Existence Of Coronary Artery Disease Research Articles

Coronary CT Angiography for Coronary Artery Disease: The Current Status and Future Challenges

Coronary computed tomographic angiography, often known as CCTA, is quickly becoming the diagnostic technique of choice for determining the existence of coronary artery disease (CAD). In the future, CCTA may play an essential part as a "one-stop shop" in the screening, diagnosis, decision making, and treatment planning processes. Plaque burden, high-risk plaque, non-invasive angiography, perfusion with hyperemia, fractional flow reserve (FFR), percent of myocardium at risk, inflammation, myocardial scar, wall motion analysis, and risk scores are some of the many measures that are utilized.

Cross sectional study of the relationship between the presence / severity of coronary artery disease evaluated by computed tomography coronary angiography and the presence/ degree of non-alcoholic fatty liver disease evaluated by trans-abdominal ultrasonography

Abstract Background Coronary artery disease is one of the common causes of mortality worldwide. Studies have shown a prevalence of 24.5% in Egypt. Therefore, early accurate diagnosis, risk factors and associations of coronary artery disease are of utmost importance. Objectives The aim of the current study is to investigate the relationship between the presence / severity of coronary artery disease and presence extent of nonalcoholic fatty liver disease. Patients and Methods Cross-sectional study on total 52 patients performed multi-slice computed tomography coronary angiography, and liver evaluation by abdominal ultrasonography at Dar Shefaa hospital. Results We found that there is a positive significant relationship between the number of coronary arteries affected and the coronary lesion degree of stenosis (proven by P value= 0.909). Also, a positive significant relationship between the number of affected vessels and the degree of non-alcoholic fatty liver disease (proven by P value =-0.783). Also, a positive significance between coronary lesion stenosis degree and the degree of non-alcoholic fatty liver disease (proven by P value= 0.785). Conclusion The existence of non-alcoholic fatty liver disease is independently associated with the presence and existence of coronary artery disease. it is not still clear whether the non-alcoholic fatty liver disease causes coronary artery disease or whether this relationship is seem because of the common mechanisms causing both diseases, yet the relationship between the existence of hepatosteatosis and the extent of coronary artery disease has been strongly documented.

Impact of Arrhythmia on Myocardial Perfusion: A Computational Model-Based Study

(1) Background: Arrhythmia, which is an umbrella term for various types of abnormal rhythms of heartbeat, has a high prevalence in both the general population and patients with coronary artery disease. So far, it remains unclear how different types of arrhythmia would affect myocardial perfusion and the risk/severity of myocardial ischemia. (2) Methods: A computational model of the coronary circulation coupled to the global cardiovascular system was employed to quantify the impacts of arrhythmia and its combination with coronary artery disease on myocardial perfusion. Furthermore, a myocardial supply–demand balance index (MSDBx) was proposed to quantitatively evaluate the severity of myocardial ischemia under various arrhythmic conditions. (3) Results: Tachycardia and severe irregularity of heart rates (HRs) depressed myocardial perfusion and increased the risk of subendocardial ischemia (evaluated by MSDBx), whereas lowering HR improved myocardial perfusion. The presence of a moderate to severe coronary artery stenosis considerably augmented the sensitivity of MSDBx to arrhythmia. Further data analyses revealed that arrhythmia induced myocardial ischemia mainly via reducing the amount of coronary artery blood flow in each individual cardiac cycle rather than increasing the metabolic demand of the myocardium (measured by the left ventricular pressure-volume area). (4) Conclusions: Both tachycardia and irregular heartbeat tend to increase the risk of myocardial ischemia, especially in the subendocardium, and the effects can be further enhanced by concomitant existence of coronary artery disease. In contrast, properly lowering HR using drugs like β-blockers may improve myocardial perfusion, thereby preventing or relieving myocardial ischemia in patients with coronary artery disease.

Value of Pericoronary Adipose Tissue Texture Analysis in Diagnosis of Coronary Artery Disease

Peri-Coronary Adipose Tissue (PCAT) was an indicator to detect the coronary inflammation. We aimed to analyze the PCAT characteristics of Right Coronary Artery (RCA) with or without plaque using texture analysis by Coronary Computed Tomography Angiography (CCTA). This article was a retrospective case-control study. In total, 67 patients with coronary artery disease were enrolled from December 2018 to September 2019. The patients were divided into two groups according to whether there are plaques existing at the RCA vessels. The radiomic features of RCA vessels calculated on the PCAT regions between groups were compared using Mann-Whitney U test. Receiver Operating Characteristic Curve (ROC) analysis was performed to evaluate the performance of each significant features to differentiate the group with or without plaques. 43 patients without RCA plaque and 24 patients with RCA plaque were included in the study. 1218 radiomic features were finally calculated, among which wavelet-based texture features were more significantly different between RCA plaque group and RCA non-plaque group. Furthermore, wavelet_LLL_ firstorder_Maximum had the highest Area Under Curve (AUC) 0.78. Therefore, PCAT texture analysis is expected to be used as a new detection method to determine the existence of coronary artery disease.

Detection of Coronary Artery Disease by an Erectile Dysfunction Questionnaire.

Background Erectile dysfunction (ED) has been become an important health challenge in recent years affecting the quality of life significantly. In addition to imposed social problems, it may warn the existence of cardiovascular diseases especially that of ischemic heart disease (IHD). We aimed to investigate the association between ED and coronary artery disease (CAD) in a population of patients with stable angina based on angiographic findings. Methods In this cross-sectional study, among patients who are diagnosed with stable angina referring for coronary angiography (excluding those with acute coronary syndrome), 200 patients were selected. They were divided equally into two groups of case and control. The former were positively CAD patients and the latter were normal peers, with respect to angiographic results. International index of erectile function (IIEF) questionnaire was used in order to evaluate erectile function during recent four weeks. Statistical analyses of the t-test and logistic regression were performed. The significance level was considered as a P value less than 5%. Results The age range of the patients was 40–65 years old. The case group was significantly older (P=0.001). There was a remarkable relation between the low score from IIEF (ED) and existence of CAD. Also, the severity of ED was in a close relationship with severity of CAD. In addition, dyslipidemia in terms of high LDL and low HDL was associated with both ED and severity of CAD. Conclusion Other than CAD, ED could be considered as one of the manifestations of atherosclerosis. Accordingly, the IIEF questionnaire is a useful tool to early diagnosis of CAD. Also, IIEF-derived scores estimate CAD severity. We suggest subjects with low score of IIEF examine their cardiovascular health with special attention to possible existence of IHD.

Evaluation of serum cysteine-rich protein 61 levels in patients with coronary artery disease.

The aim is to evaluate serum cysteine-rich protein 61 (Cyr61) levels in patients with coronary artery disease (CAD). Serum Cyr61 levels were measured in 180patients with CAD and 74 participants without CAD. Serum Cyr61 levels were significantly higher in CAD patients. Patients with acute coronary syndrome showed significantly higher Cyr61 than those with stable angina pectoris. Serum Cyr61 levels in complex lesion group were significantly higher. Serum Cyr61 was positively correlated with Gensini score and C-reactive protein. Multivariable logistic regression analyses demonstrated that serum Cyr61 levels were independently correlated with the existence of CAD (p=0.01). Our study suggested Cyr61 as a potential biomarker in characterizing CAD and therapeutic target for CAD.

Cystatin C may not be a precious predictor for coronary artery disease and its severity: an area of uncertainty.

Background and Aim: Cystatin C, an endogenous indicator for kidney function, may be also an original indicator for coronary atherosclerosis. In the current study, we intended to assess its role in establishing the existence of coronary artery disease. We also attempted to present the best cut off point for Cystatin C to discriminate coronary disease from normal coronary condition. Methods: 147 consecutive patients who were candidate for coronary angiography were included into the study. Cystatin C was measured using Auto-analyzer system and by Gentian kit with enzyme calorimetric method. Results: The mean level of Cystatin C in the patients with and without coronary artery disease was 0.97±0.51 mg/l and 1.02±0.40 mg/l with no significant difference (p=0.564). In multivariate logistic regression model, the serum level of Cystatin C could not predict coronary artery disease (OR=1.199, 95% CI: 0.531 to 1.706, p=0.662). According to the area under the ROC curve, Cystatin C was not a good indicator to discriminate coronary artery disease from normal coronary condition (AUC=0.465, 95% CI: 0.372 to 0.559, p=0.470). Considering cut of points of 0.85 and 0.94 for Cystatin C, the sensitivity of this test for predicting coronary artery disease in comparison with coronary angiography was 65% and 51%, respectively. In assessing relationship between serum level of Cystatin C and other chemical biomarkers, Cystatin C was only correlated with serum triglyceride level (r=0.207, p=0.012). Conclusions: Cystatin C measurement may not be a suitable predictor for coronary artery disease and severity of the coronary involvement. Future studies with large sample size are necessitated to demarcate distinct role of Cystatin C in coronary artery disease. (www.actabiomedica.it)

Mortality and Low Serum Bicarbonate Level in Patients on Hemodiafiltration versus Peritoneal Dialysis.

Mortality is substantially elevated in patients on chronic kidney disease in comparison to general population. In this study, we observed the mortality rate in relation to risk factors including low serum bicarbonate level, coronary artery disease (CAD), and dialysis modality in patients on dialysis during a median follow-up time of 60 months. We studied 96 dialysis patients, 62 males and 34 females, on mean age 62.1 ± 14.27 years old. The treatment modalities which were applied were predilution hemodiafiltration (HDF, n = 76), and peritoneal dialysis (PD, n = 20). We performed Kaplan–Meier curves and a Cox-regression analysis to investigate significant risk factors for mortality including hypertension, diabetes mellitus, smoking, bone disease defined by intact-parathormone, serum albumin, serum bicarbonate levels < or >22 mEq/L, dialysis modality, and the existence of CAD. Cox-regression analysis revealed a significant impact of serum bicarbonate levels <22 mEq/L on mortality in combination to dialysis modality and CAD. The prevalence of CAD on mortality was found significant (log-rank = 5.507, P = 0.02). Furthermore, the impact of dialysis modality on mortality was shown significant (log rank = 22.4, P = 0.001), noting that during the first 28–30 months from the treatment initiation, the survival was better for PD; but then, the mortality was significantly increased comparatively to HDF. Uncorrected metabolic acidosis and CAD were shown as independent significant predictors for mortality in patients on renal replacement therapy. PD may provide worse survival after 2–2.5 years of treatment initiation than HDF.

Stentless Bioprostheses for Aortic Valve Replacement in Octogenarians: The Influence of Coronary Artery Disease.

We sought to determine the long-term results of stentless biological heart valve replacement in octogenarians to find out whether coronary artery disease or the coronary artery bypass grafting (CABG) procedure itself influences survival in these aged patients. From 4,012 patients undergoing aortic valve replacement (AVR) with a stentless prosthesis (Freestyle, Medtronic) at a single center, 721 patients were older than 80 years. They had a mean age of 83 ± 2 (2,320 patient years), the male/female ratio was 42:58, NYHA (New York Heart Association) class I and II was prevalent in 22.8%, preoperative atrial fibrillation (AF) in 20.6%, coronary artery disease in 56.1%, mitral valve disease in 12.5%, and aortic disease in 3.5%. Follow-up included a total of 11,546 patient years (mean follow-up time: 74 ± 53 months); follow-up mortality data were 96.3% complete. In these aged patients, 30-day mortality in the isolated AVR group (10.3%) was similar to that in the AVR + CABG group (13.4%). Although long-term survival (15 years) in the octogenarian population is low (9% in the AVR group and 6% in the AVR + CABG group), it was not different (p = 0.191) between patients with and without coronary artery disease. The stroke rate and the myocardial infarction rate, respectively, in the AVR + CABG group (0.43%/100 patient years and 0.17%/100 patient years) were only insignificantly higher than that in the isolated AVR group (each 0.01%/100 patient years). The actuarial freedom from reoperation was 99% in both the groups. Use of the Freestyle stentless valve prosthesis for AVR is feasible also in octogenarians. The existence of coronary artery disease leads to concomitant bypass surgery, but not a higher level of perioperative or long-term mortality.

Diabetes-Invoked High-Density Lipoprotein and Its Association With Coronary Artery Disease in Patients With Type 2 Diabetes Mellitus

Although high-density lipoprotein (HDL) can exhibit anti-inflammatory properties, these potent activities can become deficient and even transform into proinflammatory effects under various pathophysiological states. We investigated the effect of diabetic HDL on the inflammatory response in human monocytes and its relation to the existence of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (DM). HDL was isolated from DM patients with (n= 61) or without (n= 31) CAD (diameter stenosis ≥50%) and healthy controls (n= 40). Human peripheral blood mononuclear cells were incubated with HDL and the proinflammatory ability of HDL was determined by tumor necrosis factor-α (TNF-α) secretion in peripheral blood mononuclear cells. Secretion of TNF-α in human monocytes in response to diabetic HDL was significantly increased compared with that of the control HDL. Of note, HDL from DM patients with CAD stimulated the release of TNF-α in monocytes to a greater extent than that of HDL from those without CAD. Multiple linear regression analysis showed that the proinflammatory ability of HDL was independently associated with diabetes duration, hemoglobin A1c, serum levels of high-sensitivity C-reactive protein (hs-CRP) and reduced glomerular filtration rate (GFR). Furthermore, the proinflammatory ability of HDL was a significant predictor for the presence of CAD in patients with DM.

Abstract 18577: Skin Autofluorescence is an Independent Predictor of the Coronary Artery Disease

Aims: Skin autofluorescence (SAF), a non-invasive measurement of the accumulation for glycation end products (AGEs) level of skin, has been reported as a useful marker for micro/macro vascular complications. However there is little data evaluating whether SAF can be the predictor of the patients with suspected a coronary artery disease (CAD) and indicating the coronary angiogram (CAG). The aim of this study was to evaluate association between SAF and CAD detected by CAG in the catheterization laboratory. Methods: From October/2013-March/2014, 333 patients with suspected the CAD and underwent CAG were enrolled prospectively. SAF were assessed with autofluorescence reader before CAG. Patients with the history of percutaneous coronary intervention, coronary artery bypass grafting were excluded. CAD was defined as if there was at least one coronary artery stenosis greater than or equal to 50% (AHA classification) by CAG. Association between SAF and existence of CAD was evaluated, and we also explored the relationship between SAF and number of diseased coronary artery. Results: Of the 333 patients, CAD was observed in 145 (43.5%) patients. In multivariate logistic regression analysis, age (odds ratio [OR]: 1.03; 95% con[[Unable to Display Character: &amp;#64257;]]dence interval [CI]: 1.00 to 1.06; p = 0.049), gender (male as reference) (odds ratio [OR]: 0.46; 95% con[[Unable to Display Character: &amp;#64257;]]dence interval [CI]: 0.28 to 0.75; p = 0.002), HbA1c (odds ratio [OR]: 1.45; 95% con[[Unable to Display Character: &amp;#64257;]]dence interval [CI]: 1.10 to 1.91; p = 0.008) and SAF (odds ratio [OR]: 4.85; 95% con[[Unable to Display Character: &amp;#64257;]]dence interval [CI]: 2.750 to 8.55; p &lt;0.001) were considered to be the predictors of CAD. Furthermore patients with higher SAF showed more number of coronary artery disease (Figure 1). When we use the response variable greater equal to 2.3 to determine CAD, sensitivity is 0.655 (0.572, 0.732) and specificity is 0.713 (0.642, 0.776). Conclusions: SAF was independent predictor of CAD and showed a possibility of being the surrogate for the CAD as non-invasive methodology.

Experience of a single-center in coronary computed tomography angiography

Cardiologia CROATICA Purpose: Coronary computed tomography angiography with calcium scoring measured with Agatston score index provides a diagnosis of coronary atherosclerosis in the patients with subclinical coronary plaque. To evaluate the diagnostic accuracy of Agatston score in comparison with the conventionally used Framingham risk score (FRS) and blood biomarkers in predicting existence of coronary artery disease (CAD) and significant coronary stenosis >50%. Patients and Methods: This retrospective single-center study is evaluating the role of Agatstone score in the prognosis of CAD in patients with previously unknown CAD. 2,597 patients underwent coronary multidetector computed tomography (MDCT) and obtained Agatston score in our Center from June 2012 to April 2014. Scanning was done with dualsource MDCT equipped with two 128-detector row units using the ECG-gating protocol. The mean amount of radiation that was obtained was 6.8 ± 4.5 mSv. The exclusion criteria included Agatston score above 800, atrial fibrillation, pre-existing kidney failure (eGFR 50% or less than 50%. The frequency of demographic and clinical characteristics, blood biomarkers and risk factors were tested between the groups by using chi-squared test and Student T-test as appropriate. To test for factors associated with predicting coronary artery stenosis, likelihood ratio, and receiver operating characteristics analyses were used. Relative risk was calculated in the context of developing coronary artery stenosis greater than 50% in the participants with Agatston score above 100. Results: Out of 2,597 patients participating, 361 patients (mean age 63 ± 8; 227 (63%) of females) with complete data were included in this study. Significant coronary artery stenosis was recorded in 84 (23%) of patients. Mean FRS values were 20 ± 13. Agatstone score (Se 85%, Sp 95%, NPV 95%, PPV 85%, AUC 0.99, 95% CI 0.968 to 1.000, p<0.0001). Conclusion: Among all considered demographic and clinical characteristics, Agatstone score was the most accurate predictor for developing of CAD and significant coronary stenosis.

Correlation between clinical prediction tests for coronary heart disease and findings on spect myocardial perfusion scintigraphy and coronary angiography

Predictive clinical tests are important diagnostic tools in determining groups of patients who should undergo further diagnostic methods for detection of coronary artery disease. The aim of this study was to determine the correlation between the probability of the existence of the coronary heart disease (CHD) obtained with Duke's clinical prediction tests for the existence of coronary artery disease and the results obtained by SPECT myocardial perfusion scintigraphy and coronary angiography. Patients and methods: The study included 56 patients with symptoms of angina pectoris (AP), 35 men and 21 women, aging 32-78 years. In all patients, the probability of the existence of coronary artery disease was calculated, i.e. the need for other diagnostic methods, by means of Duke clinical prediction (DCS). The patients subsequently underwent SPECT myocardial perfusion scintigraphy (SPECT MPI) with exercise stress test and with calculating Duke treadmill score (DTS), followed by coronary angiography (CA). The results were statistically analyzed using SPSS statistical tools, nonparametric statistical tests. Results: DCS showed a low CHD probability in 10 (17.9%), while in 46 (82.1%) there was moderate probability. DTS showed low probability in 8 (14.3%) and in 48 (85.7%) high probability of CHD. SPECT MPI resulted in 22 (39.3%) normal and 34 (60.7%) pathologilal states. CA was negative in 21 (37.5%), while in 35 (62.5%) showed significant coronary artery stenosis. In the group with low DCS and DTS probability for CHD there were no perfusion defects in SPECT MPI and no coronary artery stenosis in CA. Conclusion: Predictive clinical tests DCS and DTS, which confirm or reject suspicion of CHD, represent an important diagnostic tool that avoids unnecessary exposure of patients to further diagnostic methods which mean either an invasive diagnostic approach or any unnecessary exposure of patients to ionizing radiation. DCS and DTS have high negative predictive value and are reliable tools for selection of AP patients for further diagnostic modalities.

Correlation of fasting serum apolipoprotein B‐48 with coronary artery disease prevalence

Postprandial hyperlipidemia partially refers to the postprandial accumulation of chylomicrons and chylomicron remnants (CM-R). Many in vitro studies have shown that CM-R has highly atherogenic properties, but consensus is lacking on whether CM-R accumulation correlates with the development of atherosclerotic cardiovascular diseases. We investigated the correlation between CM-R accumulation and the prevalence of coronary artery disease (CAD). Subjects who received a coronary angiography and did not take any lipid-lowering drugs (n = 189) were enrolled. Subjects with coronary artery stenosis (≥ 75%) were diagnosed as CAD. Biochemical markers for glucose and lipid metabolism including fasting apolipoprotein (apo) B-48 concentration were compared between CAD patients (n = 96) and age-, sex-, and body mass index (BMI)-matched non-CAD subjects without overt coronary stenosis (< 75%) (n = 67). We tried to determine which metabolic parameters were correlated with the prevalence of CAD by multiple logistic regression analysis, and whether or not the combination of high apo B-48 and other coronary risk factors (high triglyceride, low HDL-C, high HbA1c or low adiponectin levels) increased the prevalence of CAD. Fasting serum apo B-48 levels were significantly higher in CAD patients than in non-CAD subjects (3·9 ± 2·4 vs. 6·9 ± 2·6 μg/mL, P < 0·0001) and had the most significant correlation with the existence of CAD. The clustering of high fasting apo B-48 levels (> 4·34 μg/mL, the cut-off value) and other coronary risk factors were found to be associated with a stronger risk of CAD compared with single high fasting apo B-48 levels. Fasting serum apo B-48 levels significantly correlated with the prevalence of CAD.

Inverse association between the existence of coronary artery disease and progression of abdominal aortic aneurysm

ObjectivesA strong degree of co-existence between coronary artery disease (CAD) and abdominal aortic aneurysm (AAA) is widely acknowledged, however, it remains to be elucidated whether the existence of CAD is associated with an accelerated expansion rate of AAA. Also, the relationship between preoperative CAD and postoperative major adverse cardiovascular events (MACE) has not been examined in Japanese patients. The aim of this study was to investigate the deleterious effects of CAD on the progression of AAA and the onset of postoperative MACE after elective AAA repair. Methods and resultsA retrospective cohort study of 665 consecutive Japanese patients who underwent elective surgical repair for infrarenal AAA at 2 high-volume Tokyo hospitals from 2003 through 2010 was performed. Preoperative CAD was shown to be a significant determinant of postoperative MACE (HR 2.29; 95%CI, 1.12–4.66; p=0.02). In the analysis of 510 patients for whom there were at least 2 follow-up CT scans of the size of their AAA before repair, the existence of CAD was shown to be inversely associated with the accelerated expansion rate of AAA. ConclusionThis study on the patients undergone elective repair for infrarenal AAA identified an inverse association between the existence of CAD and progression of AAA as well as the significant impact of preoperative CAD on the occurrence of postoperative MACE after elective AAA repair.

Abstract 9387: The Inverse Association Between the Existence of Coronary Artery Disease and the Progression of Abdominal Aortic Aneurysm

Objectives: The aims of this study are to clarify the relationship among preoperative CAD (coronary artery disease), clinical manifestation of AAA (abdominal aortic aneurysm) and postoperative MACE (major adverse cardiac events). Background: A strong co-existence of CAD and AAA is well-known, however, it remains to be elucidated whether the existence of CAD is associated with the accelerated expansion rate of AAA. Methods: We conducted a retrospective cohort study on 823 consecutive patients receiving the coronary angiography before elective surgical repair for infrarenal fusiform AAA in two hospitals from 2003 through 2009. Ruptured, saccular, traumatic or inflammatory aneurysm were excluded in advance and cases with Marfan syndrome and cases with short followed-up period (&lt;3 months) were also excluded. After exclusion, 665 patients were taken into consideration. All patients were underwent coronary angiography before surgery and their AAA size were followed up by CT scan at least more than 3 times until surgery. Results: The higher rates of postoperative MACE including cardiovascular death, acute coronary syndrome and cerebral infarction were observed in the CAD cases (n=342) compared with non-CAD cases (n=323) by Kaplan-Meier analysis (P=0.038). The initial follow-up size of AAA was 36.8±5.9 mm and the size at surgery was 52.3±10.8 mm. The existence of CAD cases was inversely associated with the accelerated expansion rate of AAA (CAD 3.8±2.1 mm/yr vs. non-CAD 5.0±3.2 mm/yr, HR 0.24, p&lt;0.01). ECG change or asynergy in echocardiography at surgery were not associated with the expansion rate. Otherwise, only ex-smoker was the risk of the expansion rate (HR 1.67, p=0.037). Coronary risk factors except for ex-smoker, and the administration of antihypertensive drugs and statin weren’t significantly associated with the expansion rate. Multiple analyses indicated the same result. Conclusions: Although CAD was the strong risk of MACE after surgical repair for AAA, the counterintuitive inverse association between the existence of CAD and progression of infrarenal AAA was identified. This is the significant study on the relationship between CAD and the expansion rate of AAA.

Abstract 9712: Lack of Association Between Common p.T111I Variant in the Endothelial Lipase Gene and the Risk for Coronary Artery Disease in Familial Hypercholesterolemia: Insights From the Modulation of Phospholipids in the HDL Particles

Background: endothelial lipase (EL) is a major determinant of high-density lipoprotein cholesterol (HDL-C) metabolism through the lipolysis of the phospholipids (PL) in the HDL particles (HDL-PL). Several studies indicated that common p.T111I variant in EL gene (LIPG: rs2000813) is negatively associated with the risk of coronary artery disease (CAD) independent of HDL-C levels. However, few data exist regarding the influence of this variant on the content of HDL-PL in terms of the association with CAD, especially in familial hypercholesterolemia (FH) subjects. The aim of our study is to elucidate the clinical impact of common p.T111I variant in the EL gene on the content of HDL-PL, and whether this variant could be useful predictor of the risk of CAD in FH subjects, which always exhibit low HDL-C levels. Methods: The p.T111I variant was genotyped in our heterozygous FH subjects (n=80, male=56, mean age=64±18yr, mean TC=340±64mg/dl). All those subjects' plasma lipoproteins were investigated by ultracentrifugation method. Overall HDL-C level, HDL-PL level, and the existence of CAD were investigated for each group (TT group vs. TI and II group). Results: The minor allele frequency in the combined pools of subjects was 0.25. There was no significant association between this variant with overall HDL-C level (42±14 vs. 43±17mg/dl, p=NS) nor with HDL-PL level (86±24 vs. 88±27mg/dl, p=NS). In addition, multiple logistic regression analysis revealed no association between this variant and CAD (odds ratio 0.96, 95%CI:0.88-1.04, p=NS) although significant associations between several coronary risk factors and CAD were observed (figure). Conclusions: These data suggest that common p.T111I variant in LIPG neither plays a role in determining HDL-C as well as HDL-PL levels nor is a useful predictor of the risk of CAD in genetically determined heterozygous FH subjects.

A multi-center survey of hypertension and its treatment in patients with maintenance hemodialysis in Shanghai

To study the prevalence, treatment policy and control of hypertension in patients with maintenance hemodialysis, and to analyze the influencing factors of hypertension control. We studied the current status of 1382 patients with maintenance hemodialysis in 11 dialysis centers in Shanghai, among them 809 were male, and 573 were female. Hypertension was defined as systolic blood pressure (SBP)≥140 and/or diastolic blood pressure (DBP)≥90 mm Hg (1 mm Hg=0.133 kPa). Those who had a history of hypertension and requiring antihypertensive therapy were also diagnosed as hypertension though their blood pressure was within normal range during the survey. Hypertension control was defined as blood pressure<140/90 mm Hg before each dialysis session. The prevalence of hypertension in the hemodialysis patients was 86.3%. The treatment rate and control rate in those patients were 96.8% and 25.5% respectively. More than half (50.4%) of patients were treated with only one kind of anti-hypertensive drug, and 34.4% with 2 kinds, 14.2% with 3 kinds, 1.0% with 4 kinds or more. Calcium channel blocker (CCB) was the most frequently prescribed drug (61.0%), followed by angiotensin II receptor blockers (56.4%), centrally acting anti-hypertensive agent (26.4%), beta blockers and alpha, beta-blockers (14.0%). The control rate of hypertension in those hemodialysis people was aggravated by the existence of coronary artery disease. The patients who need more kinds of antihypertensive agents have a poorer control rate of hypertension. The hypertension control rate elevated significantly with the adequate hemodialysis. There is a very high prevalence of hypertension in maintenance hemodialysis patients. Although the treatment rate is high, the control rate is unsatisfactory. So the control of hypertension in hemodialysis patient is still a clinical challenge. Appropriate dialysis adequacy, reasonable use of erythropoietin, treatment of heart disease and judicious use of antihypertensive drugs may be helpful to improve the clinical outcome.

Statins and vitamin D: a friendly association in pre-dialysis patients

The increased mortality rate observed in patients with chronic kidney disease is related to the high prevalence of cardiovascular disease in this population. Recently, it has been shown that interventional therapy with statins and/or vitamin D could improve the outcomes of these patients. The aim of this study was to identify the risk factors for mortality in a group of patients with chronic kidney disease (stages 4 and 5--pre-dialysis) and verify whether vitamin D and statins could change the outcome. We included 95 patients (mean age--69.4) with stages 4 and 5 (pre-dialysis) of our "low-clearance" outpatient clinic, with an average eGFR of 16.9 ml/min and a mean follow-up of 24.1 months. Several biological, nutritional, laboratory and inflammatory parameters were analysed at baseline. Our population was divided into three groups: G-I, patients not medicated with either vitamin D or statins; G-II, patients medicated with either vitamin D or statins; and G-III, patients medicated with vitamin D and statins. We found (ANOVA) that the serum levels of pre-albumin (P = 0.018) and PTH (P = 0.03) were lower in G-I. Concerning the inflammatory parameters, G-I showed higher levels of hsCRP (P = 0.014) and a trend to higher IL-6 levels (P = 0.077). We found the actuarial survival at 30 months (Kaplan-Meier), to be 56.4% in G-I, 82.3% in G-II and 100% in G-III (log rank = 13.08 P = 0.0014). Using the Cox proportional hazards model, we found that the existence of coronary artery disease (P = 0.0001) and the absence of medication with vitamin D and/or statins (P = 0.005) independently influenced the mortality of our patients. In conclusion, we found, in our study, that patients under vitamin D and statins (with a synergistic effect) were less inflamed and showed a lower mortality rate.

Significant association between score of periodontal disease and coronary artery disease

Recently, several researchers have demonstrated the association between periodontal disease and coronary artery disease (CAD). Therefore, we herein investigate the association between periodontal diseases and the existence of CAD among the study population who received both coronary angiography and dental examination. A total of 174 consecutive patients with dental examination including radiography and coronary angiography in the same hospitalization were recruited (64.5 +/- 10.3 years, M/F: 94/80). A dentist assessed severity of periodontal status markers (bleeding on probing, probing depth >or=6 mm, teeth lost, alveolar bone resorption >half of root length by radiography and smoking status). We divided these patients into two groups according to whether they had CAD (CAD group, n = 99) or not (non-CAD group, n = 75) according to the results of coronary angiography. The composite periodontal risk scores calculated from periodontal status markers were higher in the CAD group than in the non-CAD group (P = 0.02). The composite periodontal scores were higher in the CAD group of age <60 years old population (P = 0.03) and in the CAD group of patients with normal glucose tolerance (P = 0.04). However, the difference was not significant in the age >or=60 years old population or those with diabetes mellitus or impaired glucose tolerance. In all populations, hypertension, glucose tolerance, statin therapy, and composite of periodontal risk scores were associated with CAD. Multivariate analyses revealed statin therapy, glucose tolerance, and periodontal risk scores were independent and significant risk factors for CAD. Composite periodontal risk scores were independent and significant predictive factors for CAD.