Incidence Of Coronary Heart Disease Research Articles

Association between thyroid cancer and cardiovascular disease risk: a nationwide observation study

Treatment with levothyroxine and radioiodine contribute alternative cardiovascular function in adults with thyroid cancer. The risks of long-term cardiovascular conditions among thyroid cancer patients is unknown. This study aimed to compare the incidence of coronary heart disease (CHD), ischemic stroke (IS), and atrial fibrillation (AF) among adults with thyroid cancer with that of the general population, especially when stratified by age (< 65 and ≥ 65 years old). This observational cohort study enrolled patients between January 1, 2011 and December 31, 2016 with a follow-up until December 31, 2018. This study analyzed the data of Taiwanese thyroid cancer patients registered on the National Taiwan Cancer Registry Database, with CHD and IS. SIR models were used to evaluate the association between thyroid cancer and CHD, IS, AF, and cardiovascular disease outcome, stratified by age and sex. SIR analyses were also conducted for both sexes, age groups (< 65, ≥ 65 years), and different follow-up years. After excluding 128 individuals (< 20 years or ≥ 85 years old) and with missing index data, 4274 eligible thyroid cancer patients without CHD history, 4343 patients without IS history, and 4247 patients without AF history were included for analysis. During the median follow-up of 3.5 (1.2) years among thyroid cancer patients, the observed number of new CHD events was 70; IS, 30; and AF, 20, respectively. The SIR was significantly higher for CHD (SIR, 1.57; 95% confidence interval [CI] 1.2–1.93) among thyroid cancer patients compared with the age- and sex-specific standardized population. However, the association between thyroid cancer and the risks of IS (SIR, 0.74; 95% CI 0.47–1), cardiovascular disease (SIR, 0.88; 95% CI 0.7–1.05), and atrial fibrillation (SIR, 0.74; 95% CI 0.42–1.06) were insignificant. Moreover, stratification by age < 65 or age ≥ 65 years old and by sex for CHD suggested that the diagnosis of thyroid cancer in the young may attenuate the CHD risk (SIR, 2.08; 95% CI 1.5–2.66), and the CVD risk was constant among both men (SIR, 1.63; 95% CI 1.03–2.24) and women (SIR, 1.53; 95% CI 1.06–1.99). The patients had persistent higher CHD risk for 5 years after cancer diagnosis. Thyroid cancer survivors have a substantial CHD risk, even at long-term follow-up, especially in those patients < 65 years old. Further research on the association between thyroid cancer and CHD risk is warranted.

The Impact of Time Horizon on Classification Accuracy: Application of Machine Learning to Prediction of Incident Coronary Heart Disease.

Many machine learning approaches are limited to classification of outcomes rather than longitudinal prediction. One strategy to use machine learning in clinical risk prediction is to classify outcomes over a given time horizon. However, it is not well-known how to identify the optimal time horizon for risk prediction. In this study, we aim to identify an optimal time horizon for classification of incident myocardial infarction (MI) using machine learning approaches looped over outcomes with increasing time horizons. Additionally, we sought to compare the performance of these models with the traditional Framingham Heart Study (FHS) coronary heart disease gender-specific Cox proportional hazards regression model. We analyzed data from a single clinic visit of 5201 participants of a cardiovascular health study. We examined 61 variables collected from this baseline exam, including demographic and biologic data, medical history, medications, serum biomarkers, electrocardiographic, and echocardiographic data. We compared several machine learning methods (eg, random forest, L1 regression, gradient boosted decision tree, support vector machine, and k-nearest neighbor) trained to predict incident MI that occurred within time horizons ranging from 500-10,000 days of follow-up. Models were compared on a 20% held-out testing set using area under the receiver operating characteristic curve (AUROC). Variable importance was performed for random forest and L1 regression models across time points. We compared results with the FHS coronary heart disease gender-specific Cox proportional hazards regression functions. There were 4190 participants included in the analysis, with 2522 (60.2%) female participants and an average age of 72.6 years. Over 10,000 days of follow-up, there were 813 incident MI events. The machine learning models were most predictive over moderate follow-up time horizons (ie, 1500-2500 days). Overall, the L1 (Lasso) logistic regression demonstrated the strongest classification accuracy across all time horizons. This model was most predictive at 1500 days follow-up, with an AUROC of 0.71. The most influential variables differed by follow-up time and model, with gender being the most important feature for the L1 regression and weight for the random forest model across all time frames. Compared with the Framingham Cox function, the L1 and random forest models performed better across all time frames beyond 1500 days. In a population free of coronary heart disease, machine learning techniques can be used to predict incident MI at varying time horizons with reasonable accuracy, with the strongest prediction accuracy in moderate follow-up periods. Validation across additional populations is needed to confirm the validity of this approach in risk prediction.

Race-Dependent Association of High-Density Lipoprotein Cholesterol Levels With Incident Coronary Artery Disease

BackgroundPlasma lipids are risk factors for coronary heart disease (CHD) in part because of race-specific associations of lipids with CHD. ObjectivesThe purpose of this study was to understand why CHD risk equations underperform in Black adults. MethodsBetween 2003 and 2007, the REGARDS (REasons for Geographic and Racial Differences in Stroke) cohort recruited 30,239 Black and White individuals aged ≥45 years from the contiguous United States. We used Cox regression models adjusted for clinical and behavioral risk factors to estimate the race-specific hazard of plasma lipid levels with incident CHD (myocardial infarction or CHD death). ResultsAmong 23,901 CHD-free participants (57.8% White and 58.4% women, mean age 64 ± 9 years) over a median 10 years of follow-up, 664 and 951 CHD events occurred among Black and White adults, respectively. Low-density lipoprotein cholesterol and triglycerides were associated with increased risk of CHD in both races (P interaction by race >0.10). For sex-specific clinical HDL-C categories: low HDL-C was associated with increased CHD risk in White (HR: 1.22; 95% CI: 1.05-1.43) but not in Black (HR: 0.94; 95% CI: 0.78-1.14) adults (P interaction by race = 0.08); high HDL-C was not associated with decreased CHD events in either race (HR: 0.96; 95% CI: 0.79-1.16 for White participants and HR: 0.91; 95% CI: 0.74-1.12 for Black adults). ConclusionsLow-density lipoprotein cholesterol and triglycerides modestly predicted CHD risk in Black and White adults. Low HDL-C was associated with increased CHD risk in White but not Black adults, and high HDL-C was not protective in either group. Current high-density lipoprotein cholesterol–based risk calculations could lead to inaccurate risk assessment in Black adults.

High-sensitivity troponin I is associated with cardiovascular outcomes but not with breast arterial calcification among postmenopausal women

BackgroundPrior studies support the utility of high sensitivity troponin I (hsTnI) for cardiovascular disease (CVD) risk stratification among asymptomatic populations; however, only two prior studies examined women separately. The association between hsTnI and breast arterial calcification is unknown. MethodsCohort study of 2896 women aged 60–79 years recruited after attending mammography screening between 10/2012 and 2/2015. BAC status (presence versus absence) and quantity (calcium mass mg) was determined using digital mammograms. Pre-specified endpoints were incident coronary heart disease (CHD), ischemic stroke, heart failure and its subtypes and all CVD. ResultsAfter 7.4 (SD = 1.7) years of follow-up, 51 CHD, 30 ischemic stroke and 46 heart failure events were ascertained. At a limit of detection of 1.6 ng/L, 98.3 of the cohort had measurable hsTnI concentration. HsTnI in the 4–10 ng/L range were independently associated of CHD (adjusted hazard ratio[aHR] = 2.78; 95% CI, 1.48–5.22; p = 0.002) and all CVD (aHR = 2.06; 95% CI, 1.37–3.09; p = 0.0005) and hsTnI over 10 ng/L was independently associated with CHD (aHR = 4.75; 95% CI, 1.83–12.3; p = 0.001), ischemic stroke (aHR = 3.81; 95% CI, 1.22–11.9; p = 0.02), heart failure (aHR = 3.29; 95% CI, 1.33–8.13; p = 0.01) and all CVD (aHR = 4.78; 95% CI, 2.66–8.59; p < 0.0001). No significant association was found between hsTnI and BAC. Adding hsTnI to a model containing the Pooled Cohorts Equation resulted in significant and clinical important improved calibration, discrimination (Δ Cindex = 6.5; p = 0.02) and reclassification (bias-corrected clinical NRI = 0.18; 95% CI, −0.13-0.49 after adding hsTnI categories). ConclusionsOur results support the consideration of hsTnI as a risk enhancing factor for CVD in asymptomatic women that could drive preventive or therapeutic decisions.

Hidden intrapancreatic portal cavernoma by pancreatic cephalic carcinoma Ц an indication for portal vein resection Ц Case Report

Studies have shown that elevated serum uric acid (SUA) may increase the risk of coronary heart disease (CHD). However, it was still disputable how mediate effects between metabolic diseases and hyperuricemia affect the incidence of CHD. This study aimed to explore whether metabolic diseases may mediate the connection from hyperuricemia at baseline to the elevated incidence risk of CHD during follow-ups.Based on the Jinchang cohort, 48 001 subjects were followed for 9 years between June 2011 and December 2019. Multivariate-adjusted Cox regression models were applied to estimate hazard ratios (HRs) of CHD with 95% confidence intervals (CIs). Significantly increased risks of CHD were observed in hyperuricemia (HR:1.46, 95%CI:1.28, 1.67) when compared with normouricemia population. The mediating effect model further demonstrated that metabolic diseases could mediate the association between hyperuricemia and CHD pathogenesis, partially for the combined metabolic diseases with mediation effects of 45.12%, 25.24% for hypertension, 28.58% for overweight or obese status, 29.05% for hypertriglyceridemia, 6.70% for hypercholesterolemia, 3.52% for low high density lipoprotein cholesterol (HDL-C), and 6.51% for high low density lipoprotein cholesterol (LDL-C), respectively.Hyperuricemia significantly increased the risk of incident CHD, and this association was partly mediated by metabolic diseases.

Circulating Soluble CD163, Associations With Cardiovascular Outcomes and Mortality, and Identification of Genetic Variants in Older Individuals: The Cardiovascular Health Study.

Background Monocytes/macrophages participate in cardiovascular disease. CD163 (cluster of differentiation 163) is a monocyte/macrophage receptor, and the shed sCD163 (soluble CD163) reflects monocyte/macrophage activation. We examined the association of sCD163 with incident cardiovascular disease events and performed a genome-wide association study to identify sCD163-associated variants. Methods and Results We measured plasma sCD163 in 5214 adults (aged ≥65 years, 58.7% women, 16.2% Black) of the CHS (Cardiovascular Health Study). We used Cox regression models (associations of sCD163 with incident events and mortality); median follow-up was 26 years. Genome-wide association study analyses were stratified on race. Adjusted for age, sex, and race and ethnicity, sCD163 levels were associated with all-cause mortality (hazard ratio [HR], 1.08 [95% CI, 1.04-1.12] per SD increase), cardiovascular disease mortality (HR, 1.15 [95% CI, 1.09-1.21]), incident coronary heart disease (HR, 1.10 [95% CI, 1.04-1.16]), and incident heart failure (HR, 1.18 [95% CI, 1.12-1.25]). When further adjusted (eg, cardiovascular disease risk factors), only incident coronary heart disease lost significance. In European American individuals, genome-wide association studies identified 38 variants on chromosome 2 near MGAT5 (top result rs62165726, P=3.3×10-18),19 variants near chromosome 17 gene ASGR1 (rs55714927, P=1.5×10-14), and 18 variants near chromosome 11 gene ST3GAL4. These regions replicated in the European ancestry ADDITION-PRO cohort, a longitudinal cohort study nested in the Danish arm of the Anglo-Danish-DutchstudyofIntensiveTreatmentIntensive Treatment In peOple with screeNdetcted Diabetes in Primary Care. In Black individuals, we identified 9 variants on chromosome 6 (rs3129781 P=7.1×10-9) in the HLA region, and 3 variants (rs115391969 P=4.3×10-8) near the chromosome 16 gene MYLK3. Conclusions Monocyte function, as measured by sCD163, may be predictive of overall and cardiovascular-specific mortality and incident heart failure.

Causal relationships of excessive daytime napping with atherosclerosis and cardiovascular diseases: a Mendelian randomization study.

Previous observational studies have found conflicting evidence on the relationship between daytime napping and incident cardiovascular diseases (CVDs), but it remains unclear whether these associations present causality. This study aims to verify whether and why there is a causal relationship between these parameters, and whether there is an etiological basis. A two-sample Mendelian randomization analysis was performed using 79 single nucleotide polymorphisms associated with daytime napping. Summary-level data for coronary atherosclerosis, peripheral atherosclerosis, total CVD, and five CVD outcomes were obtained from the FinnGen study. Meta-analyses were aimed at investigating the relationships of excessive daytime napping with total CVD, coronary heart disease, myocardial infarction (MI), and stroke incidence. Subgroup, network meta-analysis (NMA) and trial sequential analysis (TSA) were also performed in this study. The inverse-variance weighted method demonstrated that a genetic predisposition to more frequent daytime napping was significantly associated with higher odds of coronary atherosclerosis (odds ratio [OR] = 1.55, 95% confidence interval [CI]: 1.11 to 2.17), MI (OR = 1.63, 95% CI: 1.06 to 2.50), and heart failure (OR = 1.80, 95%CI: 1.28 to 2.52). In NMA, an increased risk of developing CVD in people who napped for more than 60 min a day than those who did not nap was demonstrated and then supported by TSA results (summary relative risk = 1.98, 95% CI: 1.39 to 2.82). Habitual daytime napping is causally associated with an increased risk of incident CVD primarily via the development of coronary atherosclerosis. An average napping duration of more than 60 min is associated with an elevated risk of CVD in all participants.

Heart rate variability and the risk of heart failure and its subtypes in post-menopausal women: The Women's Health Initiative study.

BackgroundLow heart rate variability (HRV), a measure of autonomic imbalance, is associated with increased risk of coronary heart disease (CHD) and heart failure (HF). However, its relationship with HF subtypes; heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) has not been studied prior.Methods and findingsWe conducted a longitudinal study in Women’s Health Initiative study cohort to investigate the association of baseline quartiles of resting heart rate (rHR) and HRV measures; SDNN (SD of normal-to-normal RR interval) and RMSSD (root mean square of successive difference of RR interval) measured by twelve-lead electrocardiogram (ECG) on enrollment, with the risk of hospitalized HF and its subtypes. Total of 28,603 post-menopausal women, predominantly non-Hispanic whites (69%), with a mean (SD) age of 62.6 (7.1) years, free of baseline CHD and HF were included. In a fully adjusted cox-proportional hazards regression model which adjusted for age, race, BMI, alcohol intake, education, physical activity, hyperlipidemia, hypertension, left ventricular hypertrophy, use of beta-blocker, calcium-channel blocker, hormone therapy, and time-varying incident CHD, the hazard ratios of lowest quartile of HRV (Q1) with HF risk were significant (Q1 SDNN compared to Q4 SDNN: 1.22, 95% CI 1.07, 1.39; Q1 RMSSD compared to Q4 RMSSD: 1.17, 95% CI 1.02, 1.33). On subgroup analysis of HF subtypes, low HRV was associated with elevated HFpEF risk (Q1 vs Q4 SDNN: 1.22, 95% CI 1.02, 1.47) but not with HFrEF (Q1 vs Q4 SDNN: 1.19, 95% CI 0.95, 1.50; Q1 RMSSD: 1.13, 95% CI 0.90, 1.43).ConclusionLow HRV is associated with elevated overall hospitalized HF risk and HFpEF risk in post-menopausal women. Whether interventions to increase HRV through healthy lifestyle changes will decrease HF risk warrants further investigation.

Dyslipidemia in Patients with Type 2 Diabetes Mellitus (DM2) According to Ethnicity: A Systematic Review

Background: The role of dyslipidemia as a significant risk factor for cardiovascular disease (CVD) in patients diagnosed with type 2 diabetes mellitus (DM2) is well established. There are few studies examining the prevalence of dyslipidemia among different ethnic groups. This review aims to analyze literature that has studied dyslipidemia and ethnicity. Should treatment guidelines reflect ethnicity? Method: Systemic narrative synthesis and data extraction was performed using the Preferred Reporting Items for Systematic Review (PRISMA) guidelines. Studies were selected between January 2010 and January 2022 using PubMed, Medline, and Google Scholar. The quality of the studies was assessed through Joanna Briggs Institute (JBI) checklist. Results: Four relevant studies were retrieved from different countries. Asians, mainly Indians and Filipinos, have high triglycerides (TG) levels and low High-Density Lipoproteins (HDL) levels which can partially explain the high incidence of coronary heart disease (CHD) in this group. Indians have high concentrations of small LDL particles, which are more atherogenic than large LDL particles (25). Asians are more sensitive to statin treatment, and lower doses can achieve the same therapeutic target as white Caucasian individuals. Proprotein convertase subtilisin/Kexin type 9 (PCSK9) injectable therapies effectively lower cholesterol among all ethnic groups and may be a suitable alternative when statins are not tolerated. Conclusions - There are differences in dyslipidemia patterns among various ethnic groups compared to white Caucasians. South Asians have more atherogenic dyslipidemia than other ethnic minorities. Such differences might require tailored guidelines to address these ethnic differences.

Validation of risk prediction models applied to longitudinal electronic health record data for the prediction of major cardiovascular events in the presence of data shifts.

Deep learning has dominated predictive modelling across different fields, but in medicine it has been met with mixed reception. In clinical practice, simple, statistical models and risk scores continue to inform cardiovascular disease risk predictions. This is due in part to the knowledge gap about how deep learning models perform in practice when they are subject to dynamic data shifts; a key criterion that common internal validation procedures do not address. We evaluated the performance of a novel deep learning model, BEHRT, under data shifts and compared it with several ML-based and established risk models. Using linked electronic health records of 1.1 million patients across England aged at least 35 years between 1985 and 2015, we replicated three established statistical models for predicting 5-year risk of incident heart failure, stroke, and coronary heart disease. The results were compared with a widely accepted machine learning model (random forests), and a novel deep learning model (BEHRT). In addition to internal validation, we investigated how data shifts affect model discrimination and calibration. To this end, we tested the models on cohorts from (i) distinct geographical regions; (ii) different periods. Using internal validation, the deep learning models substantially outperformed the best statistical models by 6%, 8%, and 11% in heart failure, stroke, and coronary heart disease, respectively, in terms of the area under the receiver operating characteristic curve. The performance of all models declined as a result of data shifts; despite this, the deep learning models maintained the best performance in all risk prediction tasks. Updating the model with the latest information can improve discrimination but if the prior distribution changes, the model may remain miscalibrated.

FACTORS INFLUENCING THE OUTCOME OF THROMBOLYSIS IN ACUTE MYOCARDIAL INFARCTION

Coronary heart disease (CHD) is a worldwide health epidemic. It has been defined as “impairment of heart function due to inadequate blood flow to heart compared to its needs caused by obstructive changes in the coronary circulation to the heart”(1). It is the cause of 25-30% of deaths in most of the industrialized countries. In India also it is a major public health problem. It is aptly called by WHO as the 'modern epidemic'. The increasing incidence of coronary heart disease may be a reflection of increased longevity, adoption of high fat diet based on meats decreased exercise, modern lifestyle, made possible by increasing affluence.The present study is to ascertain the factors influencing outcome of thrombolysis in acute MI and concludes that Gender and Pre infarction not influence the success rate of thrombolysis, Better success rate has been seen in those consuming alcohol and smokers had a lesser success rate than non smokers but statistically not significant. Hypertensives did not show any difference with non hypertensives in the success rate. Diabetics did not differ much from non diabetics with respect to the success rate of thrombolysis. Inferior wall myocardial infarction had a better success rate than anterior wall myocardial infarctions. Those who are having short window period had a better success rate after thrombolysis. Shorter the window period higher the success rate.

Leukocyte telomere length, allelic variations in related genes and risk of coronary heart disease in people with long-standing type 1 diabetes

BackgroundType 1 diabetes is associated with accelerated vascular aging and advanced atherosclerosis resulting in increased rates of cardiovascular disease and premature death. We evaluated associations between Leukocyte telomere length (LTL), allelic variations (SNPs) in LTL-related genes and the incidence of coronary heart disease (CHD) in adults with long-standing type 1 diabetes.MethodsWe assessed associations of LTL, measured at baseline by RT–PCR, and of SNPs in 11 LTL-related genes with the risk of coronary heart disease (CHD: myocardial infarction or coronary revascularization) and all-cause death during follow-up in two multicenter French-Belgian prospective cohorts of people with long-standing type 1 diabetes.ResultsIn logistic and Cox analyses, the lowest tertile of LTL distribution (short telomeres) at baseline was associated with the prevalence of myocardial infarction at baseline and with increased risk of CHD (Hazard ratio 3.14 (1.39–7.70), p = 0.005, for shorter vs longer tertile of LTL) and all-cause death (Hazard ratio 1.63 (95% CI 1.04–2.55), p = 0.03, for shorter vs combined intermediate and longer tertiles of LTL) during follow-up. Allelic variations in six genes related to telomere biology (TERC, NAF1, TERT, TNKS, MEN1 and BICD1) were also associated with the incidence of CHD during follow-up. The associations were independent of sex, age, duration of diabetes, and a range of relevant confounding factors at baseline.ConclusionsOur results suggest that short LTL is an independent risk factor for CHD in people with type 1 diabetes.

Religiosity and coronary heart disease In Greek adults

Background: In developed countries, cardiovascular disease is the most common cause of both death and functional disability. The last decades, scientific community shows an increasing interest exploring the relationship between religious and health factors.&#x0D; Aim: The aim of the present study was to explore associations between factors related to religiosity and self-reported Coronary Heart Disease (CHD).&#x0D; Material and Method: This was a descriptive observational study, conducted during a 2-year period. The final studied sample consisted of 1062 citizens of Greece. Data collection was performed by using a special designed questionnaire based on relevant literature review.&#x0D; Results: Half of the studied sample was men, (n=529, 49.9%). The majority of participants (77.1%) was living in urban areas of the country and was mean educated (67.1%). When asked about their employment status, most of them (65%) answered that they were professionally active. As far as their medical history is concerned, the majority of participants (88%) had no CHD history, no history of diabetes mellitus (90.3%), no history of dyslipidemias (71.8%) and no history of hypertension (71.8%). Moreover, 29.9% of the participants were overweight. Religious fasting follows 51.4% of the sample and the reason for fasting is because the church imposes fasting rules. The factor “fasting” was also related to CHD occurrence, as those who were following religious fasting had no history of CHD. A significant difference was found between responders with conscious belief in God and CHD occurrence.&#x0D; Conclusion: The findings of this study suggest that factors related to religiosity, such as doubt in God belief and religious fasting may influence CHD incidence. Prospective cohort studies and clinical trial studies that specifically designed to assess the effect of religiosity on CHD outcome are necessary to be conducted.

Neighborhood deprivation and coronary heart disease in patients with bipolar disorder

The aim was to study the potential effect of neighborhood deprivation on incident and fatal coronary heart disease (CHD) in patients with bipolar disorder. This was a nationwide cohort study which included all adults aged 30 years or older with bipolar disorder (n = 61,114) in Sweden (1997–2017). The association between neighborhood deprivation and the outcomes was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (CIs). Patients with bipolar disorder living in neighborhoods with high or moderate levels of deprivation were compared with those living in neighborhoods with low deprivation scores. There was an association between level of neighborhood deprivation and incident and fatal CHD among patients with bipolar disorder. The HRs were 1.24 (95% CI 1.07–1.44) for men and 1.31 (1.13–1.51) for women for incident CHD among patients with bipolar disorder living in high deprivation neighborhoods compared to those from low deprivation neighborhoods, after adjustments for potential confounders. The corresponding HR for fatal CHD were 1.35 (1.22–1.49) in men and 1.30 (1.19–1.41) in women living in high deprivation neighborhoods. Increased incident and fatal CHD among patients with bipolar disorder living in deprived neighborhoods raises important clinical and public health concerns.

Investigation of type 1 collagen a1 chain in plasma as a potential novel biomarker for prediction of coronary heart disease

Abstract Background Remodeling of the extracellular matrix (ECM) plays a crucial role in development and progression of atherosclerosis. Collagens, in particular type I collagen, are the most abundant ECM proteins in an atherosclerotic plaque. Recently, type I collagen α1 chain (COL1α1) in plasma was identified as a potential predictor of coronary heart disease (CHD). Aim The aim was to further confirm the predictive value of COL1α1 and also to investigate its correlates in a population-based cohort as well as changes over time in patients with manifest CHD in Sweden. Methods In a total of 1007 well-characterized individuals (50% women), 86 CHD cases and 184 sex- and age-matched controls were identified at 13 years follow-up. CHD at follow-up was defined as first-time event of myocardial infarction (MI) or invasive coronary intervention. Plasma levels of COL1α1 was quantified by the Luminex assay while PRO-C1 and C1M, two markers of type I collagen synthesis and degradation, respectively, were quantified by ELISA. In Cox proportional hazard analysis, log2 values of biomarker levels were used. In addition, temporal change of COL1α1 levels was also examined in a cohort of 125 patients with acute MI followed for 6 months. Results COL1α1 levels were significantly associated with incident CHD, both unadjusted (HR = 0.69, 95% CI 0.56–0.87, p=0.001) and after multiple adjustment (HR = 0.55, 95% CI 0.41–0.75, p&amp;lt;0.001). PRO-C1 was similarly associated with CHD, unadjusted (HR = 0.62, 95% CI 0.47–0.82, p=0.001) as well as adjusted (HR = 0.61, 95% CI 0.43–0.86, p=0.005), while C1M was not. In patients with acute MI, COL1α1 levels remained stable over 6 months. COL1α1 was significantly correlated to PRO-C1 (r=0.73, p&amp;lt;0.001), while there were no correlations to C1M, markers of inflammation (C-reactive protein, interleukin-6, matrix metalloproteinase-9) or myocardial injury (troponin T). Conclusions Circulating COL1α1 in plasma was independently and inversely associated with incident CHD. Furthermore, COL1α1 levels appeared to be relatively stable after an acute MI. COL1α1 levels seem to reflect collagen synthesis rather than collagen degradation and inflammation. Future studies are needed to confirm whether COL1α1 is a clinically useful marker and/or predictor of CHD. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): This research was in part financed by a grant from the Region of Östergötland, Sweden, aimed towards scientists early in their career. We would like to thank the people behind this grant for contributing to this research.This research was also partly supported by Futurum - the academy for healthcare in Region Jönköping County.

Cholesterol remnants distribution in patients admitted for acute coronary syndrome

Abstract Background Cholesterol remnants have been identified as one of leading lipid measurements associated with the incidence of coronary heart diseases. Nonetheless, there is scarce evidence on cholesterol remnants distribution in patients with acute coronary syndrome (ACS). Methods We included all consecutive patients admitted for ACS in two different centers. Cholesterol remnants were calculated by the equation: total cholesterol minus low-density lipoprotein cholesterol (LDLc) minus high-density lipoprotein cholesterol (HDLc) and values ≥30 were considered high. Premature ACS was defined in patients presenting with age &amp;lt;55 for men or &amp;lt;65 for women. Correlation weres assessed by linear regression and predictive models were obtained after logistic binary regression. Results We included 7,479 patients, mean age 66.68 (13.02), 2,062 (27.57%) women, mean body mass index (BMI) 28.60 (4.64) kg/m2, 2088 (27,92%) with diabetes and 2,726 (36.45%) admitted for ST-elevation ACS. Median (interquartile range) remnants level was 28 mg/dl (21–39) and 3,429 (45.85%) patients had levels ≥30 mg/dl. Significantly higher levels of remnants were observed in patients with diabetes, current smokers, BMI &amp;gt;30 kg/m2, absence of previous cardiovascular disease or premature ACS. No gender differences were observed in remnants level. Age (r: −0.29) and BMI (r: 0.44) were the variables more strongly correlated. As shown in the figures, at any given age, the risk of having cholesterol remnants ≥30 increased with higher BMI. In-hospital mortality was 3.75% (280 patients). After adjustment by age, gender, previous cardiovascular disease and GRACE score, cholesterol remnants were not associated to higher mortality risk (OR: 0.89 95% CI 0.64–1.10; p=0.21) Conclusions Elevated cholesterol remnants is highly prevalent in patients admitted for ACS and their levels inversely correlate with age and positively with body mass index. We propose a risk matrix for estimating the probability of having cholesterol remnants ≥30. Elevated cholesterol remnants were not associated to higher in-hospital mortality risk. Funding Acknowledgement Type of funding sources: None.

Ultra-sensitive troponin-I and incident coronary heart disease, stroke, heart failure, cardiac arrhythmias, arterial aneurysms and venous thromboembolism hospitalizations

Abstract Background Cardiac troponin I (cTnI) as measured by high-sensitive assays has been related to incident cardiovascular disease events (CVD) in the community. With the advent of ultra-sensitive assays, it is now possible to detect troponin I at very low concentration, far below the classical threshold of 1.9 pg/mL. However, the clinical relevance of these low concentrations for predicting CVD is largely unknown. Purpose To examine the association of cTnI as low as 0.013 pg/mL with incident cardiovascular disease events (CVDs) in the primary prevention setting. Methods cTnI was analyzed in the baseline plasma (2008–2012) of CVD free volunteers from the Paris Prospective Study III using for the first time a novel ultra-sensitive immunoassay (Simoa Troponin-I 2.0 Kit, Quanterix, Lexington) with a limit of detection (LOD) of 0.013 pg/mL. Incident CVD hospitalizations for coronary heart disease, stroke, arrhythmias, venous thromboembolism, arterial aneurysms and heart failure were validated by critical review of the hospital records. Hazard ratios were estimated per log-transformed standard deviation (SD) increase of cTnI in Cox models using age as the time scale. The added value (gain in discriminatory capacity) of cTnI for CVD risk prediction was examined by calculating the Harell's C-index boostraped difference of the SCORE 2 risk model with and without cTnI. Results There were 9503 CVD free participants (40% women) aged 59.6 (6.3) years at baseline. cTnI was detected in 99.6% of the participants (median value = 0.63 pg/mL, interquartile range [IQR] 0.39–1.09). After a median follow-up of 8.34 years (IQR, 8.0–10.07), 516 participants suffered 612 events. In fully-adjusted analysis, higher cTnI (per 1 SD increase of log cTnI) was significantly associated with CVD events combined (n=516, HR= 1.21; 1.06; 1.39). In univariate Cox analysis and compared to each single established risk factor, cTnI had the highest discrimination capacity for incident CVD events (C-index=0.6349) (Figure 1). Adding log cTnI to the SCORE 2 algorithm increased significantly albeit moderately discriminatory capacity (C-index 0.698 vs. 0.685; boostraped C index difference: 0.0135 (95% CI: 0.0131; 0.0138)). Conclusion cTnI concentrations as measured by a novel ultra-sensitive immunoassay is associated with a significant increased risk of incident CVD events in the primary prevention setting. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): ANR: French National Research AgencyEurope: Horizon 2020

C-reactive protein as a possible modifier of Lipoprotein(a)-related risk for coronary heart disease in Europe: results from the BiomarCARE project

Abstract Background Lipoprotein(a) (Lp(a)) represents a unique proatherogenic lipoprotein with potent pro-thrombotic and pro-inflammatory properties. Recent studies demonstrated that Lp(a)-associated risk for cardiovascular disease (CVD) was significantly increased only in individuals with a high inflammatory burden (i.e. hsCRP levels &amp;gt;2 mg/L). However, these results have been either based on a post-hoc analysis in a highly selected study population with a high/very high CVD risk, or conducted within a multi-ethnic population with significant variation in Lp(a) levels. Purpose The main aim was to investigate whether hsCRP concentration modulates the predictive value of Lp(a) for coronary heart disease (CHD) events in the general population across Europe. Methods Data of 87,760 participants from 10 European prospective population-based cohorts, participating in the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE)-project, were used for the present analysis (79,958 subjects without and 7,189 individuals with established CHD at baseline (primary/secondary prevention cohorts, respectively)). All Lp(a) measurements were performed in the central BiomarCaRE laboratory. Fine and Gray competing risk-adjusted models stratified by study cohort were calculated to assess the association between Lp(a) levels and future CHD events stratified according to hsCRP levels (&amp;lt;1 mg/l, ≥1–&amp;lt;2 mg/l and ≥2 mg/l). Results During a median follow-up of 11.3 years, 4,928 events occurred in the CHD-free subpopulation and 1,772 events occurred in the CHD subpopulation. In the primary prevention cohort, increased Lp(a) was significantly associated with future CHD events irrespective of hsCRP: Hazard ratios (HRs) for future CHD events (top vs bottom quintile (Q) of Lp(a) distribution) were 1.46 (95% CI: 1.21–1.78; p&amp;lt;0.001) in those having a hsCRP concentration &amp;lt;1 mg/l; 1.32 (95% CI: 1.09–1.61; p=0.0052) for a hsCRP group of ≥1-&amp;lt;2 mg/l and 1.40 (95% CI: 1.22–1.61; p&amp;lt;0.001) in subjects with a hsCRP concentration ≥2 mg/l, after multivariable adjustment for traditional CV risk factors including LDL-Ccorr and lipid-lowering medication. In contrast, in the secondary prevention, we found no association between increased Lp(a) levels and CHD events in individuals with a very low inflammatory burden (HR for hsCRP &amp;lt;1 mg/l 0.92 (95% CI 0.63–1.34), p=0.66, Q5 vs Q1)), whereas the association was significant among subjects with a hsCRP concentration ≥1 mg/l (HRs: 1.43 (95% CI: 1.01–2.03; p=0.045) for hsCRP group ≥1-&amp;lt;2 mg/l and 1.35 (95% CI: 1.07–1.71; p=0.013) for hsCRP group ≥2 mg/l (both for Q5 vs Q1)). Conclusion In a primary prevention setting, Lp(a) was associated with incident CHD irrespective of the inflammatory burden. In contrast, among subjects with known CHD, the association of Lp(a) and future CHD events was only present in those with hsCRP levels &amp;gt;1 mg/l. These findings might guide target population selection for upcoming Lp(a)-targeting compounds. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the 7th Framework Programme Collaborative Project (grant agreement no. HEALTH-F2-2011-278913). The MORGAM Project has received funding from EU projects MORGAM (Biomed, BMH4-CT98-3183), GenomEUtwin (Fifth Framework Programme FP5, QLG2-CT-2002-01254), ENGAGE (FP7, HEALTH-F4-2007-201413), CHANCES (FP7, HEALTH-F3-2010-242244), BiomarCaRE (FP7, HEALTH-F2-2011-278913), euCanSHare (Horizon 2020, No. 825903) and AFFECT-EU (Horizon 2020, No. 847770); and Medical Research Council, London (G0601463, No. 80983: Biomarkers in the MORGAM Populations).

EFFECT OF HYPOTHYROIDISM ON MYOCARDIAL INFARCTION AND REVASCULARIZATION IN PATIENTS WITH RHEUMATOID ARTHRITIS

EFFECT OF HYPOTHYROIDISM ON MYOCARDIAL INFARCTION AND REVASCULARIZATION IN PATIENTS WITH RHEUMATOID ARTHRITIS

Coronary Artery Disease and Diabetes - A Review of the Current Literature with focus on Management

This article reviews current knowledge concerning cardiovascular disease in subjects with (and without) diabetes mellitus. It discusses the worldwide distribution and dimensions of these disorders. It contrasts incidence, prevalence, investigations, treatment strategies and outcomes of coronary heart disease and myocardial infarction amongst patients with and without diabetes. Emphasis is given to discussing the outcomes of various trials of treatments and management strategies applied to such patients and how closely they apply to the diabetic cohorts who constitute a substantial proportion of most of those trials. The article concludes with a review of specific treatments for elevated glucose which may have prognostic benefits in CVD.