Independent Predictor Of Coronary Artery Disease Research Articles

Plasma Homocysteine Levels as Cardiovascular Disease Risk vis-a-vis Estrogen Levels in Pre and Postmenopausal Women

Objectives: The objective of the study is to evaluate plasma homocysteine level and its relation with serum estrogen in pre and postmenopausal women as a risk factor in coronary artery disease (CAD). Materials and Methods: A cross-sectional study was conducted among premenopausal (n = 50) and postmenopausal women (n = 50) with an estimation of plasma homocysteine (Hcy) and serum estradiol (E2). Postmenopausal women based on their angiographic status were sub-grouped into A (with normal coronaries) and B (with CAD). Results: The levels of Hcy, 21.98 (20.89–24.05) μmol/L, increased significantly (P < 0.0001) and that of E2, 3.05 (2.32–3.6) pg/mL, decreased significantly (P = 0.0001) in the postmenopausal group when compared to Hcy, 6.11 (4.94–8.27) μmol/L and E2, 26.37 (25.3–29) pg/mL in premenopausal group. The levels of Hcy were elevated (24.7 ± 3.92 μmol/L) in postmenopausal Group B in comparison with postmenopausal Group A (21.37 ± 3.31 μmol/L), P = 0.002. Logistic regression analysis showed Hcy and body mass index to be independent predictors of CAD. Plasma Hcy showed an area under curve (AUC) of 1.00 with sensitivity and specificity of 100% at cutoff >12.6 μmol/L between pre and postmenopausal groups and AUC of 0.722 with 60% sensitivity and 84% specificity at cutoff >23.7 μmol/L between postmenopausal Groups A and B. Conclusion: We observed low E2 and high Hcy levels in postmenopausal women in comparison with premenopausal women. Among postmenopausal women, those with CAD had higher Hcy levels. Assessing Hcy levels routinely in postmenopausal women will help in better risk prediction of CAD and may also help in conjunction with other risk factors to decide the initiation of hormone replacement therapy.

Interleukin-4 and Interleukin-17 are associated with coronary artery disease.

The present study aimed to examine the correlation between serum cytokine levels and the incidence of coronary artery disease (CAD), a leading cause of mortality globally, which is known to have a strong association with inflammatory factors. The study further sought to determine the predictors of CAD to distinguish patients with coronary artery lesions from those suspected of having CAD. In this study, 487 patients who underwent coronary angiography as a result of suspected CAD but without acute myocardial infarction (AMI) were recruited. The serum levels of the cytokines interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17, tumor necrosis factor-α, interferon (IFN)-α, and IFN-γ were measured using a multiplexed particle-based flow cytometric assay technique. The results of the study revealed that the levels of IL-4, IL-12p70, IL-17, IFN-α, and IFN-γ in the CAD group were significantly lower compared to those in the non-CAD group. Multivariate logistic regression analysis indicated that two serum cytokines (IL-4 and IL-17), one protective factor (high-density lipoprotein cholesterol [HDL-C]), and three risk factors (sex, smoking, and diabetes) were independently predictive of CAD. The receiver operating characteristic curve analysis showed that the combined use of these predictors in a multivariate model demonstrated good predictive performance for CAD, as evidenced by an area under the curve value of 0.826. The results of the study indicated that serum IL-4 and IL-17 levels serve as independent predictors of CAD. The risk prediction model established in the research, which integrates these serum cytokines (IL-4 and IL-17) with relevant clinical risk factors (gender, smoking, and diabetes) and the protective factor HDL-C, holds the potential to differentiate patients with CAD from those suspected of having CAD but without AMI.

Relationship between vitamin D and coronary artery disease in Egyptian patients

BackgroundPrevious studies have reported conflicting results about the association of vitamin D (VD) level with coronary artery disease (CAD). We aimed to study the association of VD with atherosclerotic CAD in Egyptian individuals.ResultsWe prospectively enrolled 188 consecutive CAD patients with a median age of 55(50–62) years; 151(80.3%) were male. All patients were diagnosed by cardiac catheterization and were compared with 131 healthy controls. VD levels were measured in serum samples of all participants. Compared to controls, CAD patients had a significantly lower median VD level, 14.65 (9.25–21.45) versus 42.0 (32.0–53.0) ng/mL, p < 0.001. VD was correlated with the number of diseased coronary arteries and lipid profile (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides, p < 0.001 for each). By multivariate analyses, VD was an independent predictor of CAD [OR 1.22 (95% CI 1.07–1.4), p = 0.003, optimal cut-off value 30 ng/mL (AUC 0.92, sensitivity 81% and specificity 81.4%), p < 0.001], and the number of diseased coronary arteries, p < 0.001, especially three-vessel disease [OR 0.83 (95% CI 0.72–0.95), p = 0.008].ConclusionsWe have shown that low VD should be considered a non-traditional risk factor for CAD in Egyptian individuals. Low VD was correlated with coronary atherosclerosis, especially in patients with multivessel effects.

Abstract 11582: The Fingertip Artery is Better Than the Brachial Artery in Evaluating Vascular Endothelial Function for Coronary Artery Disease in Diabetic Patients

Introduction: Several studies demonstrated that endothelial function is impaired in diabetic patients, but no study evaluated vascular parameters in diabetic patients trough a combined analysis of macro and micro-endothelial function. In addition, the difference in vascular parameters between diabetes patients with coronary artery disease (CAD) and without CAD remains unknown. We assessed whether CAD is related to macro or micro vascular endothelial function in diabetic patients. Hypothesis: We measured vascular function in 219 diabetic patients (age 68±10 years), including 147 patients with CAD (CAD group) and 72 patients without CAD (control group). Flow mediated vasodilatation (FMD)indicating macro-endothelial function in the brachial artery was measured by ultrasound using a semi-automatic device: UNEXEF18G (UNEX Co. Nagoya, Japan). Reactive hyperemia index (RHI) indicating micro-endothelial function in the fingertip artery was measured by peripheral arterial tonometry (EndoPAT 2000). Vascular function tests were measured on the same day. Results: RHI was significantly impaired in CAD group (RHI: 2.0±0.7 vs.1.7±0.5 P=0.012), however FMD had no deference in the two groups. Logistic regression analysis revealed that RHI (odds ratio: 0.44, 95% confidence interval: 0.21-0.94) was an independent predictor for CAD in diabetic patients. Conclusions: RHI, an acknowledged marker of micro-endothelial function was a more sensitive method than FMD in evaluating the risk assessment of CAD in diabetic patients. more peripheral vascular endothelial function was associated with CAD in diabetic patients.

Which Biomarker(s) Augment the Diagnostic Value of the Positive Exercise Electrocardiography Test: Systemic Inflammatory Index, Plasma Atherogenic Index, or Monocyte/HDL-C Ratio?

The exercise electrocardiography test (EET) is still used before coronary angiography in the diagnosis of chronic coronary syndromes. This study aimed to demonstrate the value of the combination of a positive EET with the systemic inflammatory index (SII), the plasma atherogenic index (PAI), and the monocyte/HDL-C ratio (MHR) in the determination of obstructive coronary artery disease (CAD). This single-center, retrospective study included 540 patients who underwent coronary angiography after ETT. The patients were separated into Group 1, comprising 434 patients with normal coronary arteries and non-obstructive CAD, and Group 2, including 106 with obstructive CAD. In Group 2, the patients were separated into SYNTAX ≤ 22 or ≥23. Glucose, low-density lipoprotein, white blood cells, and MHR were determined to be significantly higher in Group 2 (p < 0.05). According to the multivariate logistic regression analysis, age, gender, diabetes mellitus, and low-density lipoprotein were determined to be independent predictors of CAD. In the ROC curve analysis, a cut-off value of 12 for the MHR in the determination of obstructive CAD had a sensitivity of 60.4% and a specificity of 53.0%. The main result of this study was that a high MHR is an indicator of obstructive CAD in patients with positive EET and suspected CAD.

Single-cell RNA sequencing atlas of peripheral blood mononuclear cells from subjects with coronary artery disease

BackgroundThe landscape of specific peripheral circulating immune cell subsets at the single-cell level in the occurrence and development of coronary artery disease (CAD) remains poorly understood. MethodsWe conducted single-cell RNA sequencing (scRNA-seq) of peripheral blood mononuclear cells (PBMCs) from subjects with CAD (n = 3), and controls (n = 3), as well as downstream analysis including cell- and gene-level approaches. This explored the characteristics of peripheral circulating immune cells between CADs and controls by means of Uniform manifold approximation and projection (UMAP), Monocle3 package, CellPhoneDB, and single-cell regulatory network inference and clustering (SCENIC). PBMCs were used as clinical samples for validating our findings by qRT-PCR. ResultsWe identified 33 cell clusters among 67,447 cells, including monocytes, T cells, B cells, NK cells, and platelets. The significant difference in the abundance of the 33 clusters of cell type between CADs group and controls group was not found. The JUN was shared in cluster 0, 11,13, and 24 from differential expression genes analysis and SCENIC analysis in monocyte clusters between CAD and controls. Besides, JUN was validated to be significantly upregulated in the CAD group (p = 0.018) and may act as a potential diagnostic biomarker and independent predictor of CAD. ConclusionsOur study offered a detailed profiling of single-cell RNA sequencing of PBMCs from subjects with CADs and controls. These data provide a line of evidence that the JUN signaling pathway may be a potential diagnostic and therapeutic molecule target for CAD.

The Increased TIGIT-Expressing CD3+CD56+ Cells Are Associated with Coronary Artery Disease and Its Inflammatory Environment.

We aimed to examine the correlation of T-cell immunoglobulin and ITIM domain (TIGIT)-expressing CD3 + CD56 + cells (TNKS) with coronary artery disease (CAD), atherosclerotic lesion progression, and inflammatory environment. A total of 199 subjects, including 98 patients with acute coronary syndrome (ACS), 52 patients with chronic coronary syndrome (CCS), and 49 control subjects, were recruited in the study. The TIGIT-expressing TNKS were quantified by flow cytometric analysis; the severity of coronary artery lesions was evaluated by the Gensini score. Whole blood cells were stimulated with interleukin-2 (IL-2), interleukin-7 (IL-7), and interleukin-15 (IL-15) in presence or absence of STAT, PI3K, and P38 MAPK inhibitors, respectively. The TIGIT-expressing TNKS was significantly increased in patients with CAD, ACS, and CCS compared to the control group (P < 0.05). The TIGIT-expressing TNKS were independent predictors of CAD, ACS and CCS (P < 0.05). The TIGIT-expressing TNKS were positively associated with Gensini score (P < 0.05). The TIGIT-expressing TNKS was positively correlated with age, and being male (P < 0.05). The inflammatory microenviroment with increased IL-2, IL-7, and IL-15 contributed to upregulation of TIGIT expression in TNKS. PI3K and P38 MAPK inhibitors could inhibit the upregulation of TIGIT expression in TNKS induced by IL-2, IL-7, and IL-15. The TIGIT-expressing TNKS may be involved in common pathogenesis of ACS and CCS, and atherosclerotic lesion progression. Meanwhile, the increased TIGIT-expressing TNKS might be associated with a proatherogenic microenvironment or inflammatory microenvironment. PI3K and P38 MAPK signaling pathways were involved in the regulation of TIGIT expression.

A nomogram based on endothelial function and conventional risk factors predicts coronary artery disease in hypertensives

BackgroundThere is currently a lack of a precise, concise, and practical clinical prediction model for predicting coronary artery disease (CAD) in patients with essential hypertension (EH). This study aimed to construct a nomogram to predict CAD in patients with EH based on flow-mediated dilation (FMD) of brachial artery and traditional risk factors.MethodsClinical data of 1752 patients with EH were retrospectively collected. High-resolution vascular ultrasound was used to detect FMD in all patients at the Fujian Hypertension Research Institute, China. Patients were divided into two groups, i.e. training group (n = 1204, from August 2000 to December 2013) and validation group (n = 548, from January 2014 to May 2016) according to the time of enrollment. Independent predictors of CAD were analyzed by multivariable logistic regression in the training group, and a nomogram was constructed accordingly. Finally, we evaluated the discrimination, calibration, and clinical applicability of the model using the area under curve (AUC) of receiver operating characteristic analysis, calibration curve combined with Hosmer-Lemeshow test, and decision curve, respectively.ResultsThere were 263 (21.8%) cases of EH combined with CAD in the training group. Multivariate logistic regression showed that FMD, age, duration of EH, waist circumference, and diabetes mellitus were independent influencing factors for CAD in EH patients. Smoking which was close to statistical significance (P = 0.062) was also included in the regression model to increase the accuracy. Ultimately, the nomogram for predicting CAD in EH patients was constructed according to above predictors after proper transformation. The AUC values of the training group and the validation group were 0.799 (95%CI 0.770–0.829) and 0.836 (95%CI 0.787–0.886), respectively. Calibration curve and Hosmer-Lemeshow test showed that the model had good calibration (training group: χ2 = 0.55, P = 0.759; validation group: χ2 = 1.62, P = 0.446). The decision curve also verified the clinical applicability of the nomogram.ConclusionThe nomogram based on FMD and traditional risk factors (age, duration of EH disease, smoking, waist circumference and diabetes mellitus) can predict CAD high-risk group among patients with EH.

Assessment of the Severity of CAD Regarding Number of Vessels Involved

Background: Coronary artery disease (CAD) is characterized by atherosclerotic plaque accumulation in the epicardial arteries. The dynamic nature of the CAD process results in various clinical presentations. Red blood cell distribution width (RDW) is a practical, widely available marker for assessing the severity of coronary artery disease and helps in the risk stratification of patients with CAD. This study aimed to analyze the severity of CAD regarding the number of vessels involved. Material Methods: This descriptive cross-sectional study included 124 purposively selected patients who underwent elective CAG in the Department of Cardiology, Chittagong Medical College Hospital, Chattogram, from January 2020 to June 2021. SPSS 23.0 software was used for processing and analysis at the end of the data collection period. Results: The age of the patients ranged from 32-75 years with a mean (±SD) age of 53.4 (±9.9) years. The majority of the patients (83.1%) were male with a male-to-female ratio of 4.9:1. On coronary angiography, the majority of the patients (51/124, 41.1%) had triple vessel disease, followed by double vessel disease in 23 (28.5%) patients, single-vessel disease in 31 (25.0%). In 19 (15.4%) patients no significant lesion was observed in any of the vessels. Gensini score ranged between 1 and 176 in the study with a median score of 56.77. The majority of the patients (69.4%) in the present study had a Gensini score ≥30 indicating severe stenosis. A positive correlation between RDW and coronary artery disease severity in terms of Gensini score (r=0.393). With the increase of RDW, the Gensini score increases. It was found statistically significant (p=&lt;0.001) by Pearson’s correlation test. There was a positive correlation between RDW and CAD severity regarding the number of vessels involved (rho =0.5). With the increase of RDW, the number of involved vessels increases. It was found statistically significant (p=&lt;0.001) by Spearman’s correlation test. The Median (IQR) value of RDW was 13.5 (13.0-14.0) in patients with mild stenosis compared to 14.5 (13.9-15.0) in patients with severe stenosis. This difference was statistically significant (p&lt;0.001). The median (IQR) value of RDW was the lowest in patients without any significant stenosis in any of the coronary arteries [13.1% (12.7%-13.5%)] and was the highest in patients with triple vessel diseases [14.5% (14.1%-15.0%)]. Conclusion: This study demonstrated that RDW level was an independent predictor for CAD and the severity of coronary stenosis. So, it can be concluded that RDW is an inexpensive routine laboratory test that might help identify high-risk patients before planning for a more invasive treatment strategy.

Emerging markers of inflammation and oxidative stress as potential predictors of coronary artery disease

Background and aimsThe multi-ligand receptor for advanced glycation end products (RAGE) and its ligands AGEs and S100/calgranulin proteins are important mediators of inflammation and oxidative stress whereas the soluble form of RAGE (sRAGE) by acting as a decoy and the antioxidant PARK7/DJ-1 exert antiatherogenic effects. We examined whether sRAGE and its ligands AGEs, S100A8/A9, S100B, S100A12 and DJ-1 are associated with the presence of angiographic coronary artery disease (CAD) in asymptomatic patients with and without diabetes. Methods and resultsPlasma levels of RAGE ligands, sRAGE and DJ-1 were determined in 50 patients with angiographically proven CAD and in 50 age-matched healthy controls. In the whole cohort, lower levels of sRAGE and higher levels of interleukin-6 (IL-6), the RAGE ligands S100B, S100A12 and the AGEs/sRAGE ratio were associated with CAD. In patients without diabetes (n = 72), lower levels of sRAGE and DJ-1 and higher levels of IL-6 and AGEs/sRAGE ratio were associated with CAD. In multivariable analysis, AGEs/sRAGE ratio was an independent predictor of CAD both in the whole cohort (p = 0.034, OR = 1.247, [95%CI: 1.024, 1.0519]) and in the subgroup of patients without diabetes (p = 0.021, OR = 1.363, 95%CI [1.048, 1.771]) on top of established cardiovascular risk factors. ConclusionAlterations in plasma RAGE axis inflammatory mediators are associated with atherosclerosis, and higher levels of AGEs/sRAGE ratio are independently associated with CAD in asymptomatic patients and may act as a novel biomarker for predicting CAD. DJ-1 emerges as promising marker of oxidative stress in CAD patients without diabetes, a finding that deserves further study.

Nomograms Based on the Albumin/Neutrophil-to-Lymphocyte Ratio Score for Predicting Coronary Artery Disease or Subclinical Coronary Artery Disease.

To develop and validate two nomograms incorporating the albumin/neutrophil-to-lymphocyte ratio score (ANS) for predicting the risk of coronary artery disease (CAD) or subclinical CAD. Four hundred fifty patients with suspected CAD who underwent coronary computed tomographic angiography were consecutively enrolled between September 2015 and June 2017. Nomograms were established based on independent predictors of CAD or subclinical CAD. In total, 437 patients with suspected CAD who underwent coronary computed tomographic angiography were included. Male sex, age ≥65 years, smoking, hypertension, diabetes, dyslipidemia, ischemic stroke, and ANS were independent predictors of CAD and subclinical CAD. The areas under the curve of each nomogram were 0.799 (95% CI: 0.752-0.846) and 0.809 (95% CI: 0.762-0.856), respectively. The calibration curve and decision curve analysis showed good performance for the diagnostic nomograms. The prediction of CAD or subclinical CAD by the ANS was not modified by the independent predictors (all, p for interaction >0.05). Our ANS-based nomograms can provide accurate and individualized risk predictions for patients with suspected CAD or subclinical CAD.

Predictive Value of Global Longitudinal Strain Imaging in Detecting Significant Coronary Artery Disease in Patients with Non-ST-segment Elevation Myocardial Infarction

Background: Two-dimensional speckle-tracking echocardiography (2D-STE) is a newer method for assessing left ventricular (LV) systolic function. The aim of this study was to assess the predictive value of 2D global longitudinal strain (GLS) in the detection of longitudinal LV systolic dysfunction and the identification of significant coronary artery disease (CAD) in non-ST-segment elevation myocardial infarction (NSTEMI) patients without wall motion abnormalities. Materials and Methods: We enrolled 100 patients who were suspected cases of NSTEMI with echocardiography showing LV ejection fraction &gt;50% and no regional wall motion abnormality. LV myocardial function was assessed using conventional echocardiographic measurements and myocardial deformation analysis with 2D-STE. The patients found to have significant CAD on coronary angiography were included in the cases group and those without significant CAD were considered as controls. Results: Mean age of the patients was 58.36 ± 11.21 years versus 56.54 ± 8.10 years in controls. Male preponderance was found in both case and control groups, with 66% (n = 33) and 56% (n = 28) males, respectively. The patients had significantly lower GLS as compared to the controls (-16.31 ± 1.34% vs -19.17 ± 1.63%, P &lt; 0.001). The patients with positive troponin assay had a lower mean GLS −16.49 ± 1.5% as compared to those with negative troponin assay (−19.32 ± 1.54%, P &lt; 0.001). Multivariate analyses indicated that GLS was an independent predictor of CAD in those with NSTEMI (GLS odds ratio = 0.024, P &lt; 0.001). Conclusions: The present study demonstrates that 2D-STE is superior to conventional echocardiography in excluding significant CAD. It is a promising, easy to perform, bedside tool for diagnosis and prognostication in patients with NSTEMI. GLS has a potential to be used in conjugation with other risk stratification strategies to identify patients at high risk.

The Relevance of Thrombo-Inflammatory Biomarkers and Their Relationship with Circulating Glycosaminoglycans in End-Stage Renal Disease Patients

En-stage renal disease (ESRD) is a growing public health problem. The atherosclerotic cardiovascular complications are the leading causes of mortality and morbidity in the ESRD. In this study, we sought to quantify the levels of thrombo-inflammatory biomarkers in an ESRD patients in comparison to healthy controls to determine their relevance in thrombo-inflammation and adverse outcomes. The levels of D-Dimer, C-reactive protein (CRP), plasminogen activator inhibitor 1 (PAI-1) antigen, functional PAI-1, thrombin activatable fibrinolysis inhibitor, tissue plasminogen activator, von Willebrand factor, and anti-PF4 IgG and microparticle (MP) activity were quantified by using commercially available ELISA immunoassays for each of the ESRD (n = 73) and control plasma samples (n = 10). The levels of endogenous glycosaminoglycans (GAGs) were quantified by utilizing a Heparin Red Probe (Redprobes UG, Germany). The collected data were analyzed to demonstrate the relationship between various parameters. All the tested biomarkers were increased in ESRD patients in comparison to healthy controls (p < 0.05). These biomarkers have shown significant correlations within each other except for anti-PF4 Ig G and MPs. The CRP levels were significantly higher in patients who had coronary artery disease (CAD) (p < 0.05), but there was no significant difference in other biomarkers according to the cardiovascular outcomes. In the multivariate analysis, the CRP (odds ratio: 1.19; 95% confidence interval: 1.01-1.41; p: 0.03) value was an independent predictor of CAD. In this study, we demonstrated increased levels of 10 different biomarkers in ESRD patients. The CRP levels can be a good predictor of CAD in ESRD patients.

Sex Differences in Computed Tomographic Angiography in Patients with Low and Intermediate Pretest Probability of Coronary Artery Disease

Background: Multi-slice computed tomography (MSCT) coronary angiography has become one of the hot spots in cardiovascular imaging technology. Many of the sex-based research have shown that women have different pathogenesis, clinical presentation and complication related to coronary artery disease (CAD) as compared to the males. The aim of this study investigated the relationship between gender and coronary artery calcium (CAC) in patients with chest discomfort with low and intermediate pretest probability of CAD who underwent Coronary computed tomography angiography (CCTA) and referrals by gender for subsequent invasive coronary angiography and revascularization.&#x0D; Methods: This prospective cohort study included 200 patients suspected to have coronary artery disease, negative or equivocal stress tests, with no prior known coronary artery disease (CAD), intermediate pretest probability for CAD according to the scoring method of (15-65 points), and Low likelihood for CAD (&lt; 15 points). Patients were divided into two groups according to gender and were followed up. All patients underwent Full history taking, full clinical examination, routine laboratory investigation, resting and exercise ECG, echocardiography, CT coronary angiography and invasive Coronary angiography.&#x0D; Results: Patients with mild calcium score level were significantly higher in no CAD group than CAD group (p &lt;0.001) and patients with high calcium score were significantly higher in CAD group than no CAD group (p &lt;0.001). In univariate regression analysis age, typical chest pain, obesity, coronary Ca score, and hyperlipidemia are independent predictors for CAD in females. In multivariate regression analysis, age, typical chest pain, hypertension, and coronary Ca score are predictors for CAD in males. Coronary calcium score is a good predicator for CAD (AUC =0.901, 95% CI =0.851-0.938, p value &lt;0.001). At cut off value &gt; 101, it has 70.97% sensitivity, 90.79% specificity, 92.6% PPV, and 65.7% NPV. Moreover, it is a good predicator for CAD in females (AUC =0.894, 95% CI =0.823 – 0.944, p value &lt;0.001). At cut off value &gt; 101, it has 60.71% sensitivity, 91.67% specificity, 87.2% PPV, and 71.4% NPV.&#x0D; Conclusions: In patients with chest discomfort with low and intermediate pretest probability of CAD who underwent CCTA and subsequent invasive coronary angiography and revascularization, female patients had lower age, hypertension, pretest probability score, calcium score, atypical angina, nonanginal chest pain and obstructive CAD but had higher BMI, typical angina than males’ group. In females, coronary calcium score is a good predicator for CAD. When its level exceeds 100, it has 60.71% sensitivity and 91.67% specificity. In addition, it was found that in females typical chest pain and coronary Ca score are predictors for CAD and in males, age, typical chest pain, hypertension, and coronary Ca score are predictors for CAD.

Prognostic value of plasma adipokine chemerin in patients with coronary artery disease

BackgroundAdipokine chemerin was proven to be associated with coronary artery disease (CAD), but its prognostic implications in CAD remain unclear.MethodsThis study consists of two parts, one is a basic study and the other is a clinical cohort study. First, we investigated the differential expression of six adipokines in the atherosclerotic mice model compared to mice with milder degrees of atherosclerosis and mice without atherosclerosis using microarray data. We then examined the potential of chemerin as a diagnostic and prognostic indicator in a CAD cohort. A total of 152 patients were enrolled in our study, including 77 patients with angiographically proven CAD and 75 control subjects without cardiovascular disease. Plasma adipokine chemerin levels were measured in all patients, and major adverse cardiovascular events (MACEs) were followed up, including ischemic stroke, non-fatal myocardial infarction, revascularization, and cardiovascular death.ResultsIn the aortas of atherosclerotic mice, chemerin expression was up-regulated compared to control mice. The plasma chemerin levels of CAD patients were higher than those of non-CAD patients (128.93 ± 37.06 vs. 109.85 ± 27.47 mmol/L, respectively, P < 0.001). High chemerin levels were an independent predictor of CAD (β = 2.702, 95% CI, 1.344–5.431, P = 0.001). We followed up with patients for a median duration of 5.5 years (3.9–5.6). The Kaplan–Meier curves showed that patients in the high chemerin group had a significantly higher risk of MACEs than the low chemerin group in patients with CAD (log-rank P = 0.003), not with non-CAD (Log-rank P = 0.120). Furthermore, Cox multivariate analysis revealed that high chemerin levels were an independent predictor of MACEs (HR 2.267; 95% CI, 1.139–4.515; P = 0.020). Finally, the cellular study showed that chemerin is predominantly expressed in PBMC-derived macrophages.ConclusionPlasma chemerin levels were increased in the CAD patients, and a high chemerin level increased the risk of MACEs in CAD patients.

Carotid intima-media thickness predicted the presence but not the severity or complexity of coronary artery disease in a South Asian population

BackgroundCarotid intima-media thickness (CIMT) is considered a marker of atherosclerosis, but the data is lacking from the South Asian population. We aimed to study the relation of CIMT with the presence and severity of coronary artery disease (CAD) in this population. MethodsThis was a prospective, single-center study of consecutive patients undergoing elective coronary angiography. Participants with >50% luminal stenosis in any major coronary artery were included in the CAD group and those with normal coronaries in the non-CAD group. Multivariate linear regression analysis was done to determine independent predictors of CAD. Pearson's correlation coefficients assessed correlations between CIMT and Syntax and Gensini score. ResultsThe mean CIMT was significantly much higher in the CAD group when compared to the non-CAD group (0.83±0.16 vs 0.61±0.14mm, p<0.001). On multivariable linear regression analysis only diabetes (β=0.208 and p=0.024), waist–hip ratio (β=0.178 and p=0.043), current smoker (β=0.293 and p=<0.001) and CIMT (β=0.217 and p=0.031) were independent predictors of CAD. The mean Gensini score in the CAD group was 48.59±34.25 and the mean Syntax score was 19.45±10.24. No significant relation was found between CIMT and Gensini score (r=0.009 and p=0.89), and Syntax score (r=−0.087 and p=0.171). ConclusionMean CIMT is an independent predictor of CAD along with diabetes, waist–hip ratio, and smoking. However, CIMT was not related to the severity and complexity of the CAD as assessed by the Gensini score and Syntax score, respectively.

Increased risk of subsequent cardiovascular disease among men aged 31-60 years with erectile dysfunction

ABSTRACT Background Men presenting with erectile dysfunction (ED) or coronary artery disease (CAD) can be regarded as two different manifestation of vascular occlusion incident. ED has been proven to be an independent predictor of CAD, especially young men aged 40-49 years. Although psychogenic ED is more prevalent in younger patients less than 40 years of age, but the ED presentation can also be related to vasculogenic etiology. The purpose of this study is to evaluate the subsequent CAD risk in young ED patients and also determine the relative CAD risk in ED men stratified by age. Methods A total of 3091 ED patients and 9273 randomly-selected controls without ED were selected from the National research database and studied retrospectively from January 1,1997 to December 31, 2007. The comparison cohort without ED was matched for age and comorbidities (diabetes, hypertension, hyperlipidemia and ischemic stroke). All subjects were followed up by the end of 2009. Cox proportional hazards regression models were used to explore the connection between ED and the development of CAD. Results The ED patients have a greater chance of developing cardiovascular disease compared to controls (460/3091, 14.9% vs. 1021/9273, 11.0%, p-values &amp;lt; 0.0001). Cox proportional hazards regression suggested ED increases the risk of CAD development (HR 1.37, 95% CI [1.22-1.53], p&amp;lt;0.0001). Results stratified by 10-year age decades demonstrate ED men aged 31-40 years, 41-50 years, and 51-60 years pose greater risk of developing CAD comparing to the controls (HR 1.61, 95% CI [1.04-2.52], p=0.03; HR 1.79, 95% CI [1.38-2.32], p&amp;lt; 0.0001; HR 1.68, 95% CI [1.35-2.09], p&amp;lt; 0.0001, respectively). On the contrary, the incident cardiac events were not increased in ED men aged 21-30 years, 61-70 years and 71-80 years comparing to the controls (HR 1.77, 95% CI [0.50-6.29], p=0.38; HR 1.17, 95% CI [0.95-1.44], p=0.15; HR 0.88, 95% CI [0.65-1.19], p=0.40, respectively). Conclusion Erectile dysfunction is a harbinger of cardiovascular clinical events in men aged 31-60 years. Erectile dysfunction should prompt investigation and close follow up for further cardiac events. Disclosure Work supported by industry: no.

Carotid intima-media thickness predicted the presence but not the severity or complexity of coronary artery disease in a South Asian population

BackgroundCarotid intima-media thickness (CIMT) is considered a marker of atherosclerosis, but the data is lacking from the South Asian population. We aimed to study the relation of CIMT with the presence and severity of coronary artery disease (CAD) in this population. MethodsThis was a prospective, single-center study of consecutive patients undergoing elective coronary angiography. Participants with >50% luminal stenosis in any major coronary artery were included in the CAD group and those with normal coronaries in the non-CAD group. Multivariate linear regression analysis was done to determine independent predictors of CAD. Pearson's correlation coefficients assessed correlations between CIMT and Syntax and Gensini score. ResultsThe mean CIMT was significantly much higher in the CAD group when compared to the non-CAD group (0.83±0.16 vs 0.61±0.14mm, p<0.001). On multivariable linear regression analysis only diabetes (β=0.208 and p=0.024), waist–hip ratio (β=0.178 and p=0.043), current smoker (β=0.293 and p=<0.001) and CIMT (β=0.217 and p=0.031) were independent predictors of CAD. The mean Gensini score in the CAD group was 48.59±34.25 and the mean Syntax score was 19.45±10.24. No significant relation was found between CIMT and Gensini score (r=0.009 and p=0.89), and Syntax score (r=−0.087 and p=0.171). ConclusionMean CIMT is an independent predictor of CAD along with diabetes, waist–hip ratio, and smoking. However, CIMT was not related to the severity and complexity of the CAD as assessed by the Gensini score and Syntax score, respectively.

Clinical significance of epicardial fat in suspected angina pectoris: an observational study

Abstract Funding Acknowledgements Type of funding sources: None. Background Epicardial adipose tissue (EAT) is the visceral fat between pericardium and visceral epicardium and is the source of several endocrine and inflammatory mediators. It also has paracrine affects in the neighboring coronary arteries. Objective To evaluate the association of EAT with subclinical atherosclerosis (carotid intima media thickness &amp; flow mediated vasodilation), ultrasonic and anthropometric measures of abdominal fat, metabolic syndrome and coronary artery disease (CAD) concurrently. Material and methods Patients who underwent computed tomography (CT) coronary angiography for suspected CAD were prospectively included. All underwent anthropometric measurements, laboratory investigations, ultrasonic measurement of liver fat grade &amp; B-mode hepatorenal ratio, carotid intima media thickness (CIMT), flow mediated vasodilation (FMD), CT measurement of epicardial fat thickness (EFT) &amp; epicardial fat volume (EFV) along with CT coronary angiography. Study population was divided into 2 groups on the basis of presence or absence of CAD and were compared. The relationship between risk factors and presence of CAD was assessed by logistic regression analysis. To define EFT and EFV value predictive of the presence of significant CAD, the area under (AUC) the receiver operating characteristic (ROC) curve was calculated. Correlation between EFT as well as EFV with anthropometric and laboratory parameters, CIMT and FMD were assessed by Pearson correlation coefficient. Results Total 54 patients were included in study. Mean age was 54 years, 66% were diabetic and 33% were hypertensive. Mean CIMT, FMD, EFT and EFV were 0.70 + 0.27 cm; 5.64 + 2.64%; 5.51 + 2.50 mm and 60.6 + 28.6 cc, respectively. Total 34 (62.96%) patients were detected to have CAD. EFT as well as EFV were significantly higher in CAD group (3.31 + 2.34 vs 6.24 + 1.91mm; p= &amp;lt;0.001, 72.5 + 22.3 vs 40.4 + 27.1cc; p= &amp;lt;0.001); in patients with metabolic syndrome (83.3 + 18.4 vs 49.2 + 26.1cc; p &amp;lt; 0.001, 7.13 + 1.49 vs 4.16 + 2.32mm; p &amp;lt; 0.001). Both, EFV &amp; EFT were significantly correlated with the abdominal fat, CIMT and FMD. Smoking, age and EFV were the independent predictors for CAD. EFV &amp;gt;31.65cc predicted the presence of CAD (sensitivity 91.25%, specificity 60%, AUC = 0.798, 95% CI = 0.665-0.930) and EFT &amp;gt;2.85mm predicted the presence of CAD (sensitivity 94.1%, specificity 65%, AUC= 0.820, 95% CI= 0.687-0.953). Conclusions Epicardial fat is significantly associated with presence of CAD, metabolic syndrome, visceral fat, CIMT and FMD. CT measured epicardial fat may be included with CT based CAD lesion assessment and CT coronary calcium score to screen the patients of suspected angina pectoris. Abstract Figure. Epicardial adipose tissue Abstract Figure. EFV and CAD

High-Sensitivity C-Reactive Protein to HDL-C Ratio.

Inflammation and lipid signaling are involved in the pathogenesis and progression of coronary artery disease (CAD). We proposed that high-sensitivity C-reactive proteins, as a marker of the pro-inflammatory state, and high-density lipoprotein cholesterol (HDL-C), as an anti-atherosclerosis component, should be integrated into a single novel biomarker. Our work was conducted to discuss and compare the predictive ability of the high-sensitivity C-reactive protein to high-density lipoprotein cholesterol ratio (CHR) with other existing indices, for example, neutrophil high-density lipoprotein ratio (NHR) and neutrophil lymphocyte ratio (NLR), in the severity of CAD patients.Based on the results of coronary angiography, patients were divided into the CAD+ group, CAD- group, and control group. The relationship between various serum markers and the severity of coronary artery disease was examined via Spearman's correlation analysis. Logistic regression analysis was conducted to identify the influencing factors of the coronary artery disease severity.This study included 420 patients. The Gensini score was positively correlated with CHR. Multiple regression analysis revealed that the CHR was significantly associated with CAD. CHR is an independent predictor of CAD. The receiver operating characteristic (ROC) analysis provided a cut-off value of 1.17 for CHR to predict CAD, with a specificity of 86.7%, Yoden index of 0.264, and area under the ROC curve of 0.662 (95% confidence intervals 0.606-0.719, P < 0.001). At the same time, the area under the ROC curve of the NHR was 0.652, and that of the NLR was 0.579. The results of the DeLong test indicated that the area under the ROC curve of the CHR was larger than that of the NLR (P = 0.0306). This suggests that the CHR as a predictor of CAD has better diagnostic performance than the NLR.CHR was not only closely related to the presence and severity of CAD but also an independent predictor of severe CAD.