Coronary Heart Disease Subgroups Research Articles

Associations of dietary riboflavin intake with coronary heart disease in US adults: a cross-sectional study of NHANES 2007-2018.

There is currently little study on the relationship between dietary riboflavin intake and coronary heart disease (CHD) risk. Using information from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018, we carried out a cross-sectional study. Dietary riboflavin intake and CHD risk were examined using weighted univariate and multivariable logistic regression. To learn more about the connection between dietary riboflavin intake and CHD risk, subgroup analyses and interactions were conducted. Next, the potential non-linear association was visually described using restricted cubic spline (RCS). The risk of CHD was inversely correlated with dietary riboflavin consumption. The multivariable odds ratio (OR) with 95% confidence interval (CI) for the risk of CHD was 0.52 (95%Cl: 0.34-0.81, Ptrend = 0.009) for the highest vs. lowest tertiles of riboflavin. This protective effect of dietary riboflavin on CHD was influenced by gender, drinking status and serum folate concentration. A non-linear inverse connection (Pfor nonlinearity ≤ 0.001) was shown using RCS analysis between riboflavin intake and the risk of CHD. Our research suggested that consuming more riboflavin in your diet may lessen the risk of CHD. The results improved the current knowledge base and supplied potential implications for dietary recommendations and health policy.

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.

Apolipoprotein B Displays Superior Predictive Value Than Other Lipids for Long-Term Prognosis in Coronary Atherosclerosis Patients and Particular Subpopulations: A Retrospective Study

Accumulating evidence that apolipoprotein B (apoB) plays a critical role in predicting coronary heart disease (CHD) and future outcomes. The 2019 European Society of Cardiology/European Atherosclerosis Society guidelines suggest that apoB can be an alternative to non-HDL-C or LDL-C in patients with high triglyceride levels, diabetes, obesity, metabolic syndrome, or very low LDL-C levels. This study explores whether apoB can also serve as predictive value for long-term major adverse cardiovascular events (MACEs) in normal people and specific coronary atherosclerosis patients. A total of 826 patients were followed up over 10 years, and the risk factors for MACEs were retrospectively analyzed in patients with CHD and particular subpopulations. All statistical analyses were performed in R software. Cox regressions were performed to assess independent risk factors of long-term MACEs in the atherosclerosis group and CHD subgroups. Kaplan-Meier survival curves were used to evaluate the survival rate for patients in different apoB quartiles, and receiver-operating characteristic curves were used to compare apoB and other lipids in predicting the presence of long-term MACE. apoB could be a "risk-enhancing factor" in patients with coronary atherosclerosis disease, whereas in the Normal population, LDL-C still acted as a major risk factor for predicting MACEs. apoB was a good risk predictor for long-term cardiovascular events in coronary atherosclerosis (AS) patients, including the AS group and CHD subpopulations (including CHD+triglyceride ≥2.3 mmol/L, CHD+diabetes mellitus, CHD+body mass index ≥25 kg/m2, or CHD+metabolic syndrome). In patients with CHD whose condition was complicated with diabetes, obesity, and metabolic syndrome, apoB performed better than other lipids in predicting the presence of myocardial infarction, hospitalization due to angina, and cardiac death. Despite achieving optimal LDL-C or non-HDL-C levels, patients with CHD are still at risk of worse survival if they are unable to reach a low apoB level (lower cut points such as 65 mg/dL). More attention should be paid to special populations with residual elevations of atherogenic particle numbers, and greater focus should be placed on lowering baseline apoB to achieve long-term benefits. However, given that this was an observational study, the association of baseline apoB level and long-term MACEs only was evaluated; it is unclear whether the emergence of MACEs would be influenced by the dynamic changes of apoB. Because this was a retrospective and observational analysis, bias in data analysis was unavoidable; thus, the results cannot be used to generalize implications to broader patient populations, and more large-scale clinical trials are required to verify these findings. (Clin Ther. 2022;44:1071-1092) © 2022 Elsevier HS Journals, Inc.

Levels and clinical significance of serum homocysteine (Hcy), high-density lipoprotein cholesterol (HDL-C), vaspin, and visfatin in elderly patients with different types of coronary heart disease.

To investigate the levels and clinical significance of serum homocysteine (Hcy), high-density lipoprotein cholesterol (HDL-C), visceral adipose tissue-derived serine protease inhibitor (vaspin), and visceral fat-specific adipokine (visfatin) in elderly patients with different types of coronary heart disease (CHD). A total of 208 elderly patients with CHD admitted to our hospital were selected as the observation group, and 57 healthy volunteers who received physical examinations during the same period were selected as the healthy control group. The patients in the observation group were divided into a stable angina pectoris (SAP) group, an unstable angina pectoris (UAP) group, and an acute myocardial infarction (AMI) group according to their clinical diagnosis. The levels of serum Hcy, HDL-C, vaspin, visfatin, and coronary angiography Gensini scores were compared among the CHD subgroups and the healthy control group. Pearson linear correlation analysis was used to analyze the correlation between levels of serum Hcy, HDL-C, vaspin, and visfatin with Gensini scores in elderly patients with different types of CHD. The levels of serum Hcy and visfatin in the observation group were significantly higher than those in the healthy control group (P<0.05), while the levels of serum HDL-C and vaspin were significantly lower than those in the healthy control group (P<0.05). There were statistically significant differences in the levels of serum Hcy, vaspin, and visfatin among the CHD subgroups (P<0.05). There were statistically significant differences in the Gensini scores and number of stenotic coronary arteries among the CHD subgroups (P<0.05). Pearson linear correlation analysis showed that the levels of serum Hcy, HDL-C, vaspin, and visfatin in the SAP group were not significantly correlated with Gensini scores (P>0.05). However, the levels of serum Hcy and visfatin in the UAP and AMI groups were positively correlated with Gensini scores (P<0.05), the level of serum vaspin was negatively correlated with Gensini scores (P<0.05). The levels of serum Hcy, vaspin, and visfatin vary according to the different types of CHD and are correlated with the degree of coronary artery stenosis. As such, these serum levels can be used as sensitive indicators for early detection and disease evaluation.

A case-control study of the association between the polymorphisms of APOE and SLCO1B1 and the severity of coronary artery disease

Objective The single nucleotide polymorphisms (SNPs) of APOE and SLCO1B1 were examined to explore their association with the risk and severity of coronary heart disease(CAD). Methods A total of 1 267 cases of consecutive coronary heart disease (CAD)-suspected inpatients visiting department of Cardiology in Peking University Peoples′ Hospital from March 2017 to november were recruited into this case-control study, and then 391 CAD cases and 223 non-CAD controls were enrolled for final analysis after screening by coronary angiography and exclusion criteria. The severity of the CAD cases were evaluated according to Gensini scores. The SNPs of APOE(388T>C, 526C>T) and SLCO1B1(388A>G, 521T>C) were detected using Real-time PCR and further verified using Sanger sequencing. Environmental risk factors were collected, and the correlations between SNPs of APOE and SLCO1B1 and the risk and severity of CAD were performed by SPSS version 16.0. Results The SNPs of all the subjects included in CAD group and non-CAD group were successfully detected, with an accordance of 100% to Sanger sequencing. The distribution of APOE and SLCO1B1 gene were subjected to Hardy-Weinberg. The distributions of APOE gene e3/e3 genotypes and e3 allele were most commonly found in both CAD group and non-CAD group (e3/e3: 70.8%,73.1%;e3: 83.5%,85.2%;respectively). APOE genotypes and alleles were comparable between the CAD cases and non-CAD controls (P>0.05). The frequencies of APOE gene e4+ genotype were more likely to be found in the subgroup of CAD with Gensini score≥72 (P 0.05). Conclusion This study observed no association between SNPs of APOE, SLCO1B1 and the risk of CAD in this population. However, APOE gene e4+ genotype may increase the severity of CAD. Key words: Apolipoproteins E; Solute carrier organic anion transporter family member 1b1; Polymorphism, genetic; Coronary disease; Severity of illness index

Joint effects of obstructive sleep apnea and resistant hypertension on chronic heart failure: A cross-sectional study

BackgroundObstructive sleep apnea (OSA) and resistant hypertension (RHTN) are two major risk factors of chronic heart failure (CHF) and limited information is available about the joint effects of OSA and RHTN on CHF. MethodsBaseline data of participants who had completed polysomnography were used in the current study. The relative excess risk due to interaction (RERI) and attributable proportion due to interaction (AP) were calculated, and RERI >0 or AP >0 indicates joint effect of OSA and RHTN on CHF is greater than the sum of estimated effects of OSA alone and RHTN alone. Due to significant interaction between coronary heart disease (CHD) and both OSA and RHTN, participants were stratified into with and without CHD subgroups. ResultsAmong 1157 participants, 33.1% had OSA. The prevalence of RHTN in OSA participants was 18.3%. The apnea–hypopnea index (AHI), pulse pressure and CHF were significantly associated with RHTN. In the CHD subgroup, participants with OSA and RHTN were associated with >3-fold increased odds of prevalent CHF. RERI was 2.66 and AP was 0.75. The odds of prevalent CHF with left ventricular ejection fraction (LVEF) ≥45% in participants with OSA+RHTN were >2-fold higher compared to those without, or with either OSA or RHTN, and RERI was 1.50 and AP was 0.72. ConclusionPresence of CHF, increased AHI and pulse pressure are independently associated with RHTN. OSA and RHTN have significant joint effects on CHF, especially in patients with concurrent CHD and preserved LVEF.

Beta-blockers, and real clinical practice in Russia: the gap between the understanding of the doses of beta-blockers and subsequent prognosis in patients with cardiovascular disease

Presents an analysis of the reception beta-blockers in three epidemiological studies sections of the EPOKhA. Respondents in each slice (2002, 2007, 2017) were stratified into 5 subgroups: only suffering from hypertension - AH (subgroup AH), patients with stable angina pectoris, but in history and clinically has no evidence of acute myocardial infarction (AMI) and chronic heart failure (subgroup of coronary heart disease); after myocardial infarction, but do not have clinical manifestations of chronic heart failure (subgroup myocardial infarction); patients with acute myocardial infarction formed for any reason, but with no previous history of AMI (subgroup chronic heart failure), and patients with clinical manifestations of chronic heart failure after suffering AMI in anamnesis (subgroup myocardial infarction + chronic heart failure). During 15 years in the Russian Federation the frequency of administration of beta-blockers increased from 20% in the section of cardiovascular pathology to 30%. The most sensitive to the use of beta-blockers were patients with a history of AMI and chronic heart failure. Prolonged beta-blockers have been used at the population level only in 2007, but the frequency with any cardiovascular pathology does not exceed the 50% threshold, and the achievement of goals (control heart rate) does not exceed 10% of the level at any pathology. This dependence is associated with low-dose beta-blockers. In any case, the dose of beta-blockers did not exceed 50% of recommended that can be a separate cause of cardiovascular mortality at the population level in Russia.

Comparison of Long-Term Mortality for Cardiac Diseases in Patients With Versus Without Diabetes Mellitus

Diabetes mellitus confers the highest mortality risk in primary and secondary cardiovascular prevention, but long-term prognosis differences between different forms of cardiovascular disease have not been assessed. We hypothesized that acute heart failure (HF) could have poorer outcomes than acute coronary heart disease (CHD) in patients with diabetes. We performed a prospective study of all consecutive patients admitted in a single year. Patients were categorized according to main cardiologic diagnosis: acute HF, acute CHD, rhythm disorders, or noncardiac disease. A total of 1,293 patients were included, 31.8% had diabetes and had higher mean age, more risk factors, previous cardiovascular disease, and co-morbidities. Hospital mortality (5.6% vs 1.7%; p <0.01) was higher in patients with diabetes. During follow-up (median 58.0 months; interquartile range 31.0 to 60.0), diabetic patients had higher cardiovascular mortality (27.2% vs 9.6%; p <0.01) and all-cause mortality (35.8% vs 14.5%; p <0.01); cardiovascular disease accounted for 75% of deaths. According to discharge diagnosis, patients with diabetes only had higher mortality rates in the subgroup of acute CHD. Acute HF was the diagnosis with higher cardiovascular (36.9%) and all-cause mortality (44.1%), followed by acute CHD (16.8% and 24.4%) and rhythm disorders (5.8% and 8.8%). Multivariate analysis identified an independent association with higher long-term mortality of acute HF and acute CHD in patients with and without diabetes. In conclusion, 1/3 of cardiology-admitted patients have diabetes and have poorer long-term prognosis, especially when discharged with the diagnosis of acute HF or acute CHD.

Association of N-acetyltransferase-2 polymorphism with an increased risk of coronary heart disease in a Chinese population.

We investigated the possible correlations between N-acetyltransferase-2 (NAT2) gene polymorphisms and the risk of coronary heart disease (CHD). CHD patients (113) and healthy controls (118) were enrolled from the First People's Hospital of Yuhang between January 2013 and June 2014. The patients were divided into mild CHD (N = 72) and severe CHD (N = 41) subgroups. DNA samples were extracted and the distributions of NAT2 polymorphisms were examined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Clinical characteristic indexes of severe CHD patients were also examined for relevant statistical analysis. WT, M1, M2, and M3 alleles were observed in both case and control groups. PCR-RFLP identified a wild-type homozygote, WT/WT; a mutant heterozygote, WT/Mx; and a mutant homozygote, Mx/Mx (x = 1, 2, and 3) variant of the NAT2 genotype. Mx/Mx differed significantly between case and control groups (P < 0.05); the frequencies of all four alleles did not differ significantly between case and control groups (P > 0.05). Slow acetylator genotype frequencies were notably higher in the case group than in the control group (P < 0.05). Individuals with the slow acetylator genotype were at 1.97-times higher risk of CHD and also displayed higher triglyceride and lower high-density lipoprotein cholesterol levels than those with the rapid acetylator genotype (P < 0.05). Therefore, the NAT2 polymorphism was believed to be associated with increased risk of CHD, with the NAT2 slow acetylator genotype serving as a risk factor for severe CHD in a Chinese population.

Correlation between the 677C>T polymorphism in the methylene tetrahydrofolate reductase gene and serum homocysteine levels in coronary heart disease.

The aim of the current study was to explore the correlation between serum homocysteine (HCY) levels and the methylene tetrahydrofolate reductase (MTHFR) gene 677C/T polymorphism and coronary heart disease (CHD). We consecutively enrolled 208 patients with CHD confirmed by CTA or coronary angiography from our hospital. An additional 200 healthy volunteers were enrolled as the control group. Serum HCY levels, MTHFR C677T genotype, and other related indicators were evaluated for the two groups. Compared to those in the control group, the serum HCY levels in the CHD patients were significantly higher (P < 0.05). The proportion of individuals with the heterozygous MTHFR CT genotype and homozygous mutant TT genotype among CHD patients was significantly higher than that in the control group (P < 0.05). In the acute coronary syndrome (ACS) subgroup, the proportion of those with the CT and TT genotypes was significantly higher than that of the stable CHD subgroup (P < 0.05). In summary, serum HCY levels were elevated in CHD patients, and the frequency of the CT and TT genotypes were also significantly increased, especially among the ACS subgroup. Taken together, this suggests that serum HCY levels and MTHFR C677T genotypes are correlated with CHD.

Association between the APOB XbaI and EcoRI polymorphisms and lipids in Chinese: a meta-analysis.

BackgroundNo previous meta-analysis was to report the association between the apolipoprotein B (APOB) XbaI and EcoRI polymorphisms and serum lipids in Chinese. We performed the study to investigate their potentially association.Methods and Results Studies in English and Chinese were found via a systematic search of Pubmed, Embase, CNKI and Wanfang databases. The dominant genetic model and random-effects model were used to pool data from individual studies. As a result, a total of 30 articles with 5611 subjects for XbaI and 2653 subjects for EcoRI were included in the current study. For the XbaI polymorphism, overall, subjects carrying X+ allele were significantly associated with higher TC,TG and LDL compared with X-X- genotype (Pvalue =0.0006, OR (95 %) = -0.55 (-0.86,-0.23); Pvalue = 0.0004, OR (95 %) = -0.30 (-0.47,-0.14); (Pvalue = 0.05, OR (95 %) = -0.23(-0.46,-0.00), respectively). Similar results were observed in the subgroups of Han, healthy individuals (HT), coronary heart disease (CHD), cerebral infarction (CI), and cholelithiasis. For HDL, positive association between X+ allele with Lower lipid value was found in CHD and CI subgroups. For EcoRI polymorphism, overall, the E- allele carriers were found to be obviously linked with elevated LDL and lower HDL compared with E + E+ genotype (Pvalue = 0.02,OR (95 %) = -0.27 (-0.49,-0.05); Pvalue = 0.01, OR (95 %) = 0.17 (0.03, 0.30), respectively). TC was significantly high in subjects carrying E- allele in the subgroup of hyperlipidemia. No evidence of publication bias was observed.ConclusionsThe two genetic variants of APOB may be associated with serum lipids in Chinese.

Study on the correlation between the concentration of plasma lipoprotein-associated phospholipase A2 and coronary heart disease

ObjectiveThis study explores the correlation between plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) and coronary heart disease (CHD) by comparing the level of plasma Lp-PLA2 in the plasma of patients with different types of CHD. MethodsBlood samples were collected from 56 patients diagnosed with CHD by the Department of Cardiology of the First People's Hospital of Foshan and 34 healthy subjects from February 2013 to January 2014. We measured the concentration of plasma Lp-PLA2 and determined the levels of total cholesterol (Tch), triglyceride (TG), apolipoprotein A1 (Apo-A1), apolipoprotein B (Apo-B), high density lipoprotein-cholesterol (HDL-c), low density lipoprotein-cholesterol (LDL-c), lipoprotein a (Lp(a)), glucose (Glu), and high-sensitivity C-reactive protein (hs-CRP). The concentration of plasma Lp-PLA2 in the healthy control group and each subgroup of CHD patients were compared and analyzed for correlations of plasma Lp-PLA2 between the patients in different CHD subgroups and several laboratory indicators. ResultsThe concentration of plasma Lp-PLA2 in each subgroup of CHD was significantly higher than in the control group (P < 0.05). The concentration of Lp-PLA2 in the unstable angina pectoris (UAP) group and acute myocardial infarction (AMI) group were significantly higher than in the stable angina pectoris (SAP) group (P < 0.05), and the concentration of plasma Lp-PLA2 in the AMI group was significantly higher than in the UAP group (P < 0.05). The concentration of plasma Lp-PLA2 in the CHD group merely showed a positive correlation (r = 0.493, P < 0.05) with the hs-CRP group, but the levels of Tch, TG, Apo-A1, Apo-B, HDL-c, LDL-c, Lp(a) and Glu did not. ConclusionsThe concentration of plasma Lp-PLA2 in patients with CHD was higher than that in the control group. The concentration of plasma Lp-PLA2 in the subgroups of CHD patients varied greatly from each other. The inflammatory response of atherosclerosis might be resulted from the synergy of plasma Lp-PLA2 and hs-CRP.

Levels of acylation stimulating protein and the complement component 3 precursor are associated with the occurrence and development of coronary heart disease.

The aim of the present study was to investigate whether acylation stimulating protein (ASP) and complement component 3 (C3) are associated with the occurrence and development of coronary heart disease (CHD). The participants of the study were divided into three groups, including the healthy control (n=42), metabolic syndrome (MS, n=56) and CHD (n=62) groups. An enzyme-linked immunosorbent assay was used to measure the ASP concentrations, while an immunoturbidimetric assay was employed to determine the C3 concentrations. In addition, coronary angiography was performed to determine the severity of coronary artery disease in the CHD group. The CHD group was divided into three subgroups, according to the final Gensini score of coronary artery stenosis for each patient (mild, ≤20 points; moderate, 21–40 points; severe, >40 points). Western blotting and quantitative reverse transcription-polymerase chain reaction (RT-PCR) were performed to analyze the protein and mRNA expression levels of C3 in the CHD subgroups and the healthy control group. The concentrations of ASP and C3 in the CHD group were found to be significantly higher compared with the control and MS groups. In addition, the levels of ASP and C3 in the mild and moderate CHD subgroups were significantly higher compared with the healthy controls or mild CHD patients. Furthermore, the protein expression levels of C3 in the moderate and severe CHD patients were found to be significantly higher compared with the healthy individuals and the mild CHD patients. The quantitative RT-PCR results revealed that the mRNA expression levels of C3 in the moderate and severe CHD patients were significantly higher compared with the healthy control group and the mild CHD patients. Furthermore, the mean levels of C3 transcripts in the severe CHD patients were found to be higher compared with the moderate CHD subgroup (P<0.05). Therefore, ASP and C3 were found to be associated with the occurrence and development of CHD; thus, may be used as novel indexes for CHD.

Clinical and prognostic value of elevated CA125 levels in patients with coronary heart disease.

The aims of this study were to explore the association between serum level of carbohydrate antigen 125 (CA125) and coronary heart disease (CHD), and to evaluate its role in the short-term prognosis of CHD patients. A total of 150 patients were enrolled in the study and divided into an acute coronary syndrome (ACS) group (n=40), a stable CHD group (n=64), and a control group (n=46) according to clinical presentation and angiographic results. Fasting blood samples were collected at two time points, on admission and on the fifth day after hospitalization for the measurement of serum CA125 and other biomarkers. Serum CA125 levels in both CHD subgroups were significantly higher than the control group on admission (p < 0.01 for the ACS group and p < 0.05 for the stable CHD group). The differences remained significant on the fifth day after hospitalization (both p < 0.05), and the CA125 levels in the ACS group were higher than in the stable CHD group on the fifth day (p < 0.05). The CA125 levels were positively correlated with pro-brain natriuretic peptide (pro-BNP), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), and negatively correlated with left ventricular ejection fraction (LVEF). Compared with the other patients, serum CA125 levels on admission were significantly elevated in the patients who suffered from heart failure events during a 3-month follow-up (p = 0.037). The CA125 level on the fifth day of hospitalization in these patients stayed at a significantly higher level than the other patients (p = 0.002). The serum CA125 levels were significantly related with cardiac function in CHD patients. Serum CA125 levels that remain elevated after CHD onset could be helpful for predicting the short-term risk of heart failure events in CHD patients.

Plasma levels and potential roles of catestatin in patients with coronary heart disease

Objectives. Catestatin (CST) is a new endogenous neuropeptide with a potent catecholamine release-inhibitory activity. This study was to investigate plasma CST levels in patients with coronary heart disease (CHD) and to determine the clinical significance of plasma CST in cardiovascular events. Methods. A total of 120 CHD patients and 30 age/sex-matched healthy subjects were enrolled. Plasma CST level was measured using enzyme-linked immunosorbent assay (ELISA) and norepinephrine (NE) level was measured using high-performance liquid chromatography (HPLC). Clinical and laboratory data during hospitalization were collected, and a follow-up of 1045 days was carried out. Results. Compared with controls, CHD patients had significantly higher plasma CST and NE levels on admission. ST segment elevation myocardial infarction (STEMI) patients had higher CST levels than angina pectoris patients had, but CST/NE ratios were unchanged among controls and different CHD subgroups. Plasma NE was the only independent factor associated with CST. As a dichotomous variable divided by the median value, plasma CST on admission was not associated with adverse cardiovascular events. Conclusions. Plasma CST level was positively correlated with that of NE and was elevated in parallel with that of NE in the different myocardial ischemia states. Plasma CST on admission was neither associated with adverse cardiac events nor was there any significant relationship between plasma CST and onset of new cardiovascular events. The pathophysiological role of CST in CHD needs further studies.

Signifikante Reduktion vaskulärer Risikofaktoren im Rahmen des populationsbasierten Interventionsprojektes INVADE - Eine 2-Jahres-Verlaufsuntersuchung

The INVADE project (Intervention project of cerebrovascular diseases and dementia in the district of Ebersberg) analyzes the effect of risk factor evaluation and modification on the incidence of stroke and dementia. Here we evaluated the changes of risk factors after two years in the INVADE population, particularly in participants with diabetes mellitus and coronary heart disease (CHD). Baseline data of 3909 participants were available. In addition to common risk factors and new risk indicators, various social demographic data and life style parameters were analyzed. A guideline-based therapy was proposed for each participant based on an individual risk profile. The differences between baseline and the 2-year follow-up data were analyzed using the paired t-test and the McNemar test. Complete follow-up data were available in 3185 participants (1288 men; mean age 69.5 years). For the overall project population the reduction of traditional risk factors was effective, particularly in subjects with hypertension or diabetes. The prevalence of hypertension was 76 %, including 19 % newly diagnosed subjects. In this subgroup, the systolic blood pressure could be reduced by 4.7 mmHg. 20.3 % of the participants showed a diabetes mellitus, blood glucose level decreased about 8 %. Additionally an improvement in hypertension therapy and lipid levels was seen. Comparable results were achieved in the CHD subgroup. Additionally, in the overall study population treatment with antihypertensives and statins increased significantly. Even after two years, the INVADE project was able to reduce vascular risk factors particularly in high risk patients with diabetes and CHD. Based on these findings, the primary aim of the project, the reduction of stroke and dementia incidence, can be achieved.

Factor V Leiden and Prothrombin G20210A Mutations and the Risk of Atherothrombotic Events in Systemic Lupus Erythematosus

Because genetic predisposition to atherothrombosis in systemic lupus erythematosus (SLE) remains to be determined, the most common genetic prothrombotic factors, prothrombin G20210A and factor V Leiden mutations, were studied. Seventy-four SLE patients with vascular ischemia (SLE cases) were studied and stratified into myocardial infarction and/or cerebrovascular accident subgroup (MI/CVA), and coronary heart disease subgroup without overt arterial thrombotic events (CHD). Seventy-one SLE patients without atherothrombosis were investigated as SLE controls. Factor V Leiden was detected in six cases (five in MI/CVA, one in CHD group) and three controls (OR 2.00, 95%CI 0.48-8.32). Two cases (both CHD patients) had prothrombin G20210A mutation vs. three controls (OR 0.63, 95%CI 0.1-3.88). Anticardiolipin antibodies (aCL) were increased in cases vs. controls (39/74 vs. 27/71); however, this was not statistically significant (OR 1.82, 95%CI 0.94-3.52). Neither univariate nor multivariate analysis indicated that investigated mutations are risk factors for atherothrombosis in SLE cases, MI/CVA, or CHD subgroups. Overall, disease activity was the strongest risk factor for atherothrombosis (p=0.0014) in SLE cases. Combination of disease activity+gender was the best predictor of atherothrombotic process (p=0.00045) in this cohort. In MI/CVA subgroup, disease activity was the only predictor (p=0.0058). In CHD patients, the best predictive value was conferred by combination of hypertension+gender+disease activity (p=0.00077). No other investigated risk factor (including aCL) conferred an increased risk individually or potentiated the other risk factors. The results deny the role of investigated mutations in atherothrombosis in SLE, but they underscore the importance of disease activity (i.e., ongoing inflammation) in pathogenesis of atherosclerosis and arterial thrombosis.

A comparison of the efficacy and tolerability of titrate-to-goal regimens of simvastatin and fluvastatin: a randomized, double-blind study in adult patients at moderate to high risk for cardiovascular disease

Background: Use of cholesterol-lowering regimens has been shown to reduce the risk of coronary heart disease (CHD), both in primary and secondary prevention. However, there have been few studies of the relative benefits and risks of the various cholesterol-lowering agents in patients groups with specific risk factors for CHD. Objective: The primary goal of this study was to compare the proportions of adult patients with primary hypercholesterolemia and a moderate to high risk for CHD achieving National Cholesterol Education Program low-density lipoprotein cholesterol (LDL-C) goals with titrate-to-goal regimens of simvastatin and fluvastatin. Methods: This was a multicenter, prospective, randomized, double-blind, parallel-group study enrolling adult patients with type IIa or IIb primary hypercholesterolemia, LDL-C levels <6.0 mmol/L (<232.0 mg/dL), and triglyceride levels <4.5 mmol/L (<398.6 mg/dL), and either CHD or other atherosclerotic disease (the CHD, or high-risk, group), or multiple risk factors for CHD (the MRF, or moderate-risk, group). After a 6-week washout period, patients were randomized to 18 weeks of treatment at an initial dosage of simvastatin 10 mg once daily or fluvastatin 20 mg once daily. At 6- and 12-week titration visits, the dosage in patients who had not acheived the LDL-C goal could be increased to simvastatin 20 mg once daily and then 40 mg once daily, or to fluvastatin 40 mg once daily and then 40 mg twice daily. Lipid profiles were obtained at each titration visit and at the end of treatment. In addition to the comparison between treatments, secondary comparisons were made between the CHD and MRF subgroups within each treatment group. Statistical significance was assessed using analysis of variance. Results: A total of 478 patients were enrolled, 237 in the simvastatin group and 241 in the fluvastatin group. There were no significant between-group differences in patients' characteristics at baseline. At the end of the study, 60.8% (135/222) of patients in the simvastatin group had reached target LDL-C goals, compared with 35.1% (76/216) in the fluvastatin group ( P < 0.001). In the simvastatin CHD and MRF subgroups, 49% and 73%, respectively, reached the LDL-C target, compared with 19% and 50% in the corresponding fluvastatin subgroups ( P < 0.001). The proportion of patients requiring titration was higher in the fluvastatin group than in the simvastatin group (87.1% and 64.1%, respectively; P = 0.001). The incidence of adverse events was similar between groups. Conclusion: In this study, more patients with primary hypercholesterolemia and CHD or multiple risk factors for CHD reached LDL-C goals with simvastatin treatment and required less titration than those who received fluvastatin treatment.

Ten-year incidence of coronary heart disease in the Honolulu Heart Program. Relationship to biologic and lifestyle characteristics.

In 10 years of follow-up of 7705 Japanese men living in Hawaii, aged 45-68 years and judged free of coronary heart disease (CHD) at the initial examination during 1965-1968, a total of 511 new CHD cases were identified: fatal CHD, 139; nonfatal myocardial infarction (MI), 216; acute coronary insufficiency, 55; and uncomplicated angina pectoris (AP), 101. The incidence rate of fatal CHD and nonfatal MI for this cohort is less than half the rate for US whites and approximately twice the rate for Japanese men in Japan. The relationships of 14 biologic and lifestyle characteristics measured at baseline examination to the incidence of total CHD and specific manifestations of CHD were examined in bivariate and multivariate analyses. In bivariate analyses, all variables except heart rate were significantly related to the risk of total CHD after adjustment for age. However, when an independent contribution of each variable to CHD risk was evaluated in multiple logistic analyses in which all other variables were taken into account, the numbers of risk factors retaining significant associations varied by clinical subgroup of CHD. Among the characteristics studied, systolic blood pressure was the most powerful and consistent risk factor for all manifestations except AP. Cigarette smoking showed a similar pattern. Serum cholesterol was significantly associated with fatal CHD and nonfatal MI, but its contribution to CHD risk was less potent than systolic blood pressure or cigarette smoking. Glucose intolerance was strongly associated with fatal CHD, but with no other manifestations of CHD. Alcohol consumption demonstrated a strong protective effect upon fatal CHD and nonfatal MI. Uncomplicated AP was distinguished from other CHD manifestations by the lack of association with most of the known major risk factors for CHD, including blood pressure, serum cholesterol, and cigarette smoking.

Social networks and coronary heart disease among Japanese men in Hawaii.

A group of 4653 men of Japanese ancestry living in Hawaii were studied for the association of measures of social networks with both the prevalence and incidence rates of coronary heart disease (Honolulu Heart Program, 1971-1979). Prevalence rates for myocardial infarction, angina, and total coronary heart disease were inversely associated with the social network scales in bivariate analyses with age, and in multivariate analyses including 12 other risk factors. With the incidence data, the associations were less evident. Bivariate analysis with age revealed inverse associations for nonfatal myocardial infarction and total coronary heart disease with only one of the social network scales. With multivariate analyses, there was no significant association of any subgroup of coronary heart disease with any scale, although there was a borderline association (p = 0.08) of nonfatal myocardial infarction with one scale. No individual question was significantly associated with either prevalence or incidence rates for coronary heart disease. There was also little evidence of reduced risk of incident coronary heart disease associated with the social network scale for men in high risk categories of serum cholesterol, blood pressure, and cigarette smoking.