Frequency Of Coronary Artery Disease Research Articles

Gender-related differences in presentation and treatment of patients with non-valvular atrial fibrillation: results from RAMSES study.

Gender is an important feature in the management of atrial fibrillation (AF). This study investigated gender-related differences in patients with AF in Turkey. As a part of RAMSES (ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey, NCT02344901) study, information of the patients with AF who successively applied to the hospital was analyzed. This cross-sectional, multicenter, nationwide observational study enrolled 6264 non-valvular AF (NVAF) outpatients (55.9% women) from Turkey. Compared with men, women with NVAF were older (71 years [range: 65-78 years] vs. 70 years [range: 62-77 years]; p<0.001), had lower frequency of coronary artery disease (22.0% vs. 38.3%; p<0.001) and congestive heart failure (18.2% vs. 27.2%; p<0.001). Women had higher median CHA2DS2-VASc score (4 [range: 3-5] vs. 3 [range: 2-4]; p<0.001), but similar HAS-BLED score (2 [range: 1-2] vs. 2 [range: 1-2]; p=0.141) when compared with men. Anticoagulant therapy use was higher in women (74.5% vs. 69.9%; p<0.001). Analysis of anticoagulation therapy use revealed that 68.5% of men and 61.6% of women (p=0.204) who had low risk for stroke (CHA2DS2-VASc score: 0 [male], 1 [female]) received anticoagulation therapy, and 30.5% of the men. Meanwhile, 25.3% of the women (p<0.001) with high risk for stroke (CHA2DS2-VASc score: ≥1 [male], ≥2 [female]) had not received any anticogulant therapy. Although women with NVAF receive better treatment than men, anticoagulation therapy is suboptimal in large proportion of men and women, with underuse in high-risk patients and overuse in low-risk patients. There is an urgent need to improve optimization of anticoagulation in patients with NVAF.

Syndromes coronariens aigus avec sus-décalage du segment ST et anomalies de connexion des artères coronaires

Acute coronary syndrome with ST-segment elevation associated with an anomalous connection of a coronary artery, when the latter is the culprit, may be problematic. Anatomic and radiologic knowledge of major congenital coronary abnormalities and some catheterization skills can help the operators not to delay a beneficial coronary reperfusion. The relationship between acute coronary syndromes with ST-segment elevation and anomalous connections of the coronary arteries needs to be analyzed with a large number of cases because the coronary artery disease frequency may vary with the type of coronary anomaly.

Frequency of coronary artery disease in patients with rheumatic valvular heart disease: Moroccan experience

Frequency of coronary artery disease in patients with rheumatic valvular heart disease: Moroccan experience

Ipsilateral Infarct in Newly Diagnosed Cervical Internal Carotid Artery Atherosclerotic Occlusion

Objective: We aimed to determine factors associated with recent infarct (RI) in patients with newly identified atherosclerotic cervical internal carotid artery occlusion (CICAO). Methods: This was a retrospective review of consecutive patients who underwent cervical CT angiography from 2002 to 2006 at a single tertiary center. RI was defined by positive diffusion-weighted imaging/apparent diffusion coefficient magnetic resonance imaging (MRI) in the correspondent CICAO territory. Subjects were dichotomized into those with a RI versus patients with no RI (No-RI). Results: Of 2,459 patients with cervical CT angiograms in the study period, 108 (4.4%) had complete medical records and brain MRI and were included. The mean age was 64 ± 13 years, 58% were men, and 62 (57%) had a RI. The demographics of the RI and No-RI patients were comparable, with the exception that those with RI had a lower frequency of coronary artery disease (CAD, 13 vs. 54%; p < 0.01) and dyslipidemia (38 vs. 69%; p < 0.01). The use of antiplatelets was not statistically different between the groups (56 vs. 71%; p = 0.1). Subjects with RI were less likely on statins (21 vs. 56%; p < 0.01) and antihypertensives (9 vs. 71%; p < 0.01). Multivariate regression revealed that CAD, the use of statins, and the use of antihypertensives were associated with No-RI CICAO presentation. Conclusion: The use of statins and antihypertensives is associated with a decreased risk of RI atherosclerotic CICAO.

0261 : Frequency of coronary artery disease in patients with rheumatic valvular heart disease: Moroccan experience

The prevalence of coronary artery disease (CAD) in patients with valvular heart disease varies widely between developed and in developing countries. This is likely due, at least in part, to significant differences in etiology: rheumatic valvular heart disease is the most important cause of this pathology in Morocco. to estimate the prevalence of coronary artery disease (CAD) in rheumatic valvular heart disease (RVHD) and to evaluate its interest as a preoperative exploration cause of the constraints of cost, appointments, and risks in our context. Also we studied risk factors prediction of significant coronary artery disease in patients with RVHD, and discussed other preoperative exams to explore coronary arteries. From 01/01/2011 to 31/12/2012, 80 patients underwent coronary angiography at the University Hospital cardiac catheterization laboratory of Casablanca prior to planned RVHD surgery. Data analyses were performed using Epi Info, Version 6.04. The majority of patients were men (58.75% vs. 41.25%). The prevalence of Coronary Artery Disease found was 20%. These patients were all over the age of 55 years. The rate of hypertension was high 62.5% while only 37.5% were current smokers and 75% of the patients had more than one cardiovascular risk factor. Chest pain was found in 12.5%. 38% had mitral valvular disease, 38% had aortic valvular disease and 30% both. The analysis showed that in our population, age and systemic arterial hypertension (SAH) were the most related to CAD in rheumatic valvular disease. the prevalence of CAD among RVHD patients is low. Gender, age and SAH were identified as being strongly associated with the presence of CAD in our population.

OP-261 Asymptomatic Low Ejection Fraction Patients and Coronary Artery Disease Frequency

OP-261 Asymptomatic Low Ejection Fraction Patients and Coronary Artery Disease Frequency

Factors Affecting Survival in Men Versus Women Following Transcatheter Aortic Valve Implantation

Although transcatheter aortic valve implantation (TAVI) for severe aortic stenosis is becoming an established technique, the impact of gender-related differences remains unclear. Two hundred twenty-four consecutive patients undergoing TAVI were prospectively followed up in a tertiary medical center. The primary end point of the present study was all-cause mortality at 2 years of follow-up. Interaction-term analysis was used to identify gender-specific predictors of mortality after TAVI. Fifty-seven percent of the study patients were women. Age was similar (82 ± 7 years). Compared with men, women had a lower frequency of coronary artery disease (CAD) and a higher baseline left ventricular ejection fraction (LVEF). The cumulative probability of all-cause mortality was significantly lower among women (8.6%) compared with men (26.8%; log-rank p value <0.001). A lower baseline LVEF (<45%) was associated with a significant, more than fourfold (p = 0.0019 and 0.048, respectively), increase in mortality risk among both men and women (p value for gender-by-LVEF interaction = 0.87). In contrast, the risk associated with the presence of previous CAD was shown to be gender related. Thus, in women, CAD was associated with a pronounced >14-fold increase in mortality risk, whereas in men, CAD was not associated with a significant mortality risk (p value for gender-by-LVEF interaction = 0.01). In conclusion, our findings suggest that risk assessment before TAVI should consider gender-specific differences in survival and risk factors.

Assessment of the Relationship between Non-Alcoholic Fatty Liver Disease and CAD using MSCT

BackgroundSome risk factors for atherosclerosis are followed by non-alcoholic fatty liver disease (NAFLD). We wanted to use Multislice computed tomography (MSCT) as technique for searching relationship between NAFLD and coronary artery disease (CAD). ObjectiveThe relationship between NAFLD and CAD was investigated using MSCT. MethodsA total of 372 individuals with or without cardiac symptoms who had undergone MSCT angiography were included in the study. The patients were divided into two groups according to the presence of NAFLD. Coronary artery segments were visually evaluated via MSCT angiography. Based on the coronary artery stenosis degree, those with no or minimal plaques were considered normal, whereas those who had stenosis of less than 50% and at least one plaque were considered to have non-obstructive coronary artery disease (non-obsCAD). The patients who had at least one plaque and coronary artery stenosis of 50% or more were considered to have obstructive coronary artery disease (obsCAD). NAFLD was determined according to the MSCT protocol, using the liver density. ResultsAccording to the liver density, the number of patients with non-alcoholic fatty liver disease (group 1) was 204 (149 males, 54.8%) and with normal liver (group 2) was 168 (95 males, 45.2%). There were 50 (24.5%) non-obsCAD and 57 (27.9%) obsCAD cases in Group 1, and 39 (23.2%) non-obsCAD and 23 (13.7%) obsCAD cases in Group 2. ConclusionsThe present study using MSCT demonstrated that the frequency of coronary artery disease in patients with NAFDL was significantly higher than that of patients without NAFDL.

Associations of Symptomatic or Asymptomatic Peripheral Arterial Disease with All-Cause and Cardiovascular Mortality after 3 Years Follow Up: The China Ankle-Brachial Index Cohort Study

Objective: This study aim to investigate all cause and cardiovascular mortality in Chinese in patients with symptomatic or asymptomatic Peripheral Arterial Disease (PAD) in comparison to those without PAD. Methods: All the subjects were inpatients at high risk of atherosclerosis and consecutively enrolled from July to November, 2004. A total of 3210 were followed up until an end-point was reached or until February 2008.The mean follow-up time was 38 ± 2 months. Results: Compared with non-PAD, PAD patients had significantly higher frequency of coronary artery disease, hypertension, diabetes mellitus, dyslipidemia, stroke or smoking (all P<0.01). The all cause mortality and cardiovascular mortality in patients with PAD were 25.5% and 15.6%, respectively. Those with symptomatic and asymptomatic PAD had a statistically significant higher all cause and cardiovascular mortality compared to those without PAD (P<0.01).The symptomatic PAD patients were 1.834 times (95% CI: 1.225-2.746) as likely to die as those without PAD, and 1.650 times (95% CI: 1.303-2.088) in asymptomatic PAD patients after adjusting for other factors. Those with symptomatic or asymptomatic PAD had more than twice as likely to die of cardiovascular disease as those without PAD (RR: 2.243, 95% CI: 1.363-3.691 and RR: 2.100, 95% CI: 1.561-2.824, respectively). Conclusion: In comparison to non-PAD patients, those with PAD were associated with a higher all cause and cardiovascular mortality whether or not PAD is symptomatic. ABI as a marker of atherosclerosis should be routinely done to evaluate PAD in elder patients in China.

Prevalence of cardiovascular diseases in HIV-infected outpatients: results from a prospective, multicenter cohort study

Recent studies suggest a rising rate of cardiovascular disease (CVD) in HIV-infected subjects. Although most countries have an aging HIV-infected population, there remains a lack of knowledge about associated cardiovascular diseases. This ongoing prospective multicentre observational cohort study aims to elucidate CVD prevalence in HIV-infected outpatients by standardized non-invasive cardiovascular screening. Cardiovascular and coronary risk was calculated using Framingham risk scores. 803 HIV-infected subjects (mean age 44.2years, female 16.6%) were included. The prevalence of CVD in HIV-infected subjects was 10.1% (95% CI 8.0-12.2%). Aging HIV-infected patients (≥45years, N=348) exhibited significantly increased rates of CVD, including an elevated frequency of coronary artery disease (7.5 vs. 1.8%, p<0.001), myocardial infarction (6.0 vs. 1.8%, p=0.002) and peripheral arterial diseases (4.6 vs. 1.5%, p<0.017). Furthermore, aging patients exhibited a higher rate of chronic heart failure (5.2 vs. 1.5%, p<0.001), predominantly of ischemic etiology. In multivariate analyses, age (OR 2.05 per decade, 95% CI 1.64-2.56), smoking (OR 5.96 per decade, 95% CI 2.31-15.38) and advanced symptomatic HIV infection (OR 2.60 per decade, 95% CI 1.31-5.15), were significantly associated with the prevalence of CVD. Based on the 10-year cardiovascular risk estimation, a disproportionate increase in cardiac events has to be expected in aging HIV-infected subjects in the next decades (≥45years/<45years 16.4 vs. 4.2%, p<0.001). CVD in aging HIV-infected population is an increasing medical challenge. In the era of antiretroviral therapy, prevention and diagnostic strategies are essential to reduce the prevalence of CVD in HIV-infected patients.

THE IMPACT OF AGE AND SEX IN THE PATTERN OF CORONARY ARTERY DISEASE

Coronary Artery Disease (CAD) is the primary cause of death in the world. Over the last threedecades, invasive procedures such as coronary artery bypass grafting (CABG) and percutaneouscoronary interventions (PCI) have resulted in significant improvements in survival and quality oflife for patients. Besides traditional modifiable risk factors, it has been proved that some fixed, nonmodifiablefactors contribute in the behaviour of coronary involvement. To see whether the age andsex as a coronary risk factor contribute this differential coronary involvement, we conducted thisstudy.Objective: To determine the frequency of coronary artery disease (CAD) as it varies with age andgender.Methods: It is a descriptive study carried out at NICVD Karachi. All the subjects were adults withprevious history of ischemic heart disease and recommended coronary angiography based onhistory and non-invasive tests.Results: There were 79.6% male patients and the mean age was 52 years (ranged from 28 to 85year). In 80% of patient femoral artery access was used for performing the procedure. Rightcoronary artery was found dominant in 73% angiograms.Left anterior descending artery was the most frequently involved artery(73.6%) among majorcoronary arteries and obtuse marginal was most frequently involved (20.4%) branche artery.Ramus intermedius was found diseased in 4.2%.The frequency of involvement of Left Main arteryand distal segments of major coronary arteries was increased with advancing age but there was nosignificant association between age and sex and involvement of other coronary arteries.Conclusion: In conclusion males have a higher recorded rate of coronary angiography and singlevessel disease is the most common finding. Females and ages above 80 and below 40 had lowincidence of angiographic events.

Incidence of acute myocardial infarction in the evolution of dialysis patients.

Although the estimated frequency of coronary artery disease (CAD) in patients on dialysis is very high, there is considerable variation in the studies published to date regarding the rate of acute myocardial infarction (AMI) in these patients. To establish the incidence of AMI and to analyse the characteristics and consequences of this entity on the clinical progression of incident dialysis patients. We recorded AMI in the patients treated in our dialysis unit between 01/01/1999 and 31/12/07. The variables assessed were: prior diagnosis of diabetes, hypertension, CAD (AMI or lesions observed in coronary angiography), ischaemic cerebrovascular accident, advanced peripheral artery disease (PAD), atrial fibrillation and tobacco use. Biochemical analyses included: urea, creatinine, haematocrit, calcium, phosphorous, iPTH, lipids and albumin. Follow-up lasted until transplant, death, loss to follow-up or study end in Dec. 2010. Of the 576 patients recruited (aged 64.6 ± 16 years), 24.7% had diabetes, 82.3% were on haemodialysis (17.7% on peritoneal dialysis), and 34 (5.9%) had a previous diagnosis of CAD. In a follow-up lasting a mean of 40.2 ± 32 months (1931.5 patient-years), 40 patients (6.9%) suffered an AMI. The incidence was 2.13/100 patient-years. The patients without CAD had an incidence of 1.84/100 patient-years and those with a previous diagnosis of CAD had an incidence of 7.53/100 patient-years. In 22.5% of patients, AMI happened in the first 3 months of dialysis, and 37.5% in the 1st year. Of the 40 AMI, 15 were with ST-segment elevation (incidence: 0.79/100 patient-years) and 25 were non ST-segment elevation (incidence: 1.33/100 patient-years). The factors that predicted the occurrence of AMI in dialysis were older age (OR: 1.037; 95% CI: 1.009-1.067; P=.011), previous CAD (OR: 3.35; 95% CI: 1.48-7.16; P=.004), and diabetes as a cause of nephropathy (OR: 2.96; 95% CI: 1.49-5.86; P=.002). In-hospital mortality was 30%, with 72.5% of deaths occurring in the 1st year and 82.5% in the 2nd; 80% of the patients who underwent a coronary angiography had multi-vessel disease. The incidence of AMI in incident dialysis patients is high. In previous coronary disease patients, the incidence is 3-fold higher. Post-infarction mortality is very high and multi-vessel disease is very frequent.

Comparison of the Frequency of Coronary Artery Disease in Alcohol-Related Versus Non-Alcohol-Related Endstage Liver Disease

There are conflicting data as to the prevalence of coronary artery disease (CAD) in patients with end-stage liver disease (ESLD) being assessed for liver transplantation (LT). The aims of this study were to compare the prevalence of CAD in patients with alcohol-related versus non-alcohol-related ESLD and to assess the diagnostic utility of dobutamine stress echocardiography (DSE) in predicting angiographically important CAD. Consecutive patients with ESLD being assessed for LT (n = 420, mean age 56 ± 8 years) were identified and divided into groups of those with alcohol-related ESLD (n = 125) and non-alcohol-related ESLD (n = 295). Demographic characteristics, CAD risk factors, results of DSE, and coronary angiographic characteristics were recorded. There were no significant differences in age or CAD risk factors between groups. The incidence of severe CAD (>70% diameter stenosis) was 2% in the alcohol-related ESLD group and 13% in the non-alcohol-related ESLD group (p <0.005). In the 2 groups, the presence of ≥1 CAD risk factor was associated with significant CAD (p <0.05 for all). Absence of cardiac risk factors was highly predictive in ruling out angiographically significant disease (negative predictive value 100% for alcohol-related ESLD and 97% for non-alcohol-related ESLD). DSE was performed in 205 patients. In the 2 groups, DSE had poor predictive value for diagnosing significant CAD but was useful in ruling out patients without significant disease (negative predictive value 89% for alcohol-related ESLD and 80% for non-alcohol-related ESLD). In conclusion, there was a significantly lower prevalence of severe CAD in patients with alcohol-related ESLD. These findings suggest that invasive coronary angiography may not be necessary in this subgroup, particularly in the absence of CAD risk factors and negative results on DSE.

Elevated NT-proBNP and coronary calcium score in relation to coronary artery disease in asymptomatic type 2 diabetic patients with elevated urinary albumin excretion rate

Elevated plasma N-terminal (NT)-proBNP levels and coronary calcium score (CCS) not only predicts myocardial ischaemia and coronary artery stenosis but also adverse cardiovascular events and mortality in type 2 diabetic patients with an increased urinary albumin excretion rate (UAER), whereas low levels are associated with low frequency of coronary artery disease (CAD) and good prognosis. The underlying causes of poor prognosis in patients with elevated NT-proBNP are not known; thus, we investigated the role of putative asymptomatic CAD in type 2 diabetic patients with UAER >30 mg/24 h and elevated P-NT-proBNP and/or CCS. We identified 200 type 2 diabetic patients without known CAD and with normal creatinine levels. Patients with P-NT-proBNP >45.2 ng/L (the median P-NT-proBNP value in this cohort and in accordance with our previous findings) and/or CCS ≥ 400 were stratified as high-risk patients for CAD (n = 133) and all other patients as low-risk patients (n = 67). High-risk patients were examined by myocardial perfusion imaging (MPI; n = 109) and/or computer tomography angiography (n = 20) and/or coronary angiography (CAG; n = 86). All patients received intensive mulitifactorial intervention. In 70 of 133 (53%) high-risk patients, significant CAD was demonstrated by MPI and/or CAG, corresponding to 35% (70/200) of the total cohort. Among high-risk patients, CCS but not P-NT-proBNP was paralleled by increased prevalence of significant CAD and in the 86 patients where CAG was performed, a CCS <100 had a negative predictive value for coronary artery stenosis of 94% (P = 0.04). Our study revealed that >50% of asymptomatic type 2 diabetic patients with UAER >30 mg/24 h had significant CAD based on risk stratification with P-NT-proBNP and CCS. This provides some explanation to the previously reported poor prognosis in these asymptomatic patients. Optimized cardio protective treatment in these patients is warranted.

Successful Percutaneous Coronary Intervention for Acute Coronary Syndrome in a Patient With Severe Hemophilia A

Patients with hemophilia generally have a reduced frequency of coronary artery disease compared to the general population. As advances in the management of hemophilia have increased their life expectancy, the prevalence of coronary artery disease also has increased. However, there are no standard treatment guidelines for coronary artery disease in patients with hemophilia, especially in the field of coronary intervention. We report the case of a patient with severe hemophilia A who presented with acute coronary syndrome and was successfully treated with percutaneous coronary intervention.

Left Ventricular Mass and Volume With Telmisartan, Ramipril, or Combination in Patients With Previous Atherosclerotic Events or With Diabetes Mellitus (from the ONgoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial [ONTARGET

The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) showed that the angiotensin receptor blocker telmisartan 80 mg was not inferior to the angiotensin-converting enzyme inhibitor ramipril 10 mg, and the combination no more effective than ramipril alone, in decreasing morbidity and mortality in patients with cardiovascular disease or high-risk diabetes. Although therapy targeting angiotensin II is known to decrease left ventricular (LV) mass and volume, the relative influence of angiotensin-converting enzyme inhibitor inhibitors and angiotensin receptor blocker, and their combination, on the heart remains unclear in this population. Magnetic resonance imaging was performed in 287 patients enrolled in ONTARGET, across 8 centers in 6 countries, at randomization and after 2-year treatment (90, 100, and 97 patients in the ramipril, telmisartan, and combination therapy groups, respectively). Baseline patient characteristics showed higher frequencies of coronary artery disease, Asian ethnicity, and use of statins and beta blockers than the main ONTARGET trial. LV mass decreased in all groups (p <0.0001 for each), but there were no significant differences in change in LV mass or volume among groups, except that LV mass index decreased more on combination versus telmisartan (p = 0.04). Key determinants of LV mass decrease were a history of hypertension (p = 0.03), baseline mass (p <0.0001), and decrease in systolic blood pressure (p <0.0001). The best magnetic resonance imaging predictor of composite events was end-systolic volume (p <0.0001). In conclusion, telmisartan and ramipril had similar effects on LV mass and volume, and combination therapy was not more effective, in high-risk patients with cardiovascular disease. These results are consistent with the major outcome findings of the main ONTARGET study.

The cardiac MRI substudy to ongoing telmisartan alone and in combination with ramipril global endpoint trial/telmisartan randomized assessment study in ACE-intolerant subjects with cardiovascular disease: analysis protocol and baseline characteristics

The ONTARGET and TRANSCEND clinical trials were designed to investigate the cardioprotective effects of telmisartan 80 mg and ramipril 10 mg, alone and in combination, in patients at high risk of cardiovascular disease. Cardiac MRI enables investigation of mechanistic effects of these agents on cardiac structural and functional variables. Here, we report the design, analysis protocol, reproducibility and relevant quality control procedures, and baseline patient characteristics of the ONTARGET/TRANSCEND cardiac MRI substudy. MRI was undertaken in 330 subjects enrolled in ONTARGET, and 38 subjects in TRANSCEND, across eight centers in six countries. Analyses were performed by two independent analysts using guide-point modeling. Cases with discrepancies in LV mass (LVM) of >5% were independently reanalyzed. Cases with discrepancies in end-diastolic volume (EDV) of >5%, or end-systolic volume (ESV) of >12%, were then reconciled by consensus. Baseline characteristics were broadly similar to the main ONTARGET/TRANSCEND trials, except for a higher frequency of coronary artery disease and Asian ethnicity in the substudy. Reproducibility of MRI analyses (mean +/- SD) were 2.8 +/- 3.7 ml in EDV, -0.3 +/- 3.6 ml in ESV, 3.1 +/- 3.3 ml in SV, 1.1 +/- 1.8% in EF, and 0.4 +/- 4.5 g in LVM. Subgroup analyses revealed increased ESV and LVM, and reduced EF, in subjects with a history of either coronary artery disease or myocardial infarction. The ONTARGET/TRANSCEND cardiac MRI substudy protocol provides for a reliable assessment of the effects of telmisartan and ramipril, alone and in combination, on cardiac structural and functional parameters over a 2-year follow-up period.

Distribution and risk factors of steno-occlusive lesions in patients with ischemic cerebrovascular disease

To investigate the distribution of atherosclerotic steno-occlusive lesions in Chinese patients with ischemic cerebrovascular disease and the risk factors for occlusive lesions of intracranial and extracranial arteries. 583 consecutive patients with ischemic cerebrovascular disease, 449 males and 134 females, aged 18-86, 415 with cerebral infarction and 168 with transient ischemic attack (TIA), underwent angiography. The angiographic findings and relevant clinical; data were analyzed. Fifty of the 583 patients had normal findings in angiography and 527 had occlusive lesions of different degrees, among which 24.3% had only extracranial artery disease (EAD), 36.8% had only intracranial disease (IAD), and 38.9% had both EAD and IAD. In total the incidence of IAD was 75.6%, higher than that of EAD (63.2%). In the carotid TIA patients the percentage of IAD was significantly higher than that of the EAD (P = 0.005), and in the cerebral infarction patients the percentage of IAD was higher than that of the EAD, but now significantly. In the patients with TIA of vertebrobasilar artery the incidence of IAD was significantly higher than that of the EAD (P < 0.01). The proportion of pure IAD alone was high in patients aged < or =40 was 75.5% with the middle cerebral artery as the most frequently involved site, while the proportion of coexistence of IAD and EAD was high in the middle-aged and old-aged groups (39.4% and 48.0% respectively, P < 0.001) with the origin of internal carotid artery as the commonest site of lesions. Multivariable Logistic regression identified age, diabetes, hyperlipidemia, and coronary artery disease as the independent risk factors for EAD, and hypertension, diabetes, and hyperlipidemia for IAD. The patients with EAD were significantly elder and had an increased frequency of coronary artery disease compared with those with IAD. In general, the morbidity of IAD was higher that that of EAD in the Chinese patients with ischemic cerebrovascular disease, and presents symptoms of both extracranial and intracranial arteries; however, pure EAD is not uncommon. The distribution pattern of occlusive disease differs among different groups of patients. The patients with EAD are often elder and have an increased frequency of coronary artery disease.

Hyperleptinemia as a Robust Risk Factor of Coronary Artery Disease and Metabolic Syndrome in Type 2 Diabetic Patients

Leptin has been linked to adiposity, insulin resistance, and coronary artery disease (CAD). We examined whether the leptin concentrations are associated with the risk of CAD and metabolic syndrome (MS). The plasma leptin concentrations were measured in 556 diabetic patients (341 men and 215 women). The odds ratio (OR) of CAD and MS were increased on moving from the lowest quartile (Q1) of leptin concentration to the highest quartile (Q4) and remained significant after adjusting for age, sex, BMI, concentrations of total cholesterol, triglyceride, or high-sensitivity C-reactive protein (hsCRP), and treatment modalities for hyperglycemia. The frequency of CAD was highest in the insulin resistant group (Q4 of homeostasis model assessment-insulin resistance index [HOMA-IR]) at Q4 of leptin concentration (34.5%), compared with that of Q4 of leptin (26.4%) or HOMA-IR (21.9%). In multivariate analysis, plasma leptin concentration was identified as the most significantly independent predictor for CAD (OR 10.24, 95% CI 3.01 to 45.05). Other variables with associated with CAD were age, sex, hypertension, low-HDL cholesterolemia, and hsCRP. In conclusion, hyperleptinemia might be an independent risk factor for CAD and MS in diabetic subjects. And the simultaneous measurement of insulin resistance and leptin concentration might be helpful for screening subjects with a high-risk of CAD.

The Relationship between Carotid and Coronary Atherosclerotic Damage in Dialysis Patients

Data relating carotid ultrasound (CU) to atherosclerotic damage evaluated by coronary angiography in hemodialysis patients are scarce. We carried out a cross-sectional study in 33 uremic subjects (age 55 +/- 12 years, 22 male, 7 diabetic), who have been on dialysis for 41 +/- 48 months (range 2-192). Twenty-two underwent a coronary angiography in order to complete clinical evaluation for inclusion on the kidney transplantation waiting list, and 11 because of coronary artery disease (CAD); Gensini's score was calculated. Intima-media thickness (IMT) and presence of plaques were related to the degree of coronary stenosis and to cardiovascular risk factors. Patients were divided into two groups depending on mean IMT (group 1 IM <or= 0.9 mm, n=18; group 2 IMT>0.9 mm, n=15). Group 2 was older (60 +/- 8 vs 50 +/- 12 year, p=0.01), had higher frequency of CAD (53 vs 16%, p=0.02) and had higher prevalence of coronary artery stenosis >or= 75% in the right (60 vs 22%, p=0.02), left anterior descending (46 vs 16%, p=0.06) and left circumflex coronary arteriers (60 vs 11%, p=0.05) than group 1. IMT was not related to the degree of CAD evaluated by Gensini's score. IMT sensibility and specificity in detecting the presence of hemodynamically significant coronary stenosis were 64% and 68%, respectively. Coronary narrowing was correlated with the degree of stenosis of common, internal and external carotid arteries (Spearman's rank correlation coefficient). During two years of follow-up, six major cardiac events were recorded and they were related to Gensini's score. In uremic patients, ultrasonographic evaluation of carotid arteries is a simple, noninvasive examination that could be a helpful tool in detecting coronary atherosclerotic damage, but IMT does not appear to add more information regarding risk stratification of CAD.