Evidence Of Coronary Artery Disease Research Articles

P1758The novel small leucin-rich repeat protein podocan is an independent predictor of major adverse cardiac events in patients with angiographically-defined coronary artery disease

Abstract Background Smooth muscle cell (SMC) function determines the clinical course of vascular disease via fibrous cap stability. Podocan is an inhibitor of SMC function and is circulating in peripheral blood rendering it a candidate biomarker to predict MACE in patients with Coronary Artery Disease (CAD). Purpose We designed a prospective cohort study assessing the predictive value of Podocan for cardiovascular outcome (MI, CVA or death) in patients with CAD. Methods 308 patients with angiographic evidence of CAD were enrolled. At index cardiac catheterization Syntax Score was calculated. For patient baseline characteristics see Table. Podocan and CRP-1 were measured using a human Podocan and CRP-1 ELISA. The Kaplan-Meier method was used to construct survival curves, which were compared using the log-rank test. Cox proportional hazard modeling was used for all univariate/multivariate analyses. Statistical analysis was performed using STATA. Results Podocan was detected in 212 patients (69%) with a detection threshold of 0.01 ng/ml. The median Podocan level observed was 1.4±8.2 ng/ml. 96 patients did not have a detectable Podocan level. Mean CRP-1 was 0.117±0.15 mg/ml. Mean Syntax Score was 12±9. Podocan did not correlate with CRP-1. There was also no association between Podocan and Syntax Score, age, BMI, smoking, LDL, and HDL, HgbA1c, LVEF and GFR. At the univariate level, presence of Podocan was associated with an increased rate of MACE (17% Podocan present vs. 7% Podocan absent, p=0.02). Kaplan-Meier survival analysis showed higher event free survival in patients with no detectable Podocan vs. detectable Podocan level (Figure). In a limited multivariate Cox proportional Hazard analysis, Podocan remained an independent predictor of MACE (HR: 2.5; P=0.042) in addition to diabetes, and LV ejection fraction. Baseline Characteristics Total (N=308) Chronic ischemic heart disease (N=273) Acute coronary syndrome (N=35) Age (Year) 66.5±9.5 67±9 61±11 Female (Sex) 106 (33%) 90 (31%) 16 (46%) Hypertension 282 (89%) 244 (89%) 26 (74%) Diabetes 142 (44%) 124 (45%) 11 (31%) Hyperlipidemia 269 (87%) 243 (89%) 26 (74%) CRP (mg/dL) 0.11±0.14 0.10±0.13 0.18±0.19 LVEF (%) 49±10 49±10 48±9.5 CRP, C-reactive protein; LVEF, Left ventricular ejection fraction. Kaplan Meier Survival Curves by Podocan Conclusion Podocan is a novel biomarker independently predicting MACE in secondary prevention of CAD warranting to be further studied in a Multicenter Clinical Trial.

Cohort profile: role of lipoproteins in cardiovascular disease—the LipidCardio study

PurposeThe LipidCardio Study was established for in-depth analyses of cardiovascular risk factors, providing well-defined cardiovascular and metabolic phenotypes. In particular, the role of lipoproteins in the pathobiological process and treatment...

Mirror image: Recurrent Takotsubo cardiomyopathy with variable regional involvement

Takotsubo cardiomyopathy (TCM), a stress-induced cardiomyopathy, is a well-recognised cause of left ventricular dysfunction. It commonly presents similar to acute coronary syndrome with chest, dyspnoea, and electrocardiographic changes consistent with ischaemia and elevations of cardiac markers. Takotsubo cardiomyopathy often presents with acute myocardial stunning without evidence of coronary artery disease or atherosclerotic disease that is out of proportion to the demonstrated disease. Takotsubo cardiomyopathy has characteristic left ventriculography and radiographic findings – including left ventricular hypokinesis, adjacent areas of hyperkinesis, and variable regional involvement (i.e. apical, mid-ventricular, or basal ballooning patterns). Recurrent disease can occur and is often found to have similar ventricular wall dysfunction patterns. However, we present an uncommon case of possible recurrent Takotsubo cardiomyopathy that was found to have variable regional involvement.

SUN-LB094 Massive Pericardial Effusion as an Initial Presentation of Hashimoto's Thyroiditis

Background: Pericardial effusion is a known complication of hypothyroidism and usually correlates with the severity and duration of the disease. However, massive pericardial effusion as the primary presenting manifestation of Hashimoto’s thyroiditis is extremely rare. Case: We present a 44-year-old female with a past history of diabetes mellitus who presented to the hospital with complaints of chest pain described as intermittent, sharp, non-radiating, 10/10 intensity ongoing for six days. On physical examination, she appeared lethargic with slow speech, cool dry puffy skin and muffled heart sounds on auscultation. EKG showed sinus rhythm and no significant ST-T wave changes and troponins trended negative. Initial lab-work was significant for a very high TSH of 86.4 (0.35-5.5 uIU/ml) and a low free T4 of 0.54 (0.61-1.12 ng/dl) with a normal free T3 and total T4. CBC, ESR and CRP were within normal limits. The patient did not endorse noticing any of the classical symptoms of hypothyroidism prior to this admission. Chest X-ray and Chest CT were concerning for a large pericardial effusion. Bedside echocardiogram revealed an ejection fraction of 30% and a massive pericardial effusion. No pericardial calcification or thickening was noted. Due to concern for tamponade physiology on echocardiogram, emergent pericardiocentesis was performed and 720 ml of straw-colored fluid was removed. Cardiac catheterization did not show any evidence of coronary artery disease and repeat echo showed trivial pericardial effusion with improvement in ejection fraction to 40-45%. The fluid analysis did not show evidence of mesothelial cells and cultures were negative. Serological markers for viral diseases (Coxsackie virus, EBV, Adenovirus), as well as immunological markers for rheumatoid arthritis (rheumatoid factor) and lupus (double-stranded DNA) were negative. Serum thyroid peroxidase (TPO) antibody was strongly positive: 877 IU/ml (<9IU/ml). Ruling out other common etiologies, pericardial effusion was attributed to severe hypothyroidism. The patient was treated with IV levothyroxine and IV hydrocortisone and her mental status improved over the course of her stay. Conclusion: Hypothyroidism should certainly be considered as a differential diagnosis in patients presenting with unexplained pericardial effusion. The mainstay of treatment for cases with mild to moderate effusions is thyroxine supplementation. Pericardiocentesis is only indicated in patients with massive effusion who are at risk of developing tamponade. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Abstract 291: Abstract Title: Assessment of The High risk and unmEt Need in Patients with CAD and Type 2 Diabetes (ATHENA): US Healthcare Resource Use and Cost in a Commercially-Insured Population

Background: THEMIS is a large randomized controlled trial (NCT01991795) comparing the effect of ticagrelor vs placebo (both with background acetylsalicylic acid) for the prevention of major cardiovascular (CV) events in patients with coronary artery disease (CAD) and type 2 diabetes (T2D) with no prior myocardial infarction (MI) or stroke. The current study evaluated healthcare resource utilization (HCRU) and cost in patients similar to those eligible for enrollment in THEMIS (THEMIS-like) and in a broader population (T2D-CAD). Methods: This retrospective, observational study included patients, &gt; 50 years old, with pharmacologically treated T2D and no prior MI or stroke collected from the Optum Research Database including Medicare Advantage Part D coverage between January 1, 2007 and December 31, 2017. Both cohorts were followed until disenrollment or end of the study period. The THEMIS-like cohort included patients with evidence of CAD including percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), or an angina diagnosis. In addition to CAD as above, the broader T2D-CAD cohort included use of prescription antiplatelet therapy. Selected HCRU (heart failure hospitalizations [hHF], nontraumatic bleeding hospitalizations or ED visits, medication use), annualized costs (all-cause and CV-related total, medical, and pharmacy), and secondary prevention medication (antiplatelets, statins, ACE inhibitors, ARBs, and beta-blockers) persistence were analyzed. Results: The T2D-CAD (N=203,916) and THEMIS-like (N=127,125) cohorts accounted for 3.5% and 2.2% of the total T2D population, respectively. Mean + SD ages were 68 + 9 vs 67 + 9 years and 57% vs 56% were men, respectively. Mean annual all-cause total costs for the THEMIS-like and T2D-CAD cohorts were $43,332 and $36,254, and pharmacy costs accounted for 15.3% and 19.2% of total cost, respectively. CV-related costs accounted for 38.2% of all-cause costs in the THEMIS-like cohort, and 29.1% in T2D-CAD cohort, respectively. Mean all-cause pharmacy and CV-related pharmacy costs were $6,668 and $497 for the THEMIS-like cohort and $6,985 and $739 for the T2D-CAD cohort, respectively. Medication persistence was between 55% and 61% for all medication classes for both cohorts. At least one hHF was experienced by 13.3% of patients in the THEMIS-like cohort and by 10.3% of patients in the T2D-CAD cohort. Bleeding event rates were 0.35 and 0.38 per 100 person-years in the THEMIS-like and T2D-CAD cohorts, respectively. Conclusion: Patients in a US commercially-insured population similar to those enrolled in THEMIS incurred high cost of care, which was largely attributable to CV-related causes. Nearly 1 in 7 THEMIS-like patients experienced hHF, and bleeding incidence was low. These findings identify a unique patient population that may benefit from better preventive measures.

Over Sized Adult Hearts Can Be Used for Paediatric Transplant Recepients with Good Medium Term Outcomes

Purpose Finding ideal donor hearts perfectly matched for age and weight is a challenge, especially for very sick children. This is a retrospective study evaluating the use of oversized adult hearts for children. Methods Over a 6 year period, 73 children, aged 1 to 17,(median 12) had a heart transplant in our unit. 10 of these patients had a preoperative cardiac arrest, resuscitated with ECMO (ECPR) . ECMO was converted to centrimag in 4 patients. 58 patients received hearts from donors less than 40 years of age,median age 22 (Group A) 15 patients received hearts from donors over 40 years of age, median age 52, recepient age range 8 to 18. (Group B) 35 patients had donor to recipient weight ratio (D:R) less than 2, and 38 had D:R more than 2(maximum D:R of 5) Results There were 7 early deaths and 5 late deaths in the first year after surgery in the entire series.(84 % one year survival) There were no further late deaths in a followup of upto 5 years. The one year survival in both group A and B was similar. 83 vs 80 %.. However 5 patients in group B had evidence of donor coronary artery disease in coronary angiogram done within a year of transplant and 3 have undergone stenting . out of the 39 patients with D:R more than 2,there were 6 early and 2 late deaths(one year survival of 79.5 %). Of the 43 patients with D:R less than 2,there were 2 early and 4 late deaths.(one year survival of 86 %). There were 3 patients who had a delayed chest closure for upto 48 hours after surgery due to size mismatch with no adverse outcomes. 5 patients had a “big heart syndrome with cerebral hyper perfusion and convulsions with hypertension early on in the series. there were 2 early and 2 deaths in this cohort. All these patients were very sick,intermacs 2 and received hearts with excellent ventricular function,with a D: R ratio ranging from 1.47 TO 3.8, median 2.7. with aggressive control of blood pressure and excessive cardiac output, this syndrome is no longer seen. Over sized hearts even with significant ventricular dysfunction seem to function well in smaller recepients. 7 out of 10 patients of ECPR are alive at one year follow up after transplant Conclusion Hearts from oversized adults including those with significant dysfunction can be used safely in children with very good medium term results of 84 % actuarial survival at 5 years. Children receiving hearts from donors over the age of 40,need careful followup for evidence of coronary artery disease.

Atherosclerotic plaque burden evaluated from neck to groin: effect of gender and cardiovascular risk factors.

We explored the impact of gender and cardiovascular risk factors (RF) in the distribution and burden of coronary and extra-coronary atherosclerotic plaques among patients undergoing ECG-gated thoracoabdominal computed tomography angiography (CTA) from the supra-aortic trunks to the femoral arteries. We included a consecutive cohort of patients who underwent ECG-gated thoracoabdominal aortic CTA from the supra-aortic trunks to the pubic symphysis. We evaluated the number of coronary segments with plaques [segment-involvement score (SIS)]; and the extra-coronary atherosclerotic plaque burden, comprising the aorta and supra-aortic trunks, iliofemoral arteries, and visceral arteries (extra-coronary SS). A total of 3400 vascular segments were evaluated in 100 patients (mean age 67.0 ± 12.6 years, 66% male). Seventy-two (72%) patients had evidence of atherosclerosis in the coronary tree (coronary SIS ≥ 1), of which 32% was extensive (coronary SIS > 5). Males had a significantly higher prevalence of coronary SIS ≥ 1 [53 (80%), vs. 19 (56%), p = 0.018], and coronary SIS > 5 [24 (36%) vs. 8 (24%), p = 0.035] than females. Extra-coronary SS was similar between genders (males 10.2 ± 5.8 vs. females 9.7 ± 5.4, p = 0.70), irrespective of the location along the different vascular beds. The number of coronary RF was significantly related to the coronary SIS (p = 0.038), and hypertension and diabetes were consistently related to coronary and extra-coronary plaque burden. In the present study involving analysis of multiple vascular beds from the supra-aortic trunks to the femoral arteries, we identified significant sex-related differences in coronary plaque burden, whereas extra-coronary plaque burden was similar between genders irrespective of the vascular bed assessed.

The role of diagonal earlobe as evidence of coronary artery disease in a Salahiddin province- Iraqi population

There are several dermatological indicators associated with Coronary Artery Disease CAD, which contribute the early diagnosis the seriousness of coronary artery disease. It is these indicators Diagonal Earlobe Crease DELC, which showed some studies a relationship between them and coronary artery disease, but Iraqi population data are limited. Therefore included the study (100) Iraqi samples has been taken from patients with CAD and 50 without CAD. The results showed values cardiac risk factors, which included the age, Body Mass Index BMI, Hypertension, Diabetes, Hypercholesterolemia, Hypertriglycerimia. HDL, as it was increased significantly the patients with CAD compared to controls. Results showed prevalence of ELC and PAC was 64%, 73% respectively in those with CAD while the prevalence of ELC and PAC was 11%, 16 % respectively in those without CAD. Cases with DELC were increased prevalence significantly of both any, associated with coronary artery than those without DELC. The odds ratio for diagonal earlobe crease was 6.30, and for Preauricular crease was 5.74.

A study on serum bilirubin levels in coronary artery disease patients

Background: The protective effect of bilirubin relates to the antioxidant property of bilirubin, which prevents lipid oxidation, especially low-density lipoprotein (LDL), and inhibits free radical-induced dam-ages. Lower serum bilirubin level has been proven to be associated with endothelium and microvascular malfunction. The aim of the present study was to assess the association between serum bilirubin levels and coronary artery disease in comparison with controls without coronary artery disease.Methods: A cross-sectional study was conducted for a period of a one year in our medical college hospital. Patients with evidence of coronary artery disease for not more than 10 years of duration confirmed by ECG, ECHO and other previous case records were taken as cases. Controls were selected matched with age, gender and other co-morbid conditions. Total of 200 subjects were included in the study with 100 cases and 100 controls. General and systemic examination was conducted on all study subjects including laboratory investigations like complete blood count, renal function test, lipid profile, viral markers such as HBsAG, HCVIgM and liver function test which includes total bilirubin, direct and indirect, liver enzymes, albumin and globulin levels. A 12 lead ECG and a transthoracic echocardiogram was performed for all patients.Results: The various liver function test parameters were compared between the cases and controls it was found that the serum bilirubin levels which includes total bilirubin, direct bilirubin and indirect bilirubin was found to be lower among the case group compared to the control group and this difference was found to be statistically significant (p &lt;0.05). A perfect linear correlation between the ejection fraction and serum bilirubin levels, as the ejection fraction decreases the serum bilirubin levels was also decreasing.Conclusions: This study showed a significant association between the reduced serum bilirubin levels and the occurrence of CAD; therefore, bilirubin level can serve as a predictive factor, together with other influential factors for identifying a person at risk of developing coronary artery disease.

Reversible Cerebral Vasoconstriction Syndrome: A Novel Mechanism for Neurological Complications in Schimke Immuno-osseous Dysplasia

BackgroundSchimke immuno-osseous dysplasia is a rare autosomal recessive disease resulting from biallelic SMARCAL1 mutations. It presents in early childhood and is characterized by short stature, nephropathy, and immunodeficiency. Approximately 50% of those affected have neurological complications including migraines, transient ischemic attacks, and strokes. MethodsWe present a six-year-old boy with Schimke immuno-osseous dysplasia without evidence of atherosclerosis with recurrent episodes of severe headache, fluctuating hemiparesis, and aphasia. ResultsMagnetic resonance imaging and angiography were normal during the initial episode; multiple areas of reversible restricted diffusion with decreased perfusion and arterial stenosis were seen with subsequent attacks. ConclusionsThis constellation of symptoms and imaging findings is suggestive of reversible cerebral vasoconstriction syndrome, which we propose as a mechanism for the transient ischemic attacks and infarcts seen in some patients with Schimke immuno-osseous dysplasia, as opposed to accelerated atherosclerosis alone. This new insight may provide a basis for novel preventative therapy in this rare disorder.

Management of Patients With Coronary Artery Malperfusion Secondary to Type A Aortic Dissection

This study reviewed our experience with coronary artery (CA) malperfusion secondary to type A aortic dissection. Between 2002 and 2017, 76 patients presented with CA malperfusion, with a dissection flap limited to the aorta in the region of the coronary ostium (type A lesion) in 26 (34%), with a dissection flap involving the CA itself (type B lesion) in 32 (42%), or with complete avulsion of the CA (type C lesion) in 18 (24%). Ostial repair was successfully performed in 23 type A patients (88%), in 20 type B patients (63%), and in no type C patient (0%). CA bypass grafting was performed when antegrade cardioplegia could not be applied in all 18 type C patients (100%) and in 5 type B patients (16%) because of a primary entry at the coronary ostium and in 7 patients (type A: 3 patients [12%], type B: 4 patients [13%]) with evidence of CA disease (p < 0.001). Perioperative mortality in patients with CA malperfusion was high (18 patients [24%]), but there was no difference in short-term (p= 0.153) or long-term survival (log-rank p= 0.542). Also, a landmark analysis showed equal survival of discharged patients with and without CA malperfusion (log-rank p= 0.645). We recommend CA bypass grafting in patients with type C lesions or in patients with underlying CA disease for optimal delivery of cardioplegia and ostial pledgetted suture repair in patients with type A lesions or type B lesions when the administration of antegrade cardioplegia is successful.

EMBOLIC MYOCARDIAL INFARCTION. EXPERIENCE IN DIAGNOSIS AND MANAGEMENT

Acute myocardial infarction (AMI) is one of the main causes of morbidity and mortality, both in the Russian Federation and around the world. Approximately, in up to 10% of patients with clinical diagnostic features of AMI, early angiography does not reveal an occluded vessel or possibly any evidence of coronary artery disease. These patients constitute an intriguing subgroup referred to as “Myocardial Infarction with Non-Obstructive Coronary Arteries” (MINOCA). MINOCA is a collective concept that unites many different pathologies, which determines the essential heterogeneity of the etiological factors. Coronary artery embolism is recognized as an important non-atherosclerotic cause of AMI. In turn, the most common underlying disease in those with coronary embolism is the atrial fibrillation. The advantages of reperfusion strategy and cardioprotective therapy in the treatment of obstructive arteriosclerosis are well studied, widely presented in the literature and supported by a strong evidence base, while the issues of diagnosis and treatment of patients with MINOCA are currently widely discussed We present two clinical cases of embolic myocardial infarction in patients with atrial fibrillation, diagnosed in our clinic in 2017.

Should Moderate or Less Functional Tricuspid Regurgitation be Repaired During Surgery for Degenerative Mitral Valve Disease?

ABSTRACTBackground: It is unclear whether moderate or less functional tricuspid regurgitation (TR) should be repaired during surgery for degenerative mitral valve (MV) disease. We studied the natural course of unaddressed moderate or less TR and identified risk factors for TR progression after surgery for degenerative MV disease.Methods: From 2001 to 2011, 2,982 patients with isolated degenerative MV disease and no evidence of coronary artery disease underwent MV surgery. To generate an enriched sample of patients with TR, by random selection 200 patients without TR, 197 with mild TR, and 177 with moderate TR were studied. A total of 1,150 echocardiograms were available for longitudinal analysis of TR progression after surgery in 550 of these 574 patients.Results: Overall prevalence of severe TR was 1.1%, 2.2%, 3.6%, and 4.4% by 1, 3, 5, and 7 years, respectively. Patients with moderate preoperative TR were more likely to progress to severe TR by 7 years (8.6%) than those with mild TR (3.2%) or no TR (1.3%) preoperatively (p < 0.001). Other risk factors for progression to severe TR included larger diastolic tricuspid valve diameter (p = 0.03), shorter right ventricular base-to-apex length (p = 0.0004), smaller tethering area (p = 0.01), older age, and preoperative heart failure. During follow-up, no patient underwent TV intervention.Conclusion: Routine repair of moderate or less functional TR during surgery for degenerative MV disease does not appear to be warranted, because progression to severe TR is uncommon. Instead, we suggest a tailored approach, reserving TR repair during surgery for degenerative MV disease for patients with known risk factors.

Novel risk genes identified in a genome-wide association study for coronary artery disease in patients with type 1 diabetes

BackgroundPatients with type 1 diabetes are more at risk of coronary artery disease than the general population. Although evidence points to a genetic risk there have been no study investigating genetic risk factors of coronary artery disease specific to individuals with type 1 diabetes. To identify low frequency and common genetic variations associated with coronary artery disease in populations of individuals with type 1 diabetes.MethodsA two-stage genome wide association study was conducted. The discovery phase involved the meta-analysis of three genome-wide association cohorts totaling 434 patients with type 1 diabetes and coronary artery disease (cases) and 3123 T1D individuals with no evidence of coronary artery disease (controls). Replication of the top association signals (p < 10−5) was performed in five additional independent cohorts totaling 585 cases and 2612 controls.ResultsOne locus (rs115829748, located upstream of the MAP1B gene) reached the statistical threshold of 5 × 10−8 for genome-wide significance but did not replicate. Nevertheless, three single nucleotide polymorphisms provided suggestive evidence for association with coronary artery disease in the combined studies: CDK18 rs138760780 (OR = 2.60 95% confidence interval [1.75–3.85], p = 2.02 × 10−6), FAM189A2 rs12344245 (OR = 1.85 [1.41–2.43], p = 8.52 × 10−6) and PKD1 rs116092985 (OR = 1.53 [1.27–1.85], p = 1.01 × 10−5). In addition, our analyses suggested that genetic variations at the ANKS1A, COL4A2 and APOE loci previously found associated with coronary artery disease in the general population could have stronger effects in patients with type 1 diabetes.ConclusionsThis study suggests three novel candidate genes for coronary artery disease in the subgroup of patients affected with type 1 diabetes. The detected associations deserve to be definitively validated in additional epidemiological studies.

Cardiogoniometry Compared to Fractional Flow Reserve at Identifying Physiologically Significant Coronary Stenosis: The CARDIOFLOW Study

Cardiogoniometry (CGM) is method of 3-dimensional electrocardiographic assessment which has been shown to identify patients with angiographically defined, stable coronary artery disease (CAD). However, angiographic evidence of CAD, does not always correlate to physiologically significant disease. The aim of our study was to assess the ability of CGM to detect physiologically significant coronary stenosis defined by fractional flow reserve (FFR). In a tertiary cardiology centre, elective patients with single vessel CAD were enrolled into a prospective double blinded observational study. A baseline CGM recording was performed at rest. A second CGM recording was performed during the FFR procedure, at the time of adenosine induced maximal hyperaemia. A significant CGM result was defined as an automatically calculated ischaemia score < 0 and a significant FFR ratio was defined as < 0.80. Measures of diagnostic performance (including sensitivity and specificity) were calculated for CGM at rest and during maximal hyperaemia. Forty-five patients were included (aged 61.1 ± 11.0; 60.0% male), of which eighteen (40%) were found to have significant CAD when assessed by FFR. At rest, CGM yielded a sensitivity of 33.3% and specificity of 63.0%. At maximal hyperaemia the sensitivity and specificity of CGM was 71.4 and 50.0% respectively. The diagnostic performance of CGM to detect physiologically significant stable CAD is poor at rest. Although, the diagnostic performance of CGM improves substantially during maximal hyperaemia, it does not reach sufficient levels of accuracy to be used routinely in clinical practice.

Long-term Western diet fed apolipoprotein E-deficient rats exhibit only modest early atherosclerotic characteristics

In the apolipoprotein E–deficient mouse, the gut microbiota has an impact on the development of atherosclerosis, but whether such correlations are also present in rats requires investigation. Therefore, we studied female SD-Apoetm1sage (Apoe−/−) rats fed either a Western diet or a low-fat control diet with or without gluten, which is known to promote gut microbiota changes, until 20 weeks of age. We hypothesized that the manifestation of atherosclerosis would be more severe in Apoe−/− rats fed the Western high-fat diet, as compared with rats fed the low-fat diet, and that atherosclerosis would be accelerated by gluten. Both Western diet-feeding and gluten resulted in significant changes in gut microbiota, but the microbiota impact of gluten was transient. Compared with Apoe−/− rats fed a low-fat diet, Western diet-fed Apoe−/− rats were heavier and became glucose intolerant with increased levels of oxidative stress. They developed early fatty streak lesions in their aortic sinus, while there was no evidence of atherosclerosis in the thoracic aorta. No conclusions could be made on the impact of gluten on atherosclerosis. Although Western diet-fed Apoe−/− rats exhibited a more human-like LDL dominated blood lipid profile, signs of obesity, type 2 diabetes and cardiovascular disease were modest.

Dyslipidemia.

Dyslipidemia.

English

INTRODUCTION: Diabetes Mellitus is one of the leading cause of morbidity and mortality worldwide. Its Prevalence is gearing up at a faster pace all over the world especially in developing countries like India. It is the most important risk factor in the pathogenesis of Acute Coronary syndrome. Coronary artery disease is one of the most common Macro vascular complications of Diabetes, especially Type 2 diabetes. It is the leading cause of mortality and morbidity in diabetes. In addition, diabetic patients are likely to have Poor treatment outcome compared with non-Diabetic controls. Its occurrence is increasing in younger age group,causing premature coronary artery disease and premature death inflicting economic burden to the family and to the society. Recently studies are focussing on serum Fibrinogen and its role in the pathogenesis of Coronary artery disease in Diabetes. Fibrinogen being an acute phase reactant is also a pro-coagulant. It plays a major role in coagulation of blood. It has a significant role in Athero-thrombosis. Hence its role in adverse cardiac events in Diabetics and its prognostic value is currently the study of interest. AIMS & OBJECTIVES: 1. To determine the concentration of Fibrinogen in diabet ic CAD and its causal relationship to adverse cardiac events. 2. To ascertain serum fibrinogen‟spredictive value of major adverse cardiac events in Diabetic CAD. 3. To ascertain the prognostic value of serum fibrinogen in Diabetic patients presenting with subs equent major adverse cardiac events. 4. To evaluate the relation between serum Fibrinogen and other factors that cause adverse cardiac events. MATERIALS AND METHODS: Study site: Department of General Medicine, Government Stanley Medical College and Hospital, Chennai. Collaborating Departments: Department of Cardiology and Department of Medical Biochemistry. Study Design: Cross sectional study. Study Period: June 2012 to November 2012. Selection of study population: Inclusion criteria: Diabetic inpatients with past history or evidence of Coronary artery disease. Sample size: • Using the above mentioned criteria 50 subjects were Recruited. Sampling method: • Convenience sampling method was adopted. Exclusion Criteria: • Disseminated intravascular coagulation. • Pregnancy. • Liver disease. • Sepsis. • Drug abuse like OCP,Antifibrinolytic, hormones. • Dysfibrinogenemia. CONCLUSION: The summary of results obtained is as follows: The study included 50 diabetic patients with coronary artery disease. • Age varied from 44 to 78 years. • 52% of the patients suffered from major adverse cardiac events(recurrent angina and congestive cardiac failure). • Older patients had more severe forms of major adverse cardiac events. • There is no significance between gender of patients and severity of major adverse cardiac events. • Longer the duration of diabetes more severe the major adverse cardiac events. • Higher blood sugar levels and poorer glycemic control leads to severe major adverse cardiac events. • No correlation between mean serum fibrinogen level and age or gender of the patient. • Mean serum fibrinogen levels was significantly higher in patients with longer duration of diabetes, higher blood sugars and poor glycemic control. • Increase in severity of major adverse cardiac events correlates with increase in serum fibrinogen titres.

Association of the waist-hip ratio with plasma adiponectin related to coronary artery disease

Objective: By enrolling a prospective study of 82 patients that underwent non-urgent coronary angiography for coronary artery disease (CAD), it is aimed to investigate the correlation between adiponectin and waist-hip-ratio with severity of CAD.Materials and methods: The results of the angiography, divided the patients into two groups, patients admitted with a diagnosis of CAD and non-CAD. In the conducted hospital based research, two groups were involved: the study group with documented angiographically CAD and control group without angiographic evidence of CAD. Some of the baseline adiponectin levels in stored serum samples of all patients, anthropometric and biochemical risk factors were assessed in both groups.Result and discussion: As the result, we have seen the presence of CAD that was associated with current smoking, male gender, waist–hip ratio (WHR).While, no significant difference between median adiponectin levels at baseline were observed between cases and controls.Conclusion: There is a significant positive correlation between waist - hip ratio and presence of severity of coronary artery disease.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.290-295

Abstract P274: Cross-sectional Analysis of Baseline Characteristics for New Users of Vorapaxar (PAR-1 Antagonist) and P2Y 12 Inhibitors

Introduction: Vorapaxar is indicated for the reduction of thrombotic events in patients with a prior myocardial infarction (MI) or peripheral arterial disease (PAD), and contraindicated in patients with a prior stroke, transient ischemic attack (TIA), or intracranial hemorrhage (ICH). This is the first descriptive study of vorapaxar in US clinical practice. Objectives: Main objective was to describe baseline characteristics of vorapaxar new users. For context, P2Y 12 new users were also examined, with indications summarized in Table 1. Methods: Cross-sectional analysis of vorapaxar new users ≥18 years with ≥1 prescription between June 2014 - June 2016 identified in Symphony Health’s outpatient pharmacy claims database linked to private practitioner claims and hospital data. Concomitant clopidogrel use was defined with overlapping days of supply. Medical history was defined using a 1-year baseline period. Results: The analysis included 1,362 vorapaxar (44% with clopidogrel), 975,023 clopidogrel, 133,724 ticagrelor, and 98,101 prasugrel new users (Table 1). Most ticagrelor (87%) and prasugrel (85%) users had evidence of coronary artery disease (CAD) compared with 52% of clopidogrel and 58% of vorapaxar users. In contrast, &lt;1% of ticagrelor and prasugrel users had PAD but no CAD vs. 6% of clopidogrel and 15% of vorapaxar users. The proportion of vorapaxar users (44%) with PAD, alone or with CAD, was 3-5 times larger than P2Y 12 users. PAD was more prevalent for vorapaxar with (50%) vs. without (39%) clopidogrel. Contraindications were infrequent for vorapaxar users - no ICH, &lt;4% with stroke or TIA. Median time from recent MI to therapy start was 6 months for vorapaxar vs. 3 days for ticagrelor and prasugrel and 7 days for clopidogrel. Vorapaxar users were mostly male and on average ~65 years old. Conclusions: The majority of vorapaxar new users had a history of CAD and/or PAD, with PAD prevalence more than twice that of P2Y 12 new users. Contraindications were infrequent.