Future Myocardial Infarction Research Articles

Predicting Coronary Heart Disease: From Framingham Risk Score to Ultrasound Bioimaging

Atherosclerosis is the leading cause of death and disabling disease. Whereas risk factors are well known and constitute therapeutic targets, they are not useful for prediction of risk of future myocardial infarction, stroke, or death. Therefore, methods to identify atherosclerosis itself have been tested and found useful (ie, coronary calcium detection by computed tomography scanning, reduction in ankle-brachial index, and ultrasound scanning of the carotid arteries). This review will focus on the latter technique. Detection of thickened carotid intima-media by ultrasound has been used in many large epidemiological studies, but although it has been found to be associated with increased risk of cardiovascular death, its clinical utility is limited. Detection of carotid plaque has, on the other hand, been found to be associated with a substantial risk of future events. Similarly, detection of plaque in the femoral arteries is associated with increased risk, and plaque in the femoral as well as carotid arteries predicts even higher risk. Furthermore, quantification of plaque size (plaque area), such as quantification of amount of coronary calcium on computed tomography scanning, improves predictability-the larger the plaques, the higher the risk. So far, studies using ultrasound all have been performed with 2-dimensional ultrasound imaging. Recently, 3-dimensional ultrasound imaging has been introduced, which allows for more accurate quantification of atherosclerosis. Small studies pioneering its use have indicated the utility of measuring changes in vessel-wall volume and plaque volume with respect to treatment effect. The High-Risk Plaque Initiative BioImage Study is currently investigating the predictive value of total carotid plaque volume with respect to prediction of future cardiovascular events.

Predicting myocardial infarction and other serious cardiac outcomes using high-sensitivity cardiac troponin T in a high-risk stable population

ObjectivesPrevious work on high-sensitivity troponin I (hs-cTnI) has demonstrated that it may identify patients with stable cardiovascular disease (CVD) at risk for future myocardial infarction (MI). In this study, we assessed if hs-cTnT concentrations could also identify those stable CVD patients at high risk for future MI and other ischemic cardiac outcomes. Methodshs-cTnT (lot:153-401) was measured in specimens obtained at randomisation in the Heart Outcomes Prevention Evaluation (HOPE) study (n=2941 stable CVD patients, 4.5years follow-up). The primary outcome for the HOPE study (MI, stroke, or cardiovascular death) was used to identify cutoffs by receiver operating characteristic (ROC) curve analysis and was used in conjunction with the 95th and 99th percentile upper limits to construct different concentration ranges, which were assessed using log-rank tests and multivariable Cox proportional hazard models. These different concentration ranges were then assessed for the components of the primary outcome and for heart failure (HF). ResultsThe ROC derived hs-cTnT cutoff was 8ng/L for the primary outcome. Subjects with hs-cTnT either below (8 to <14ng/L) or slightly above the published 99th from a healthy population (14 to 21ng/L) had similar probability for the primary outcome. Those with hs-cTnT concentrations >31ng/L had the highest probability and greatest risk for future MI, HF, and cardiovascular death as compared to those with hs-cTnT concentrations <8ng/L. ConclusionIn patients with stable CVD disease hs-cTnT measurement identifies those at risk for MI as well as HF and cardiovascular death.

Matrix Metalloproteinase-9 (MMP-9) and Myeloperoxidase (MPO) Levels in Patients with Nonobstructive Coronary Artery Disease Detected by Coronary Computed Tomographic Angiography

The aim of this study was to evaluate whether matrix metalloproteinase-9 (MMP-9) and myeloperoxidase (MPO) are elevated in patients with nonobstructive coronary artery disease. Eighty-four patients with nonobstructive coronary artery disease (group A) and 90 patients with no coronary plaques (group B) were enrolled. MMP-9 and MPO levels were compared between the two groups. The relationships between these biomarkers and Framingham risk score were analyzed. Receiver-operating characteristic curves were used to evaluate the ability of these biomarkers to predict the presence of coronary artery plaques. The MMP-9 and MPO values in group A were significantly higher than in group B (P < .001). The levels of MMP-9 and MPO showed significant correlations with Framingham risk score (r = 0.796, P < .001, and r = 0.409, P < .001, respectively). The areas under the receiver-operating characteristic curves for MMP-9 and MPO were 0.80 (95% confidence interval, 0.74-0.87) and 0.74 (95% confidence interval, 0.66-0.81), respectively. Levels of MMP-9 and MPO are positively correlated with Framingham risk score. Additionally, in patients with nonobstructive coronary artery disease, elevated levels of MMP-9 and MPO may identify patients at risk for future myocardial infarction or sudden cardiac death.

The levels of MDA-LDL in circulating immune complexes predict myocardial infarction in the VADT study

ObjectiveCirculating immune complexes (IC) containing modified forms of LDL (mLDL) are strongly pro-inflammatory and strong predictors of cardiovascular disease (CVD) progression in type 1 diabetes. The present study was undertaken to determine whether the levels of oxidized LDL (oxLDL), malondialdehyde-LDL (MDA-LDL) and advanced glycation end products-LDL (AGE-LDL) in IC predict incident CVD events in type 2 diabetes (VADT cohort). Methods and resultsLevels of mLDL in IC were measured in 907 patients of the VADT cohort, a median of two years after entry into the study. Participants were followed for an average of 3.7 years for vascular outcomes. Hazard ratios (HRs) for CV endpoints in relation to mLDL-IC quartiles were calculated by Cox proportional hazard models. The primary composite CVD endpoint included documented myocardial infarction (MI); stroke; death from CVD; congestive heart failure; cardiac, cerebrovascular, or peripheral VD surgical intervention; inoperable CVD; and amputation for ischemic gangrene. During follow-up, 4.7% and 16.8% of participants had an MI or a composite endpoint, respectively. After adjustments by conventional risk factors, individuals in the highest quartile of MDA-LDL-IC were at higher risk of MI [HR = 2.44 (95% CI: 1.03, 5.77)] and composite endpoint [HR = 1.71 (95% CI: 1.04, 2.80)], relative to individuals in the lowest quartile. Similar comparisons for oxLDL and AGE-LDL levels yielded HR values of 1.08 and 1.31 for MI and 0.91 and 1.34 for composite endpoint. ConclusionsOur study indicates that high levels of MDA-LDL in isolated IC predict future MI and acute CV events in patients with type 2 diabetes.

Association Study of CRP Gene and Ischemic Stroke in a Chinese Han Population

High-sensitivity C-reactive protein (hsCRP) was reported as a strong, independent predictor of future myocardial infarction and stroke. It is of importance to illustrate the conformance of CRP genetic variation, increment of plasma hsCRP and cerebral events. A case-control study including 548 patients with acute ischemic stroke and 993 age-matched controls from community-based population was conducted and four tagging SNPs (tagSNPs) were genotyped. Multiple logistic regression was applied to evaluate the association of CRP gene and stroke hsCRP elevation with adjustment for covariates. The results indicated that rs3093059 and rs3091244 presented statistical associations with ischemic stroke. Odds ratios (ORs) (95 % confidence interval [CI]) of additive model, dominant model and minor allele at rs3093059 were 0.697 (0.528-0.921), 0.671 (0.487-0.923) and 0.811 (0.666-0.988), and ORs (95 % CI) of dominant model at rs3091244 was 0.728 (0.536-0.988), after adjusting for covariates. But there were no significant differences of genotype or allele frequencies of the four SNPs observed between hypertension (HT) and normal blood pressure (NBP) groups. Further analyses indicated the genetic variations of rs876537 and rs3093059 were positively associated with increased square root transformed hsCRP and hsCRP elevation (≥3 mg/l) in ischemic stroke patients, and rs876537 and rs3091244 were associated with hsCRP elevation in controls as well. Our finding suggests that the CRP genetic polymorphisms were associated with decreased risk of ischemic stroke and elevated plasma hsCRP and further replication study and functional research would be warranted.

Prospective Study on Circulating MicroRNAs and Risk of Myocardial Infarction

This study sought to explore the association between baseline levels of microRNAs (miRNAs) (1995) and incident myocardial infarction (1995 to 2005) in the Bruneck cohort and determine their cellular origin. Circulating miRNAs are emerging as potential biomarkers. We previously identified an miRNA signature for type 2 diabetes in the general population. A total of 19 candidate miRNAs were quantified by real-time polymerase chain reactions in 820 participants. In multivariable Cox regression analysis, 3 miRNAs were consistently and significantly related to incident myocardial infarction: miR-126 showed a positive association (multivariable hazard ratio: 2.69 [95% confidence interval: 1.45 to 5.01], p = 0.002), whereas miR-223 and miR-197 were inversely associated with disease risk (multivariable hazard ratio: 0.47 [95% confidence interval: 0.29 to 0.75], p = 0.002, and 0.56 [95% confidence interval: 0.32 to 0.96], p = 0.036). To determine their cellular origin, healthy volunteers underwent limb ischemia-reperfusion generated by thigh cuff inflation, and plasma miRNA changes were analyzed at baseline, 10 min, 1 h, 5 h, 2 days, and 7 days. Computational analysis using the temporal clustering by affinity propagation algorithm identified 6 distinct miRNA clusters. One cluster included all miRNAs associated with the risk of future myocardial infarction. It was characterized by early (1 h) and sustained activation (7 days) post-ischemia-reperfusion injury and consisted of miRNAs predominantly expressed in platelets. In subjects with subsequent myocardial infarction, differential co-expression patterns of circulating miRNAs occur around endothelium-enriched miR-126, with platelets being a major contributor to this miRNA signature.

Acute impact of apheresis on oxidized phospholipids in patients with familial hypercholesterolemia

We measured oxidized phospholipids (OxPL), lipoprotein (a) [Lp(a)], and lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) pre- and postapheresis in 18 patients with familial hypercholesterolemia (FH) and with low(∼10 mg/dl; range 10-11 mg/dl), intermediate (∼50 mg/dl; range 30-61 mg/dl), or high (>100 mg/dl; range 78-128 mg/dl) Lp(a) levels. By using enzymatic and immunoassays, the content of OxPL and Lp-PLA(2) mass and activity were quantitated in lipoprotein density fractions plated in microtiter wells, as well as directly on apoB-100, Lp(a), and apoA-I immunocaptured within each fraction (i.e., OxPL/apoB and Lp-PLA(2)/apoB). In whole fractions, OxPL was primarily detected in the Lp(a)-containing fractions, whereas Lp-PLA(2) was primarily detected in the small, dense LDL and light Lp(a) range. In lipoprotein capture assays, OxPL/apoB and OxPL/apo(a) increased proportionally with increasing Lp(a) levels. Lp-PLA(2)/apoB and Lp-PLA(2)/apoA-I levels were highest in the low Lp(a) group but decreased proportionally with increasing Lp(a) levels. Lp-PLA(2)/apo(a) was lowest in patients with low Lp(a) levels and increased proportionally with increasing Lp(a) levels. Apheresis significantly reduced levels of OxPL and Lp-PLA(2) on apoB and Lp(a) (50-75%), particularly in patients with intermediate and high Lp(a) levels. In contrast, apheresis increased Lp-PLA(2)-specific activity (activity/mass ratio) in buoyant LDL fractions. The impact of apheresis on Lp(a), OxPL, and Lp-PLA(2) provides insights into its therapeutic benefits beyond lowering apoB-containing lipoproteins.

Polymorphisms Related to the Serum 25-Hydroxyvitamin D Level and Risk of Myocardial Infarction, Diabetes, Cancer and Mortality. The Tromsø Study

ObjectiveLow serum 25(OH)D levels are associated with cardiovascular risk factors, and also predict future myocardial infarction (MI), type 2 diabetes (T2DM), cancer and all-cause mortality. Recently several single nucleotide polymorphisms (SNPs) associated with serum 25-hydroxyvitamin D (25(OH)D) level have been identified. If these relations are causal one would expect a similar association between these SNPs and health.MethodsDNA was prepared from subjects who participated in the fourth survey of the Tromsø Study in 1994–1995 and who were registered with the endpoints MI, T2DM, cancer or death as well as a randomly selected control group. The endpoint registers were complete up to 2007–2010. Genotyping was performed for 17 SNPs related to the serum 25(OH)D level.ResultsA total of 9528 subjects were selected for genetic analyses which were successfully performed for at least one SNP in 9471 subjects. Among these, 2025 were registered with MI, 1092 with T2DM, 2924 with cancer and 3828 had died. The mean differences in serum 25(OH)D levels between SNP genotypes with the lowest and highest serum 25(OH)D levels varied from 0.1 to 7.8 nmol/L. A genotype score based on weighted risk alleles regarding low serum 25(OH)D levels was established. There was no consistent association between the genotype score or individuals SNPs and MI, T2DM, cancer, mortality or risk factors for disease. However, for rs6013897 genotypes (located at the 24-hydroxylase gene (CYP24A1)) there was a significant association with breast cancer (P<0.05).ConclusionOur results do not support nor exclude a causal relationship between serum 25(OH)D levels and MI, T2DM, cancer or mortality, and our observation on breast cancer needs confirmation. Further genetic studies are warranted, particularly in populations with vitamin D deficiency.Trial RegistrationClinicalTrials.gov NCT01395303

Levels of MDA-LDL in Circulating Immune Complexes Predict Myocardial Infarction in the Veterans Affairs Diabetes Trial (VADT) Cohort

Synopsis: In previous studies, authors have demonstrated a relationship between modified low-density lipoprotein (LDL) and cardiovascular disease (CVD); however, few have examined the relationship between the content of modified LDL in circulating immune complexes (ICs) and CVD, even though the majority of modified LDL in plasma circulates as part of immune complexes. Purpose: To determine whether high levels of oxidized LDL (oxLDL), malondialdehyde-LDL (MDA-LDL), and advanced glycation end products-LDL (AGE-LDL) in circulating IC are associated with incident cardiovascular events in the VADT cohort of type 2 diabetes (T2DM). Methods: We performed prospective analyses to determine associations between modified LDL-IC and vascular end points among 907 VADT subjects (mean age 59.8 years; 96.8% male; 40.9% minority). Modified LDL-IC were measured a median of 2 years after entry into the VADT study, and participants were subsequently followed an average of 3.7 years for outcomes. Cox proportional hazard models were used to calculate hazard ratios (HRs) for macrovascular end points in relation to modified LDL-IC quartile. The primary composite end point included documented myocardial infarction (MI); stroke; death from cardiovascular causes; new or worsening congestive heart failure; surgical intervention for cardiac, cerebrovascular, or peripheral vascular disease; inoperable coronary artery disease; and amputation for ischemic gangrene. Results: During follow-up, 16.8%, 4.7% and 6.4% of participants had a primary composite end point, MI or death, respectively. After wed adjusted for age, minority status, treatment arm, whether an individual had an event before the VADT, as well as systolic blood pressure (SBP) level, LDL-C level and statin use at the time of IC measurement, individuals in the highest quartile of MDALDL IC as compared with individuals in the lowest quartile of MDA-LDL IC were at greater risk of MI (hazard ratio [HR] 2.44; 95% confidence interval [95% CI] 1.0325.77) and the composite end point (HR 1.71; 95% CI 1.0422.80) but similar risk of all-cause mortality (HR 1.15; 95% CI 0.5222.52). In contrast, oxLDL-IC and AGE-LDL-IC were not associated with cardiovascular events. Moreover, subsequent analysis found that individuals with high MDA-LDL IC and low oxLDL-LDL IC were at particularly high risk of MI relative to individuals with low MDA-LDL IC and low oxLDL-IC (HR 3.46; 95% CI 1.5227.87). Results were similar when AGELDL IC was substituted for oxLDL-IC (HR 2.56; 95% CI 1.0626.20). Conclusions: Our study indicates that high levels of MDALDL in isolated IC predict future MI and cardiovascular events in patients with T2DM and supports distinct roles of different modified forms of LDL in the occurrence of macrovascular events.

Carotid intima-media thickness (cIMT) and plaque from risk assessment and clinical use to genetic discoveries

Summary Carotid intima–media thickness (cIMT) and carotid plaque are ultrasound imaging measures of carotid atherosclerosis and strong predictors of future stroke, myocardial infarction and vascular death. The use of ultrasound measures of cIMT and carotid plaque as a screening tool in clinical practice however have been extremely limited by a lack of recognition of its value by medical communities, health care policy makers and a lack of reimbursement by third-party payers engaged in the delivery of vascular imaging services. This review addresses the role of cIMT and plaque in vascular disease risk prediction. Recent data from large population based studies on reclassification of the vascular risk using carotid ultrasound imaging markers is presented. In addition, the common clinical scenarios for the appropriate use of cIMT in clinical setting are summarized according to the recent study conducted by the Society of the Atherosclerosis Imaging and Prevention in collaboration with the International Atherosclerosis Society. This presentation is intended to provide a practical guide for use of cIMT and plaque to clinicians to promote optimal clinical use of cIMT and to researchers to direct cIMT and plaque research towards investigating environmental and genetic factors of a complex disorder – subclinical atherosclerosis – leading to future genetic discoveries and new anti-atherosclerotic therapies.

The Association of Tooth Scaling and Decreased Cardiovascular Disease: A Nationwide Population-based Study

ObjectivePoor oral hygiene has been associated with an increased risk for cardiovascular disease. However, the association between preventive dentistry and cardiovascular risk reduction has remained undetermined. The aim of this study is to investigate the association between tooth scaling and the risk of cardiovascular events by using a nationwide, population-based study and a prospective cohort design. MethodsOur analyses were conducted using information from a random sample of 1 million persons enrolled in the nationally representative Taiwan National Health Insurance Research Database. Exposed individuals consisted of all subjects who were aged≥50 years and who received at least 1 tooth scaling in 2000. The comparison group of non-exposed persons consisted of persons who did not undergo tooth scaling and were matched to exposed individuals using propensity score matching by the time of enrollment, age, gender, history of coronary artery disease, diabetes, hypertension, and hyperlipidemia. ResultsDuring an average follow-up period of 7 years, 10,887 subjects who had ever received tooth scaling (exposed group) and 10,989 age-, gender-, and comorbidity-matched subjects who had not received tooth scaling (non-exposed group) were enrolled. The exposed group had a lower incidence of acute myocardial infarction (1.6% vs 2.2%, P<.001), stroke (8.9% vs 10%, P=.03), and total cardiovascular events (10% vs 11.6%, P<.001) when compared with the non-exposed group. After multivariate analysis, tooth scaling was an independent factor associated with less risk of developing future myocardial infarction (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.57-0.85), stroke (HR, 0.85; 95% CI, 0.78-0.93), and total cardiovascular events (HR, 0.84; 95% CI, 0.77-0.91). Furthermore, when compared with the non-exposed group, increasing frequency of tooth scaling correlated with a higher risk reduction of acute myocardial infarction, stroke, and total cardiovascular events (P for trend<.001). ConclusionTooth scaling was associated with a decreased risk for future cardiovascular events.

Abstract P347: The Impact of the Length of the Follow-up on the the Strengths of the Associations Between Cardiovascular Risk Factors and Future Myocardial Infarction, Stroke and Heart Failure

Objective: The aim of this study was to investigate how the length of the follow-up period influences the strength of the associations between major cardiovascular risk factors and different cardiovascular outcomes (myocardial infarction [MI], stroke and heart failure). Methods: We examined 1826 men aged 50 regarding cardiovascular risk factors in 1970-74. The follow-up time was 33 years. The hazard ratio (HR) was calculated yearly for each risk factor and outcome. During follow-up, 571 cases of MI, 381 cases of stroke and 384 cases of heart failure occurred. Results: Two major patterns were found regarding influence of the follow-up time on the associations between risk factors and the different cardiovascular outcomes. First, a gradual decline in the HR over time was seen for blood pressure in relation to all three outcomes, with the most rapid decline for heart failure and stroke. This pattern was also seen for BMI in relation to MI and heart failure, and for smoking regarding MI and stroke. Second, we observed a gradual increase in HRs to a maximum at 20-25 years, and thereafter a slight decline. This pattern was seen for the apoB/A1 ratio, HDL, and triglycerides, mainly in relation to MI and heart failure. Conclusion: The length of follow-up influenced the associations between traditional risk factors and cardiovascular outcomes in different ways. The collective influence of the risk factors did however show a substantial decline in discrimination over time for the outcomes stroke and heart failure, but not regarding myocardial infarction.

Correlation between the body fat composition and high sensitive C-reactive protein in Turkish adults

The adipose tissue is an active immune organ. High sensitive C-reactive protein CRP (hs-CRP) is a strong independent predictor of a possible future myocardial infarction and stroke, and it has also been shown to be related to the subclinical atherosclerosis. The aim of this study was to investigate the relation between the body fat composition, metabolic syndrome, and the hs-CRP plasma levels. Total 246 consecutive Turkish subjects, admitted to the internal medicine clinic with the diagnosis of diabetes mellitus, insulin resistance or metabolic syndrome, were included into the study. The total body fat composition was measured in every participant with a commercially available bio-impedance meter. The hs-CRP levels, body composition parameters, and biochemical variables were compared. The hs-CRP levels increased in parallel with the body weight in Turkish subjects. This increase was significant especially in the women. The waist circumference, body mass index (BMI), and body composition variables (visceral fat level, total body fat, and total body muscle mass) were significant correlates of the hs-CRP. The waist circumference and BMI were independent predictors of the hs-CRP. The waist circumference, BMI, and body composition variables (visceral fat level, total body fat and total body muscle mass) were significant correlates of the hs-CRP in Turkish adults. Body weight control may account for an important target especially in patients with the metabolic syndrome.

Gamma-glutamyl transferaze (GGT) activity and lipid concentration in patients with coronary artery disease (CAD)

A serum lipid profiles are established risk factors for atherosclerosis. High sensitivity C-reactive protein (hsCRP) level, are a powerful predictor of future myocardial infarction and cardiac death among apparently healthy individuals. The aim of this study was to investigate serum GGT activity and hsCRP level and others atherosclerosis biochemistry markers in patients with stable coronary artery disease. We studied 94 (women, n=45 and men, n=49), mean age was 64.8±9.7 years, consecutive patients with stable coronary artery disease (CAD), hospitalized in the Department of Cardiology Cardinal Wyszyński Hospital in Lublin. Patients with acute coronary syndroms (ACS) in history where 53% (n=51) of studied population (unstable angina n=3; no ST elevation myocardial infarction n=17, ST elevation myocardial infarction n=31). The patients with acute and chronic kidney disease, liver diseases, active autoimmune disease, malignancy, thyroids diseases, alcohol disease were excluded from the analysis. The patients had worse laboratory parameters than the reference group. They had increased concentration of TG, hsCRP and GGT activity, and decreased concentration of HDL-C as compared to the reference group. However, ALT activity and creatinine concentration were non-significantly increased vs. the controls. We concluded that dyslipidemia together with GGT activity and hsCRP concentration may be good markers to predict cardio-vascular events and vessels lesions in asymptomatic patients with CAD. However, these results require further studies.

Carbamylated Low-Density Lipoprotein: Nontraditional Risk Factor for Cardiovascular Events in Patients With Chronic Kidney Disease

The high cardiovascular morbidity and mortality associated with chronic kidney disease (CKD) cannot be explained entirely by traditional risk factors. Urea spontaneously dissociates to form cyanate, which modifies proteins ina process referred to as carbamylation. Carbamylated low-density lipoprotein (cLDL) has been shown to have all of the major biological effects relevant to atherosclerosis, including endothelial cell injury, increased expression of cell adhesion molecules, and vascular smooth muscle cell proliferation. Recent studies indicate that cLDL leads to endonuclease G activation, which participates in cellular injury. In addition, cLDL has been shown to enhance generation of oxidants. Limited human data have demonstrated high levels of cLDL in hemodialysis patients, with the highest levels in patients who have atherosclerosis. In 2 separate clinical studies, plasma levels of carbamylated protein independently predicted an increased risk of coronary artery disease, future myocardial infarction, stroke, and death. Future prospective studies to examine the association and/or predictive value of cLDL and studies to establish cause-effect relationship in patients with CKD are needed.

Abstract 17704: The Association of Tooth Scaling and Decreased Cardiovascular Disease -A Nationwide Population-Based Study

Background: Poor oral hygiene has been associated with increased risk for cardiovascular disease frequent tooth brushing has been reported to decrease the risk for CVD recently. However, the association between preventive dentistry and cardiovascular risk reduction remained undetermined. The aim of this study is investigate the effect of mouth scaling on cardiovascular disease and stroke risk, using a nationwide, population-based study and a retrospective cohort design. Methods: 51108 adult subjects without previous history of stroke or myocardial infarction (MI) who had received full or partial mouth scaling at least once were rerolled from the Taiwan National Health insurance. Another 51512 age-, gender-, and cormobidities-matched subjects without history of stroke or MI and did not receive mouth scaling comprised the comparison control. Cox proportional hazard regressions were performed as a means of comparing the cardiovascular events rate between these two cohorts. Results: During an average follow-up period of 7 years, a total of 102,620 patients were enrolled, of which 51,108 patients who had ever received tooth mouth scaling had lower incidence of acute MI and stroke when compared to the control group (0.55% vs. 0.44%, p=0,013 and 2.57% vs. 2.27%, p=0.002, respectively). The log-rank test and Kaplan-Meier survival analysis showed that patients with tooth scaling have significantly higher AMI- free and higher stroke-free survival rates ( p =0.027 and p= 0.04 respectively). Cox proportional hazard regression model analysis showed that tooth scaling was the independent factor associated with less risk of developing future MI (Hazard Ratio, HR, 0.76, 95% CI, 0.60-0.96; p =0.021) and stroke (HR 0.87, 95% CI, 0.78-0.96; p =0.007). Furthermore, the frequency of tooth scaling correlated with the risk reduction of MI with HR of 0.76 (95% CI, 0.60-0.96; p =0.021) and HR of 0.87 (95% CI, 0.71-1.07; p= 0.188), comparing often and occasional with never tooth scaling, respectively; stroke with HR 0.87, (95% CI, 0.78-0.96; p =0.007) and HR of 0.91 (95% CI, 0.83-1.00; p =0.045), comparing often and occasional with never tooth scaling, respectively. Conclusions: Tooth scaling was associated with decreased risk for cardiovascular risk and stroke.

Exercise testing and disease risk: individualized medicine without the “omics”?

exercise testing is a powerful physiological tool that can provide insights into cardiopulmonary fitness, all-cause mortality, and the risk of death from cardiovascular disease ([1][1], [9][2]). It can also be combined with a variety of other technologies to provide specific insight into a variety

High-Sensitivity Cardiac Troponin I Measurement for Risk Stratification in a Stable High-Risk Population

Past investigations regarding the utility of high-sensitivity cardiac troponin I (cTnI) assays have been focused primarily on the acute coronary syndrome setting. We assessed whether such assays can predict future ischemic cardiovascular events in a stable high-risk population. We quantified serum cTnI using an investigational high-sensitivity assay (hs-cTnI IUO, Beckman Coulter) in 2572 participants from the Heart Outcomes Prevention Evaluation (HOPE) study. The derived ROC curve cutoff and the 99th percentile for the hs-cTnI assay were assessed by Kaplan-Meier and Cox analyses for the primary outcome [composite of myocardial infarction (MI), stroke, and cardiovascular death] at 4.5 years of follow-up. We also assessed individual outcomes (MI, stroke, cardiovascular death) and the combined outcome (MI/cardiovascular death) by regression analyses to determine hazard ratios (HRs) and c statistics in models that included established risk factors, C-reactive protein, and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Participants with hs-cTnI >6 ng/L (ROC cutoff) were at higher risk for the primary outcome (HR 1.38, 95% CI 1.09-1.76; P = 0.008, adjusted models). For the individual outcomes, participants with hs-cTnI above the 99th percentile (≥10 ng/L) had higher risk for cardiovascular death (HR 2.15, 95% CI 1.32-3.52; P = 0.002) and MI (HR 1.49, 95% CI 1.05-2.10; P = 0.025) but not stroke (HR 1.38, 95% CI 0.76-2.47; P = 0.288, adjusted models). Addition of hs-cTnI to an established risk model with NT-proBNP also yielded a higher c statistic for the combined outcome of MI/cardiovascular death. The investigational Beckman Coulter hs-cTnI assay provides prognostic information for future MI and cardiovascular death in a stable high-risk population.

Significance of LDL-C lowering therapy in diabetic patients

Diabetes is considered to be a risk factor equivalent of pre-existing coronary heart disease for the development of future myocardial infarction and cardiovascular death. In addition to improved glucose control, the increased risk of coronary disease in diabetics makes intensive lipid-lowering treatment necessary. A number of studies have demonstrated that lipid-lowering therapy in diabetes is effective in decreasing the number of cardiac events. The most important objective in the treatment of diabetes is to reduce LDL-C to a target of <100 mg/dl. Different types of lipid-lowering drugs are available. Statins are the current lipid-lowering drugs of choice to reduce LDL-C. However, some questions remain unanswered. This article will describe and discuss the significance of LDL-C lowering therapy in subjects with diabetes.

Cardiac Arrhythmias in Obstructive Sleep Apnea (from the Akershus Sleep Apnea Project)

Increased prevalence of cardiac arrhythmias has been reported in patients with severe obstructive sleep apnea (OSA), but this may not be generalizable to patients from the general population with a milder form of the condition. The aim of this study was to assess the association between cardiac arrhythmias and OSA of mainly mild and moderate severity. In total, 486 subjects (mean age 49 years, 55% men) recruited from a population-based study in Norway underwent polysomnography for OSA assessment and Holter recordings for arrhythmia assessment. Of these, 271 patients were diagnosed with OSA (apnea-hypopnea index [AHI] ≥5, median AHI 16.8, quartiles 1 to 3 8.9 to 32.6). Mean nadir oxygen saturations were 82% and 89% in patients with and without OSA, respectively. Ventricular premature complexes (≥5/hour) were more prevalent in subjects with OSA compared to subjects without OSA (median AHI 1.4, quartiles 1 to 3 0.5 to 3.0) during the night (12.2% vs 4.7%, p = 0.005) and day (14% vs 5.1%, p = 0.002). In multivariate analysis after adjusting for relevant confounders, AHI was independently associated with an increased prevalence of ventricular premature complexes at night (odds ratio per 1-U increase of log-transformed AHI 1.5, 95% confidence interval 1.1 to 2.0, p = 0.008) and during the day (odds ratio 1.37, 95% confidence interval 1.0 to 1.8, p = 0.035). In conclusion, the prevalence of ventricular premature complexes is increased in middle-aged patients with mainly mild or moderate OSA, suggesting an association between OSA and ventricular arrhythmias even in mild OSA.