Higher Prevalence Of Coronary Artery Disease Research Articles

Clinical phenotypes in relation to outcomes in heart failure patients with cardiac resynchronization therapy and defibrillators (CRT-D): an unsupervised cluster analysis

Abstract Background Patients with heart failure undergoing CRT are an heterogenous and complex population. Selecting patients before implantation is essential to obtain a favorable response to CRT-D. Data-driven cluster analysis may be an approach to identify different patients’ phenotypic categories. Purpose To identify different clusters of patients with CRT-D who share similar clinical phenotypes, and to evaluate the associations between clusters and clinical outcomes, using cluster analysis. Methods Three agglomerative hierarchical cluster analysis were performed in CRT-D patients seen between 2010 and 2019 in French hospitals. Associations between clusters and death at one year and death during whole follow-up (FU) were evaluated using Cox regression analyses. Results The study included 23,029 CRT-D patients with no prior history of VT/VF/cardiac arrest (mean age 67.7 ± 9.9 years; 78.8 % male), who were analyzed in relation to 3 ways, as follows: the first group was a 50% random sample of all patients (n = 11,514), the second group included patients dead at 1 year (n = 1,604) and the third group included those alive at 3 years FU (n = 14,228). A cluster analysis was performed on each group. Four clusters were identified in the first group: Cluster 1 identified young patients with dilated cardiomyopathy and low prevalence of coronary artery disease (CAD), cardiovascular (CV) risk factors and comorbidities (chronic kidney disease, lung and liver disease) (low-risk phenotype); Cluster 2 was composed of male patients with CAD but low burden of CV risk factors and comorbidities (CAD phenotype); Cluster 3 included CRT recipients with several CV risk factors but low prevalence of comorbidities (CV risk factors phenotype); Cluster 4 identified old patients with high prevalence of CAD, atrial fibrillation, CV risk factors and comorbidities (clinical complex phenotype). These phenotypes were maintained in the other two groups (dead at 1 year and alive at 3 years FU), with the highest consistency for low-risk and high-risk phenotypes(Cluster 1 and 4 respectively). Compared with Cluster 1, Clusters 2, 3 and 4 were independently associated with an increased risk of all-cause death at 1-year FU and during the whole FU (Cluster 2: HR 1.21, 95% CI 1.08 - 1.36; Cluster 3: HR 1.15, 95%CI 1.04 - 1.26; and Cluster 4: HR 1.79, 95%CI 1.65 - 1.96). There were high prevalences of CAD, atrial fibrillation, mitral regurgitation, and comorbidities (which are all predictors of CRT-nonresponse) not only in Cluster 4 at baseline, but also among patients who died at 1-year FU in all 4 clusters. Conclusion Cluster analysis identified four statistically driven groups of CRT recipients, with specific clinical phenotypes and associated with different risks for all-cause death. Identifying those patients at higher risk of adverse events might help in the selection of patients with heart failure undergoing CRT-D implantation, especially in relation to CRT-nonresponse.Risk of all-cause death in 4 clusters

Symptoms and ASCVD score fail to identify majority of the patients at risk of first myocardial infarction

Abstract Background Cardiovascular disease screening has long relied on the presence of symptoms like chest pain or on the Atherosclerotic Cardiovascular Disease (ASCVD) risk score, which is typically initiated at age 40. However, current research suggests that the ASCVD risk score may not incorporate a comprehensive range of factors and should be started earlier. Furthermore, the absence of symptoms such as angina in some patients prior to acute coronary syndrome (ACS) casts doubt on the reliability of symptom-based screening methods. Purpose This study aimed to evaluate the effectiveness of the ASCVD risk score and chest pain as predictors for ACS. Methods We retrospectively analyzed the data of all patients of 65 or younger who presented with their first ACS event in a single US center from January 2020 to January 2024. We collected the demographic and clinical data, including age, sex, lipid panel, blood pressure, medical history, onset of symptoms, and calculated their individual ASCVD risk score. We explored whether these patients, if assessed one week before their ACS event, would have been identified as at risk and thus prescribed lipid lowering or recommended for further diagnostic tests. Results Among 166 patients presenting with ACS, 64 (39%) were considered low risk with an ASCVD risk score of <5 or too low to calculate. 20 (12%) patients were assessed as borderline risk with an estimated risk score of 5-7.5%. In the intermediate risk category, 20 patients (12%) had a score of 7.5% -10% and 42 patients (25%) were estimated to have a score of >10 to <20%. 14 patients (8%) fell in the high-risk category, and lastly 6 patients had an LDL that was above 190 mg/dl. Regarding symptoms of chest pain or shortness of breath, 14 patients (8%) did not experience any symptoms prior to their presentation, 98 (59%) patients experienced their first episode of symptoms within 48 hours, 19 patients (11%) within 2 days to a week, 10 patients (6%) had CP leading up to their event from a week to a month, 6 patients (4%) in the range of a month to 3 months and 19 patients (11%) had symptoms longer than 3 months prior to their presentation. To summarize if there were seen 1 week prior to their first ACS events, 51% of them were not recommended for statin therapy based on their ASCVD risk score and 67% of patients either had no chest pain until the event or chest pain within 48hrs of onset of their ACS and consequently would not have been routinely screened for coronary artery disease (CAD) by any anatomical or functional methods. Conclusion(s) ASCVD risk score and symptoms fail to identify majority of patient below 65 years of age with their first MI. Given high prevalence of CAD and associated mortality, improved screening tools, in addition to symptomatology or risk scores, would be more effective in identifying individuals at risk.

Type 2 diabetes mediating the increased cardiovascular risk in patients with rheumatoid arthritis: a bidirectional mendelian randomisation approach

Abstract Background Patients with rheumatoid arthritis (RA) are at increased risk of developing coronary artery disease (CAD) as is evident from epidemiological studies. This however is not a causative association, as we have shown by two-sample mendelian randomisation (MR) in previous work. Mediators linking RA to cardiovascular phenotypes have yet to be identified. Purpose The present study seeks to determine whether type 2 diabetes (DM II) is such a mediator conferring the increased cardiovascular risk of patients with RA. Methods The associations between the phenotypes RA, CAD and DM II were tested for causality with two-sample MR using genetic instruments from genome-wide association studies (GWAS) in largely non-overlapping cohorts. For RA, genetic instruments were obtained from 14,361 cases and 43,923 controls of European ancestry in the dataset by Okada, comprised of 18 studies (1). For the trait DM II, the DIAbetes Genetics Replication and Meta-analysis (DIAGRAM) Consortium was used (2). This GWAS covered 120,000 SNPs from the Metabochip array in mixed European and Pakistani Population (34,840 cases and 114,981 controls). Genetic instruments for CAD were obtained from the CARDIoGRAMplusC4D consortium with 60,801 cases and 123,504 controls from 48 studies (3). Several MR regression methods such as MR Egger regression and inverse-variance weighted meta-analysis and sensitivity tests for pleiotropy and heterogeneity were performed for each exposure-outcome pair. Results Genetic predisposition to RA was not significantly associated with higher risk of CAD (OR = 1,02 [0,99-1,05]), see figure. In contrast, DM II was significantly, albeit weakly related as outcome to genetically determined manifestation of RA as exposure (OR = 1,04 [1,01-1,08]) and, conversely, genetic instruments of DM II conferred an increased risk of developing CAD ((OR = 1,11 [1,05-1,17]). Conclusions Despite the high prevalence of CAD among RA patients in observational studies, cardiovascular outcomes are not casually linked with RA. Instead, DM II could serve as a mediator, based on its significant associations with both RA and CAD in two-sample MR.

SAFETY AND EFFICACY OF DUAL ANTIPLATELET THERAPY IN PAKISTANI PATIENTS UNDERGOING PCI: A MULTICENTER STUDY

Percutaneous coronary intervention (PCI) is widely used to treat coronary artery disease (CAD), particularly in patients with acute coronary syndromes. Dual antiplatelet therapy (DAPT), which includes aspirin and a P2Y12 inhibitor such as clopidogrel, ticagrelor, or prasugrel, is the standard post-PCI treatment to prevent thrombotic complications. Despite the benefits of DAPT, its safety and efficacy in the Pakistani population, which has a high prevalence of CAD, are not well-documented. Objective: This study aimed to evaluate the safety and efficacy of DAPT in Pakistani patients undergoing PCI by measuring the incidence of stent thrombosis, bleeding complications, and major adverse cardiac events (MACE) over a 12-month follow-up period. Methods: This prospective observational study was conducted from January 2022 to December 2023 across three centers: Lady Reading Hospital Peshawar, Mardan Medical Complex, and Hayatabad Medical Complex. The study included 300 adult patients scheduled for PCI. Participants received DAPT, consisting of aspirin and a P2Y12 inhibitor, before PCI and continued for at least 12 months post-procedure. Primary outcomes were the incidence of stent thrombosis, bleeding complications, and MACE. Secondary outcomes included improved left ventricular ejection fraction (LVEF), exercise tolerance, and angina symptoms. Data were analyzed using SPSS version 26.0. Results: The mean age of participants was 60 ± 10 years, with 65% male. The overall incidence of stent thrombosis was 3%, bleeding complications occurred 8%, and MACE was observed in 15% of patients. LVEF improved from 42% ± 8% pre-procedure to 50% ± 7% post-procedure (p < 0.001). The six-minute walk test distance increased from 320 ± 55 meters pre-procedure to 370 ± 50 meters post-procedure (p < 0.01). The frequency of angina episodes decreased from 4.2 ± 1.5 to 1.7 ± 0.9 per week (p < 0.001). Conclusion: DAPT significantly improves clinical outcomes in Pakistani patients undergoing PCI, enhancing LVEF and exercise tolerance and reducing angina episodes. However, the risk of bleeding complications necessitates careful patient management. These findings support the continued use of DAPT in this population, emphasizing the need for individualized treatment plans and continuous monitoring.

Correlation of Coronary Artery Disease in Patients with Peripheral Artery Disease: Cross-Sectional Study

Background Peripheral Artery Disease (PAD) and Coronary Artery Disease (CAD) represent two facets of atherosclerotic cardiovascular disease, significantly impacting global health. Despite their high morbidity and mortality rates, the epidemiological and clinical nexus between PAD and CAD remains underexplored. Understanding the interrelation of these conditions is paramount for optimizing diagnostic and therapeutic strategies. Objective This study aimed to delineate the incidence and clinical correlation of CAD in patients diagnosed with PAD, thereby providing insights into the epidemiological characteristics and enhancing the clinical management of these conditions. Methods A cross-sectional analysis was conducted at Afridi Medical Complex's departments of vascular surgery and cardiology from 2021 to 2023. One hundred PAD patients referred for peripheral angiography were enrolled. Demographic data, Ankle Brachial Index (ABI) readings, ejection fraction percentages, and the presence of multivessel disease were evaluated. Statistical analyses were performed using SPSS version 25, focusing on mean, median, range, and significance levels to elucidate the prevalence of CAD among PAD patients. Results The study revealed a median age of 58 years among participants, with a significant male predominance (84%). ABI analysis showed that 74% and 108% of patients had mild and moderate PAD severity, respectively. The incidence of CAD in the PAD population was 56%, with angiographic assessments indicating single, double, and triple vessel disease in 23.21%, 39.29%, and 37.5% of patients, respectively. Notably, diabetes and dyslipidemia were prominent predictors of CAD presence in PAD patients. Conclusion The high prevalence of CAD in PAD patients underscores the critical need for comprehensive cardiovascular risk assessment and suggests the potential benefit of routine coronary angiography in symptomatic PAD cases, particularly among those with diabetes and dyslipidemia. This study reinforces the intertwined nature of PAD and CAD, advocating for an integrated approach to the diagnosis and management of these atherosclerotic conditions.

Impact of Magnesium on In-Hospital Ami Outcomes in Bangladesh.

Background: Coronary artery disease (CAD) is a major cause of death globally. Bangladesh has a high prevalence of CAD, especially in urban areas. Acute myocardial infarction (AMI) is a serious condition that occurs when there’s a blockage in the coronary arteries. Electrolyte imbalances, such as magnesium deficiency, can worsen AMI. Objectives: To evaluate the association between serums magnesium level on in-hospital acute myocardial infarction outcomes. Study Design and Methods: This prospective study recruited 110 patients diagnosed with AMI in Dhaka, Bangladesh. Researchers measured serum magnesium levels, monitored patients, and recorded clinical outcomes. Results: The study found that patients with lower magnesium levels were more likely to experience complications such as arrhythmias, cardiogenic shock, and left ventricular dysfunction. Conclusion: The study highlights the importance of monitoring magnesium levels in AMI patients. However, more research is needed to determine the optimal magnesium level and its impact on patient outcomes.

Dietary inflammatory index in relation to severe coronary artery disease in Iranian adults.

Limited findings are available on the relationship between dietary inflammation index (DII) and severe coronary artery disease (CAD). Considering the high prevalence of CAD and its complications, we examined the relationship between DII and CAD. This cross-sectional study was conducted on 275 adults who underwent elective angiography. Severe coronary artery disease was measured by the gensini scoring system. DII was measured by a valid semi-quantitative 168-item food frequency questionnaire (FFQ). Blood samples were collected after 12 h of fasting to measure serum lipid profile and quantitative C-reactive protein (q-CRP) levels. Binary logistic regression was used to calculate the odds (OR) and 95% confidence interval (CI). People in the last tertile of the DII had a higher chance of suffering from severe coronary artery disease (OR: 3.71; 95% CI: 1.97-6.98), hypercholesterolemia (OR: 2.73; 95% CI: 5.03-1.48), reduced HDL-cholesterol levels (OR: 3.77; 95% CI: 9.34-1.52), and hypertension (OR: 1.93; 95% CI: 3.49-1.06) compared to people in the first tertile. After adjusting for confounding factors, the relationship remained significant. A direct and significant relationship was observed between the DII and increased q-CRP levels, which disappeared after adjusting for confounding factors in the adjusted model (OR: 2.02; 95% CI: 0.86-4.73). This cross-sectional study showed a direct and linear relationship between following an anti-inflammatory diet and decreasing the chance of severe CAD. Therefore, it seems necessary to implement community-based educational programs to promote healthy nutrition in order to prevent CADs.

Atrial fibrillation and coronary artery disease: An integrative review focusing on therapeutic implications of this relationship.

The incidence of both atrial fibrillation (AF) and coronary artery disease (CAD) increases with advancing age. They share common risk factors and very often coexist. Evidence points to an intricate relationship between atrial tissue excitability and neuronal remodeling with ischemia at the microcirculatory level. In this review, we delineated this complex relationship, identified a common theme between the two, and discussed how the knowledge of this relationship translates into a positive and meaningful impact in patient management. Recent research indicates a high prevalence of CAD among AF patients undergoing coronary angiography. Further, the incidence of AF is much higher in those suffering from CAD compared to age-matched adults without CAD underlying this reciprocal relationship. CAD adversely affects AF by promoting progression via re-entry and increasing excitability of atrial tissue as a result of ischemia and electrical inhomogeneity. AF in turn accelerates atherosclerosis via endothelial dysfunctional and inflammation and together with enhanced thrombogenicity and hypercoagulability contribute to micro and macrothrombi throughout cardiovascular system. In a nutshell, the two form a vicious cycle wherein one disease promotes the other. Most AF recommendations focuses on rate/rhythm control and prevention of thromboembolism. Very few studies have discussed the importance of unmasking coexistent CAD and how the treatment of underlying ischemia will impact the burden of AF in these patients. Inflammation and endothelial dysfunction remain central to both disease processes and form a handsome therapeutic target in the management of the two diseases. The relationship between AF and CAD is complex and much more than mere coincidence. The two diseases share common risk factor and pathophysiology. Hence, it is impractical to treat them in isolation. Accordingly, we share the implications of managing underlying ischemia and inflammation to positively impact and improve quality of life among AF patients.

The chronic coronary syndrome-Heart failure roundabout: A multimodality imaging workflow approach.

Heart failure (HF) is a complex syndrome of considerable burden with high mortality and hospitalization rates. Approximately two-thirds of patients with HF have ischemic etiology, which makes crucial the identification of relevant coronary artery disease (CAD). Moreover, patients with chronic coronary syndrome (CCS) can first show signs of dyspnea and left ventricular (LV) dysfunction. If establishing a diagnosis of HF and consequent management is clear enough, it will not be the same when it comes to recommendations for etiology assessment. Ischemic heart disease is the most studied disease by cardiac multimodality imaging with excellent diagnostic performance. Based on this aspect, the high prevalence of CAD, the worst outcome-HF patients should undergo a diagnostic work-up using these multimodality imaging techniques. The aim of this mini-review is to provide insights on multimodality imaging for diagnosing CCS in patients with new onset of HF and propose a diagnostic work-up based on current international studies and guidelines.

Prevalence and in-Hospital Outcomes of Cardiac Events in Iron Deficiency Anemia: A National Inpatient Database Analysis

Introduction: Anemia is a serious global public health problem. It causes a reduction in oxygen carrying and delivering capacity thereby counteracting the very function of the heart. There is some literature regarding iron deficiency and heart failure, however, less is known about the implications of iron deficiency anemia (IDA) in other cardiac conditions. We seek to find this association between IDA and cardiac conditions namely acute coronary syndrome (ACS), atrial fibrillation(AF), coronary artery disease (CAD), and heart failure (HF). Methods: The National Inpatient Sample 2017 was queried for the adult population (age>18 years) with a primary or secondary diagnosis of IDA. Prevalence of cardiovascular risk factors including diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLD), tobacco use, and obesity were compared between patients with and without IDA. The association of cardiac diagnoses including ACS, AF, CAD, and HF with IDA was also analyzed. Multivariate regression analysis was performed adjusting for chronic comorbidities taking all-cause mortality as a primary outcome and total cost of hospital stay as a secondary outcome. The association of the above cardiac conditions with these outcomes was studied. Results: A total of 1252409 (4.11%) adult patients were identified with a primary or secondary diagnosis of IDA in 2017. The mean age of this study population was 62.5 years and 62.34% of these were females. In a cohort of adults with IDA being compared to adults without IDA ,DM (32.24 % vs 24.57%; p<0.001), HLD (36.79 % vs 31.93%; p<0.001), tobacco use (24.26% vs 21.53%; p<0.001) and obesity (18.23% vs 15.23%; p<0.001) were more prevalent. However, hypertension (30.38% vs 33.13%; p<0.001) was less prevalent in adults with IDA. IDA was associated with greater prevalence of HF (5.23% vs 3.79%; p=0.004), CAD (23.9% vs. 18.77%; p<0.001) and AF (20.12% vs. 14.45%; p<0.001) but no such significant association was seen with ACS (3.49 vs 3.42; p=0.61) Multivariate regression analysis after adjusting for demographics and risk factors showed increased mortality associated with AF (OR: 1.43; C.I :1.345- 1.534, p<0.001), ACS (OR: 2.40; C.I: 2.175- 2.658; p<0.001) and HF (OR: 1.163; C.I: 1.049-1.290; p=0.004) in the sub-population of adult patients with IDA. Similarly, patients with IDA incurred significantly higher total costs when they had AF ( mean increase: $8910; CI: 7634- 10185, p<0.01) or ACS (mean increase: $38779; CI :35678- 41880; p=<0.01). However, the total cost was not statistically significant in patients with IDA and HF ($141; CI: -1707-2002; p=0.882). Conclusion: In our study, patients with IDA had a higher prevalence of CAD, AF, and HF. The odds of all-cause mortality in the subpopulation of IDA were higher if they had coexisting ACS, AF, or HF. The total cost of hospital stay was also higher in patients with IDA when they had ACS or AF, but no significant difference was noted if heart failure was coexisting with IDA. Although easily reversible, IDA given its high prevalence and potential to cause worse outcomes should be further studied in various cardiac conditions like ACS, CAD, and AF to better identify its role and develop therapeutic approaches which can limit mortality and morbidity. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

A cross-sectional study on coronary artery disease diagnosis in patients with peripheral artery disease

PurposeCompared with healthy individuals, patients with peripheral artery disease (PAD) generally have a very high risk of subclinical Coronary artery disease (CAD) and cardiovascular events. To determine the correlation between CAD in PAD patients, thereby promoting the lifetime of PAD patients and reducing the serious impacts of CAD. MethodsThis clinical-based cross-sectional study comprised 100 consecutive patients in India from 2014 to 2016. In this research, PAD patients were screened for CAD by treadmill stress test and cardiac colour Doppler examination. In addition, this study performed coronary angiography followed by peripheral angiography for patients who could not perform the treadmill test. ResultsWith the statistical results, the study observed a high prevalence of CAD in PAD patients that can be detected only with angiography. Further, 30.93% of asymptomatic CAD prevalence was observed in PAD patients. The study strengthens the need for coronary angiography in all symptomatic lower limb PAD cases to detect early CAD, particularly in patients with diabetes and dyslipidemia. ConclusionThere exists a strong correlation between PAD and CAD. Hence, precise diagnosis followed by supervision of PAD patients is significant for avoiding local progression of cardiovascular risk.

Tenascin-C as a noninvasive biomarker of coronary artery disease.

Coronary artery disease (CAD), is the leading cause of mortality and morbidity worldwide. Tenascin-C (TNC) with high expression levels in inflammatory and cardiovascular diseases, leads to the rupture of atherosclerotic plaques. The origin of plaque destabilization can be associated to endothelial dysfunction. Given the high prevalence of CAD, finding valuable biomarkers for its early detection is of great interest. Using serum samples from patients with CAD and individuals without CAD, we assessed the efficacy of TNC expression levels in serum exosomes and during endothelial cell differentiation as a noninvasive biomarker of CAD. TNC expression was analyzed using the RNA-sequencing data sets of 6 CAD and 6 normal samples of blood exosomes and endothelial differentiation transitions. Additionally, TNC expression was investigated in the serum samples of patients with CAD and individuals without CAD via qRT-PCR. ROC curve analysis was employed to test the suitability of TNC expression alterations as a CAD biomarker. TNC exhibited higher expression in the exosomes of the CAD samples than in those of the non-CAD samples. During endothelial differentiation, TNC expression was upregulated and then consistently downregulated in mature endothelial cells. Moreover, TNC was significantly upregulated in the serum of the CAD group (P = 0.02), with an AUC of 0.744 for the expression level (95% confidence interval, 0.582 to 0.907; P = 0.011). Hence its expression level can be discriminated CAD from non-CAD samples. Our study is the first to confirm that altered TNC expression is associated with pathological CAD conditions in Iranian patients. The expression of TNC is involved in endothelial differentiation and CAD development. Accordingly, TNC can serve as a valuable noninvasive biomarker with potential application in CAD diagnosis.

The Impact of an Elevated Uric Acid Level on the Prevalence of Coronary Artery Disease in Pancreas Transplant Candidates with Type 1 Diabetes: A Cross Sectional Study.

Pancreas transplantation is considered a high-risk surgery with cardiovascular complications. Early detection of all potential cardiovascular risk factors can decrease the perioperative risk and improve the pancreas recipients’ outcome. The present study aims to evaluate the association between serum uric acid (UA) levels and the prevalence of coronary artery disease (CAD) in patients eligible for pancreas transplantation. We prospectively enrolled 63 consecutive patients with type 1 diabetes (T1D) who underwent cardiological evaluation before pancreas transplantation in our center. Participants underwent clinical evaluation, laboratory assays, and coronary angiography. The median concentration of UA in patients with CAD was significantly higher than in participants without CAD (6.43 (4.93–7.26) vs. 4.41 (3.64–5.49) mg/dL, p = 0.0002). We showed the positive correlation between UA concentration and systolic blood pressure, pulse pressure (PP) and triglycerides (r = 0.271, p = 0.032; r = 0.327, p = 0.009; r = 0.354, p = 0.004, respectively). In a multivariate analysis, the concentration of UA (OR 2.044; 95% CI: 1.261–3.311, p = 0.004) was independently associated with the prevalence of CAD in pancreas transplant candidates with T1D. We demonstrated that elevated UA levels were strongly associated with the high prevalence of CAD in pancreas transplant candidates with T1D. To stratify cardiovascular risk, the measurement of the UA concentration should be considered in all T1D patients qualified for pancreas transplantation.

Management of concomitant coronary artery disease and aortic valve stenosis in the era of transcatheter aortic valve treatment

Severe calcific aortic stenosis (AS) and coronary artery disease (CAD) have common risk factors and are frequently encountered in the same patient in clinical practice. CAD has been reported in ≥ 50% of AS patients undergoing both surgical treatment and transcatheter aortic valve implantation (TAVI). In the last two decades, TAVI has been established as a less invasive alternative to surgery. Recently, more and more young and low surgical risk patients undergo TAVI. Despite the high prevalence of CAD in patients treated with TAVI, the management strategy of concomitant CAD in these patients remains an area of considerable uncertainty. This review provides an updated overview of the current knowledge about this topic and offers points for reflection about the best approach to use.

A Meta-Analysis and Systematic Review on the Global Prevalence, Risk Factors, and Outcomes of Coronary Artery Disease in Liver Transplantation Recipients.

The shift in the changing etiology of cirrhosis requiring liver transplantation (LT) has resulted in an increasing prevalence of coronary artery disease (CAD) that can potentially impact post-LT outcomes. This systematic review and meta-analysis evaluates the prevalence of CAD, risk factors, and outcomes of patients diagnosed with CAD before LT. MEDLINE and EMBASE were searched for articles describing CAD in pre-LT patients. Meta-analysis of proportions using the generalized linear mix model was conducted to analyze the pooled prevalence of CAD in pre-LT patients. Associated risk factors for CAD in pre-LT patients and outcomes were evaluated in conventional pairwise meta-analysis. A total of 39 studies were included. The pooled prevalence of patients diagnosed with CAD before LT was 15.9% (95% CI, 9.8%-24.7%). Age, male sex, diabetes mellitus, hypertension, hyperlipidemia, smoking, nonalcoholic steatohepatitis, hepatitis B virus, and hepatocellular carcinoma were significantly associated with CAD. Patients from high-income countries especially North America, Europe, and South America, with the associated risk factors were at increased risk for CAD before LT. CAD before LT was associated with an increased odds of overall mortality (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.4-1.4; P=0.01) and cardiac-related mortality (OR, 1.2; 95% CI, 1.1-1.3; P=0.03). A total of 48.7% of included articles considered the presence of cardiovascular risk factors for CAD screening. However, 10.3% of the studies screened for CAD in pre-LT patients via invasive coronary angiography only, without stress testing or risk stratification. This study demonstrates the high prevalence of CAD in pre-LT patients, associated risk factors, and outcomes. There is heterogeneity among guidelines and practice in screening for pre-LT CAD, and more studies are needed to establish consensus.

Association of Lower Urinary Tract Symptoms Based on the International Prostate Symptom Score and Cardiovascular Disease.

Because it is unclear whether lower urinary tract symptoms (LUTS) are associated with cardiovascular disease (CVD) in the Japanese population, we explored the association in general Japanese men aged 55-75 years.Methods and Results:The cross-sectional study included male participants who had both national health checkup data and the International Prostate Symptom Score (IPSS) in the same calendar year between 2009 and 2017. LUTS severity was evaluated by IPSS. A robust Poisson regression model was used to assess the association between LUTS severity and the composite CVD outcome [coronary artery disease (CAD), stroke, or atrial fibrillation (AF)] and each component of the composite outcome. Prevalence ratio (PR) was adjusted for conventional cardiovascular risk factors. Of 16,781 male participants (mean age, 67±5 years), mild LUTS were observed in 9,243 (55.1%); moderate, 6,445 (38.4%); and severe, 1,093 (6.5%). Compared with the mild LUTS group, moderate LUTS [PR 1.18, 95% confidence interval (CI) 1.10-1.25, P<0.001] and severe LUTS (PR 1.38, 95% CI 1.24-1.53, P<0.001) were significantly associated with a higher prevalence of CVD. LUTS severity was associated with higher prevalence of CAD and stroke, but not AF. The severity of LUTS was associated with a higher prevalence of CVD, especially CAD and stroke, independent of conventional CVD risk factors.

How Fast Foods Impact Coronary Artery Disease Incidence: A Cross-Sectional Study

Coronary artery disease (CAD) is a very ordinary health problem around the globe. CAD is affected by numerous factors like diabetes, obesity, smoking, gender, and diet. However, the association of CAD with diet is understudied in our region that’s why our study was aimed to evaluate the effect of diet on CAD incidence. This cross-sectional study was completed among local population of Rawalpindi, Pakistan in almost 6 months from November 2020 to April 2021. People were taken in our study via set criteria. Data was collected by self-structured proforma. Data analysis was performed by applying IBM SPSS version 25. Descriptive statistics were applied for quantitative variables. Statistical tests like Chi-square test and Spearman correlation analysis were applied to know the association, direction, and strength of study variables. Our current study displays overall high prevalence CAD (17.48%) among study population. Mean value of age for study participants was 45.42 with SD of ±8.01years. Prevalence of CAD was more common among females, faster food eaters and fresh fruit and raw vegetables non-eaters. Gender, fast food, and fresh fruits and vegetables were associated with CHD significantly with p-values 0.030, 0.0007, and 0.0006 respectively. Strength and direction for fast food and CAD association was very strong and positive while for association between fresh fruits and raw vegetables and CAD was very strong and negative with correlation coefficient +0.812 and -0.831 respectively. In a nutshell, current study indicates high prevalence of CAD especially among females, fast food eaters and fresh fruits and raw vegetables non-eaters. Higher consumption of fast foods leads to higher incidence of CAD and vice versa while higher consumption of fresh fruits and raw vegetables bring down the incidence of CAD incidence and vice versa. So, we need to create awareness among people about the impact of food on CAD and gender specific interventions for each gender to lower down the CAD incidence.

CORONARY ARTERY DISEASE (CAD): INTERPLAY OF NUTRITION, SERUM PARAMETERS AND GENETICS

Coronary artery disease (CAD) is a leading cause of death worldwide. The death rate is decreasing in developed countries due to awareness, but the disease burden is increasing in developing countries. Pakistan is a country with high prevalence of CAD. The serum lipids have long been implicated in the development of CAD by the deposition of mainly LDL on endothelial lining resulting in atherosclerosis. Progression to CAD involves environmental as well as genetic factors. The genetic component is due to the contribution from various low to modest effect size variants in many genes. Common variants have been used to construct a genetic risk score (GRS) to calculate the risk of future CAD. In conclusion, lifestyle interventions in concert with the knowledge of genetic predisposition based on family history and use of population data may one day lead to the development of personalized medicine for the treatment and prevention of CAD.

CORONARY ARTERY DISEASE (CAD): INTERPLAY OF NUTRITION, SERUM PARAMETERS AND GENETICS

Coronary artery disease (CAD) is a leading cause of death worldwide. The death rate is decreasing in developed countries due to awareness, but the disease burden is increasing in developing countries. Pakistan is a country with high prevalence of CAD. The serum lipids have long been implicated in the development of CAD by the deposition of mainly LDL on endothelial lining resulting in atherosclerosis. Progression to CAD involves environmental as well as genetic factors. The genetic component is due to the contribution from various low to modest effect size variants in many genes. Common variants have been used to construct a genetic risk score (GRS) to calculate the risk of future CAD. In conclusion, lifestyle interventions in concert with the knowledge of genetic predisposition based on family history and use of population data may one day lead to the development of personalized medicine for the treatment and prevention of CAD.

Association between vitamin D deficiency and serum Homocysteine levels and its relationship with coronary artery disease.

Homocysteine (Hcy) elevation and vitamin D deficiency have emerged as potential markers of coronary artery disease (CAD). However, even tough hypovitaminosis D has been suggested to interfere with Hcy catabolism, no study has so far addressed the interaction of vitamin D and Hcy and their impact on CAD, that was the aim of present study. A cohort of consecutive patients undergoing coronary angiography in a single center were included and analyzed within the year 2019. Significant CAD was defined as at least 1 vessel stenosis > 50%, while severe CAD as left main and/or three-vessel disease. Hcy and vitamin D levels were assesssed at admission. We included 3150 patients undergoing coronary angiography at our centre, who were divided according to the quartiles values of vitamin D. Patients with lower levels of Vitamin D displayed a higher cardiovascular risk profile and a higher prevalence of CAD. We observed an inverse linear relationship between lower levels of vitamin D and higher Hcy (r = − 0.092, p < 0.001) and a higher prevalence of hyperhomocysteinemia in patients with lower quartiles values of vitamin D (p < 0.001). By forward conditional regression model, low vitamin D appeared as independent predictors of Homocysteine levels above the median (OR[95%CI] = 1.79[1.37–2.33], p < 0.001). In addition, patients with low vitamin D (below the median) and increased Hcy displayed a non-significantly higher rate of CAD (81% vs 77.7%, p = 0.13, adjusted OR[95%CI] = 1.16[0.88–1.54], p = 0.29) but a significant increase in the rate of severe left main/3-vessel CAD (37.4% vs 30.5%, p = 0.005, adjusted OR[95%CI] = 1.29[1.02–1.67], p = 0.04). Among patients with vitamin D levels above the median, Hcy levels did not impact on the prevalence and extent of CAD (77.7 vs 77.2%, p = 0.81, adjusted OR[95%CI] = 0.94[0.73–1.20], p = 0.60 for CAD and 31.8% vs 27.7%, p = 0.08, adjusted OR[95%CI] = 0.97[0.75–1.25], p = 0.81 for severe left main/3-vessel CAD). No significant interaction between Hcy and vitamin D with CAD or severe CAD was observed. The present study shows an independent inverse linear relationship between vitamin D and Hcy values. Moreover, the association of Hcy with the extent of CAD was significant only among patients with hypovitaminosis D, and not in the cohort of subjects with vitamin D levels above the median, suggesting that a normal vitamin D status can prevent the deleterious effects of hyperhomocysteinemia on coronary atherosclerosis, a hypothesis that certainly needs further confirmation in larger randomized trials.Supplementary InformationThe online version of this article (10.1007/s11239-021-02391-w) contains supplementary material, which is available to authorized users.