients without this type (n = 73). Results. In patients with chronic coronary syndrome with type D personality, compared with patients without this type, concomitant diabetes mellitus (35 % and 15 %, respectively; p = 0.018), signs of diastolic dysfunction of left (Е/е’ ratio 7.1 [6.48; 8.0] and 5.0 [4.55; 5.74], respectively; p = 0.0038) and right (Et/At ratio – 0.8 [0.66; 1.35] and 1.38 [1.28; 1.63], respectively; p = 0.014) ventricles were more often diagnosed. Correlation analysis revealed associations of diabetes mellitus with type D personality (r = 0.243; p = 0.011), severity of negative excitability (r = 0.253; p = 0.008) and social suppression (r = 0.224; p = 0.020), as well as association of ankle-brachial index (ABI) with the severity of negative excitability (r = 0.393; p = 0.004) and social suppression (r = 0.414; p = 0.002). Conclusion. In patients having chronic coronary syndrome with type D personality, concomitant diabetes mellitus, as well as left and right ventricular filling disorders are more often detected. Correlation analysis revealed associations of diabetes mellitus with type D personality and its subscales; the ABI level was associated with subscales of type D personality, but not with the level of anxiety and depression.

Prognosis of coronary heart disease after percutaneous coronary intervention: a bibliometric analysis over the period 2004–2022

BackgroundAs the complexity and diversity of the percutaneous coronary intervention (PCI) are being explored and reported, burgeoning research has progressed in this field. However, there is no comprehensive analysis available on PCI-related studies published in the literature. This study aimed to analyze and visualize the changes of scientific output regarding prognosis of coronary heart disease (CHD) after PCI over the past 20 years and to reveal the knowledge domain and development trends in this field by using CiteSpace software.MethodsRelevant articles published over the period 2004–2022 were retrieved from the Web of Science Core Collection database. After manual selection, qualified documents were included and recorded with the information of their title, abstract, keyword, author, descriptor, citation, identifier, publishing year and publishing organization. We transferred the data to CiteSpace V5.8.R2 (Version 5.8.R2) to draw knowledge maps and to conduct co-occurrence analysis, cluster analysis, timeline analysis, burst term detection and citation analysis.ResultsA total of 14,699 literature records were found relating prognosis of CHD after PCI in the past 20 years (2004–2022), including 14,212 original articles and reviews, and they were published in 153 different journals. Publication production has increased annually and a total of 1182 authors, 796 institutes and 147 countries have contributed to these publications. Moreover, the most representative author was Gregg W Stone from the CardioVascular Research Foundation (CVRF) with 368 publications, whose team mainly focused on exploring the efficacy and safety of revascularization and the characteristics of susceptible population. The global productivity ranking was led by the USA with 3326 published papers, followed by Italy (n = 1355), Japan (n = 1080), China (n = 1075) and Germany (n = 937). And the keywords of these publications were “percutaneous coronary intervention” (n = 2271), “outcome” (n = 1756), “mortality” (n = 1730) and “impact” (n = 1334). Other commonly-used words were “predictor” (n = 1324), “intervention” (n = 1310), “angioplasty” (n = 1299), “risk” (n = 1144), “acute myocardial infarction” (n = 1136) and “artery disease” (n = 1098). Cluster analysis showed that 15 high connected clusters were generated with a modularity Q of 0.831 and a weighted mean silhouette of 0.9388 by applying the log-likelihood ratio algorithm, and the top 5 clusters were #0 optical coherence tomography, #1 dual antiplatelet therapy, #2 bleeding, #3 clopidogrel and #4 thrombus aspiration. Furthermore, the frontiers in the field of prognosis of CHD after PCI mainly involved “decision making”, “reperfusion”, “angioplasty”, “balloon”, “unstable angina”, “dual antiplatelet therapy”, “cardiac surgical score”, “restenosis”, “reperfusion”, “thrombolytic therapy”, etc.ConclusionsTo sum up, efficacy and safety of different types of stents, the risk factors of restenosis and thrombotic events after PCI, early risk assessment, and secondary prevention and complications of patients with CHD after PCI were research hotspots and frontier topics in the area by bibliometric analysis. The results could provide a comprehensive overview of the research hotspots and frontier topics relating prognosis of CHD after PCI, promoting a better understanding of the knowledge domain and development trends in this field during the past 20 years.

Detection of coronary heart disease based on MFCC characteristics of heart sound

BackgroundPhonocardiogram (PCG) has been widely used to aid in the diagnosis of cardiovascular diseases. Coronary heart disease (CHD) is one of the leading causes of death, the use of heart sounds noninvasive and convenient detection of CHD, can assist the doctor’s diagnosis and treatment, and prognosis, reducing the huge burden of disease.Objective:This study proposes a CNN + attention mechanism model that can assist in the diagnosis of CHD without relying on manual extraction of heart sound features, and initial screening of CHD in groups presenting with chest pain and other symptoms. MethodsHeart sounds were preprocessed and converted into two-dimensional characteristic MFCC. The SPC-3D model designed in this study was subjected to 5-fold cross-validation and compared with seven common deep learning models.Results:The accuracy of the SPC-3D model designed in this study was 91.4993%, the precision was 89.9039%, the F1 score was 91.9398%, the sensitivity was 94.0911%, the specificity was 88.6965%, and the results were the best. Its accuracy is 3.5% higher than the basic network MobileNetV2, and 1.2% higher than that of DenseNet, which has a deep network structure.Conclusion:Compared with other models, the sensitivity and specificity of the model designed in this study are less different, indicating that the model has strong robustness. Collecting more detailed information on the patient's condition will help to further classify, and assist in the treatment, and prognosis of CHD.

Prognostic Significance of Cardiac Fat Deposits in Patients with Coronary Heart Disease

INTRODUCTION: Obesity is one of the leading risk factors for the development of cardiovascular diseases. At present, of the greatest scientific interest are local deposits of adipose tissue as a possible morphological substrate for the development of this group of diseases. Along with the traditional risk factors, one more risk factor for a poor prognosis of cardiovascular disease can be a change in the thickness of the epicardial fat (EF) and of the interatrial septum (IAS) in case of its lipomatosis.&#x0D; AIM: To study the significance of EF and of IAS thickness as markers of cardiovascular risk in coronary heart disease.&#x0D; MATERIALS AND METHODS: The study involved 116 individuals with coronary heart disease (55 men (47%) and 61 women (53%), mean age 68 [61; 72] years). Thickness of EF and IAS was evaluated by the method of echocardiography. The frequency of poor outcomes was evaluated using KaplanMeier method, ROC-curve analysis. The differences were considered statistically significant at p 0.05.&#x0D; RESULTS: In the group of patients with unstable angina, the threshold value of IAS thickness was 0.7 cm (p 0.001), and of EF thickness 0.8 cm (2 = 10.89, p = 0.001), in the group of patients with myocardial infarction 0.7 cm (p 0.001) and 0.8 cm (p 0.001), respectively. In the group of patient with unstable angina, IAS thickness 0.7 cm (2 = 10.3, p = 0.0013) and EF thickness 0.8 cm (2 = 10.89, p = 0.001) demonstrate a poor prognosis in comparison with the parameters below the threshold values. In the group of patients with myocardial infarction, IAS thickness 0.7 cm (2 = 8.4, p = 0.005) and EF 0.8 cm (2 = 9.66, p = 0.0019) demonstrate poor prognosis in comparison with the parameters below the threshold values.&#x0D; CONCLUSION: In unstable angina and myocardial infarction, the value of IAS thickness 0.7 cm (p = 0.0013 and p = 0.005, respectively) and of EF thickness 0.8 cm (p = 0.001 and p = 0.0019, respectively) present a poor prognosis compared to lower values. It is recommended that EF and IAS thickness be determined in echocardiography as an additional marker for a poor prognosis in coronary heart disease.

Effects of a Primary Care-Based Intervention on the Identification and Management of Patients with Coronary Heart Disease and Mental or Cognitive Comorbidity-A Study Protocol.

Mental and cognitive disorders (MCD) negatively affect the incidence and prognosis of coronary heart disease (CHD). Medical guidelines recommend the appropriate management of comorbid MCD in patients with CHD, yet there is evidence that the implementation in primary care is not always adequate. We present the protocol for a pilot study that aims to develop a minimally invasive intervention and evaluate its feasibility in the primary care setting to improve the identification and management of comorbid MCD in patients with CHD. The study consists of two consecutive parts and will be carried out in Cologne, Germany. Part 1 comprises the development and tailoring of the intervention, which is guided by qualitative interviews with primary care physicians (PCPs, n = 10), patients with CHD and MCD and patient representatives (n = 10). Part II focuses on the implementation and evaluation of the intervention in n = 10 PCP offices. Changes in PCP behaviour will be analysed by comparing routine data in the practice management system six months before and six months after study participation. In addition, we will explore the influence of organisational characteristics and perform a socio-economic impact assessment. The outcomes of this mixed-method study will inform the feasibility of a PCP-based intervention to improve quality of care in patients with CHD and comorbid MCD.

Elevated postprandial triglyceride-rich lipoproteins in patients with diabetes and stable coronary artery disease correlated with early renal damage and systemic inflammation

BackgroundDyslipidaemia is key in the development of coronary heart disease (CHD) in patients with diabetes mellitus (DM). Accumulated evidence supports that diabetic nephropathy increases the mortality risk of patients with CHD, while the influence of diabetic dyslipidaemia on renal damage in patients with DM and CHD remains unknown. Moreover, recent data indicate that postprandial dyslipidaemia has predictive value in terms of CHD prognosis, especially in patients with DM. The study aimed to determine the relationship of triglyceride-rich lipoproteins (TRLs) after daily Chinese breakfast on systemic inflammation and early renal damage in Chinese patients with DM and SCAD.MethodsPatients with DM diagnosed with SCAD while in the Department of Cardiology of Shengjing Hospital from September 2016 to February 2017 were enrolled in this study. Fasting and 4-h postprandial blood lipids, fasting blood glucose, glycated haemoglobin, urinary albumin-to-creatinine ratio (UACR), serum interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) concentrations, and other parameters were measured. Fasting and postprandial blood lipid profiles and inflammatory cytokines were analysed using a paired t-test. The association between variables was analysed using Pearson or Spearman bivariate analysis. P < 0.05 was considered to be statistically significant.ResultsThe study enrolled 44 patients in total. Compared with fasting state, postprandial total cholesterol high-density lipoprotein-cholesterol (HDL-C),low-density lipoprotein-cholesterol (LDL-C) and non-high-density lipoprotein-cholesterol (non-HDL-C) all showed no significant change. Postprandial serum triglyceride (TG) concentration increased significantly compared with that at fasting (1.40 ± 0.40 vs. 2.10 ± 0.94 mmol/L, P < 0.001), as did serum remnant lipoprotein-cholesterol (RLP-C) (0.54 ± 0.18 mmol/L vs. 0.64 ± 0.25 mmol/L). Pearson analysis revealed that serum TG and RLP-C positively correlated before and after breakfast. Moreover, during fasting, positive correlations were observed between TG and serum IL-6, TNF-α, and UACR. Positive correlations were observed between RLP-C and IL-6, UACR under fasting condition, while both TG and RLP-C were positively correlated with postprandial serum IL-6, TNF-α, and UACR concentrations. Finally, positive correlations were observed between UACR and IL-6 and TNF-α concentration under both fasting and postprandial conditions.ConclusionsAn increase in postprandial TRLs was observed in Chinese patients with DM and SCAD after daily breakfast, and this increase may be related to early renal injury via the induction of systemic inflammation.

Effects of exercise on wall shear stress in male and female patients with coronary heart disease

Coronary heart disease (CHD) seriously endangers human health, and there are obvious gender differences in incidence rate and prognosis, which are related to the evident differences in anatomical structure, physiological characteristics, and wall shear stress between males and females. In recent years, cardiac rehabilitation has been proven to be safe and effective in controlling the progression and improving the prognosis of CHD. Thereinto, exercise therapy is the central link of cardiac rehabilitation. Exercise can significantly affect vascular endothelial function by regulating wall shear stress. Based on previous research, this paper will briefly review the influence of exercise on wall shear stress in male and female patients with CHD, in order to provide a reference for formulating personalized cardiac rehabilitation programs and further improve the prognosis of CHD.

A network analysis of cardiovascular risk factors in patients with heart disease: the role of socioeconomic status and sex.

Diverse risk factors influence the development and prognosis of coronary heart disease (CHD) independently and mutually. Low socio-economic status (SES) seems to exacerbate these risk factors' influences. Additionally, sex differences have been identified for individual risk factors. Network analysis could provide in-depth insight into the interrelatedness of the risk factors, their predictability, and into the moderating role of sex, to ultimately contribute to more refinement in prevention and cardiac rehabilitation (CR). 1682 participants (78% male; Mage = 69.2 ± 10.6) with CHD completed questionnaires on psychosocial factors and health behaviors. Cardiometabolic data were retrieved through medical records. An SES index was created based on self-reported occupation and education, and area (i.e., postal code)-based median family income. Using R, we conducted a mixed graphical model network analysis on all risk factors combined with and without the moderating role of sex. SES belonged to the more influential risk factors with moderate to high levels of expected influence and degree centrality, indicating it plays a considerable role in the risk factor network. When considering the moderating role of sex, relationships between SES and most risk factors were found to be stronger for women (b = 0.06 - 0.48). The current study provided an insight into an interrelated network of psychosocial and medical risk factors among CHD patients. With SES belonging to the more influential risk factors and female sex influencing the strength of all the SES-risk factor relationships, CR and prevention techniques could be more refined by accounting for both influences.

Does Anxiety Affect Survival in Patients with Coronary Heart Disease?

Behavioral and physiological risk factors worsen the prognosis of coronary heart disease (CHD). Anxiety is known to be a psychological predictor of CHD. In this study, we investigated whether this factor is associated with all-cause mortality in CHD patients in the long term. We studied 180 patients (mean age 60.6 SD 9.2 years, 26% women) with CHD from the Berlin Anxiety Trial (BAT) and the Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD) study. Their cardiac and psychological risk profile was represented by standardized procedures, including the Hospital Anxiety and Depression Scale (HADS) questionnaire. Mortality outcomes were assessed using a community-based registry. Of 180 patients, we obtained information on all-cause mortality in 175 (96.7%) after a mean follow-up of 12.2 years (range 10.4-16.6 years). Of all participants, 54.4% had prior myocardial infarction, 95.3% had percutaneous transluminal coronary angioplasty and 22.2% had prior coronary artery bypass graft. Most of the patients (98.4%) had New York Heart Association class I and II, 25.6% had diabetes and 38.2% were smokers. Patients had a mean HADS anxiety score of 9.7 SD 4.1 at study entrance. We found the highest HADS anxiety quartile all-cause mortality in 14%, 30.2% in the middle quartiles and 58.7% in the lowest quartile (chi2 20.8, p = 0.001). Related to psychological mechanisms, a low level of anxiety, seemed to be a significant predictor of all-cause mortality. We found no advantage for patients who had received psychosocial therapy in terms of survival. These first data confirmed our hypothesis about the association of psychological risk factors with the long-term outcome of CAD patients. Future studies will clarify whether the severity of disease, age or a particular type of coping or denial mechanism are associated with the presented outcome in low-anxious patients.

Prognostic Value of Pentraxin-3 Change After Primary Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction.

So far, ST-segment elevation myocardial infarction (STEMI) is still the main cause of morbidity and mortality of cardiovascular diseases worldwide. Recent studies showed that pentraxin-3 (PTX3) was related to the early diagnosis and prognosis of coronary heart disease. This study aimed to investigate the dynamical change of PTX3 after primary percutaneous coronary intervention (pPCI) in STEMI patients and its prognostic value. In this prospective cohort study, a total of 350 patients were enrolled. The plasma level of PTX3 was measured at admission, 24-hour and 5-day after pPCI. The primary endpoint was the incidence of major adverse cardiac cerebral events (MACCEs) during 1-year follow-up. Compared with the admission, PTX3 levels were significantly increased at 24 hours, and decreased at 5 days after pPCI in the whole cohort. PTX3 levels at these three time points were not significantly different between the patients with and without MACCEs. Notably, the change in PTX3 from admission to post-pPCI 24-hour (ΔPTX3) was higher in patients with MACCEs (112.83 vs 17.94 ng/dl, P = 0.001). The ROC curves showed that the cut-off value was 29.22 ng/dl and the area under curves was 0.622 (95% CI: 0.554-0.690, p = 0.001). Multivariable cox regression models revealed that the high ΔPTX3 group was an independent predictor of MACCEs (adjusted HR = 2.010, 95% CI = 1.280-3.186, p = 0.003). The higher ΔPTX3 group had significantly higher incidences of revascularization (HR = 2.094, 95% CI: 1.056-4.150, p = 0.034) and composite MACCEs (HR = 2.219, 95% CI: 1.425-3.454, p < 0.001). However, the change of PTX3 level from admission to post-pPCI 5-day had no independently predictive value. The higher increase of PTX3 level 24-hour after pPCI appeared to have a potential value in independently predicting the incidence of 1-year MACCEs in STEMI patients, especially for coronary revascularization.

SOCIO-DEMOGRAPHIC INDICATORS IN PATIENTS WITH CORONARY HEART DISEASE ACCOMPANIED BY DEPRESSION

Depressive disorders are more common both in the general population (more than 350 million people suffer from depressive disorders) and among patients with cardiovascular disease, especially coronary heart disease. The World Health Organization predicts that, by 2030, coronary heart disease and depressive disorders will play a leading role in disability and incapacity for work in the developed countries of the world. The prevalence of depressive disorders at the population level ranges from 2.5% to 10% [1, 2]. Depression is a risk factor for coronary heart disease, negatively influences the course of cardiovascular diseases, and adverse prognosis of the disease in such categories of people is a significant predictor [3, 4]. So, the Whitehall II study showed that the sharper the symptoms of depression, the higher the risk of coronary heart disease [5]. In addition, in patients suffering from cardiovascular diseases, the depressive state aggravates the clinical picture of the disease, and a direct link between the severity of depression and the risk of death has been established [6-11]. Because depression is not diagnosed and treated in time, patients often seek outpatient care and are hospitalized [11]. Due to complications of angina pectoris and many non-coronary complaints, patients' quality of life decreases. Thus, in patients with coronary heart disease in the postoperative period, against the background of depression, an additional decrease in their functional capabilities is revealed [12]. The negative influence of depressive disorders on the development of coronary heart disease is caused by behavioral and physiological mechanisms. The dysfunction of the hypothalamic-pituitary-adrenal, thyroid, and immune systems of the body and the disruption of serotonin, melatonin, and dopamine receptor activity are observed against the background of depression. One of the most important mechanisms of depression's effect on coronary heart disease prognosis is that sympathoadrenal system activation increases the risk of life-threatening cardiac rhythm disturbances [3, 5, 8, 13–15]. Depression significantly changes the behavior of patients with cardiovascular diseases and reduces their quality of life: patients do not want to follow their diet and treatment regimen, do not want to quit smoking or consuming alcohol, do not want to increase physical activity, and do not want to switch to a healthy lifestyle [16–19]. Often, depressive disorders are accompanied by anxiety. Anxiety increases the risk of coronary heart disease by about 41% and the risk of other cardiovascular diseases by up to 52% [20, 21], while increasing the risk of fatal cardiovascular cases [22] and reducing patients' social activity [23]. ]

Clinical and Genetic Aspects of Depression Comorbid Coronary Heart Disease

Objective: to analyze available scientific publications on the problem of clinical and genetic aspects of depressive disorders in patients with coronary heart disease (CHD). Material and methods: by keywords “coronary heart disease”, “mental disorders”, “depression”, “genetics”, “genetic markers”, “polymorphism”, “personality” articles in English and Russian were searched in the MEDLINE/PubMed, Scopus, Web of science, eLibrary databases in the period from 2020 to 2021. Conclusion: depression comorbid CHD is considered as a clinical problem due to its high prevalence, as well as its influence on the features of the course and prognosis of CHD, as well as on the compliance of patients. Heterogeneity of the clinical structure of depressive disorders in CHD (nosogenic, endogenomorphic, endogenous, somatogenic depression) causes difficulties in differential diagnosis and complex therapeutic measures. There are several factors contributing to the onset of depression in CHD patients: biological, clinical, personal characteristics. Genetic markers of depression in CHD, which have prognostic value, require further clarification.