Independent Risk Factor For Coronary Heart Disease Research Articles

Predictive Value of Small Dense Low-Density Lipoprotein in Coronary Heart Disease in the Chinese Population.

Coronary heart disease (CHD) is a global public health concern, and CHD risk assessment remains a major challenge. Therefore, in this study, the ability of small dense low-density lipoprotein (sdLDL) alone to sufficiently predict CHD risk in the Chinese population was evaluated. Patients with CHD (139) and healthy controls (58) were included in this study. Serum sdLDL was measured using the peroxidase method. Other lipid parameters were also determined. The sdLDL level in the CHD group was significantly higher than that in the control group (p < 0.001). Logistic regression analysis revealed that sdLDL was an independent risk factor for CHD. Based on the receiver operating characteristic curves, the area under the curve (AUC) of sdLDL alone for CHD was 0.722. The AUC of triglycerides (TG), high-density lipoprotein (HDL), and sdLDL combined was 0.763, which was larger than that of the independent ones or combinations of any two; however, the value was not significant. sdLDL alone can predict CHD risk efficiently similar to the combination of TG, HDL, and sdLDL. This finding suggests that sdLDL can be considered as an ideal parameter for the preliminary diagnosis of CHD in Chinese people.

Coronary Heart Disease Risk in Blood or Marrow Transplant Survivors

INTRODUCTION: Exposure to total body irradiation (TBI) increases the risk for cardiovascular risk factors (CVRFs) such as diabetes, hypertension and dyslipidemia in Blood or Marrow Transplant (BMT) survivors with the potential to increase the risk of post-BMT Coronary Heart Disease (CHD). Chest radiation is associated with accelerated atherosclerosis in conventionally treated patients. These factors, with or without additional factors such as smoking likely place BMT survivors at a high risk for CHD. Yet, a comprehensive evaluation of the risk of late-occurring CHD in BMT survivors is lacking. We addressed this gap using the resources offered by the BMT survivor study (BMTSS). METHODS: BMTSS includes patients transplanted between 1974 and 2014 at 3 US sites, and who had survived ≥2 years after BMT, and were alive and ≥18 years at BMTSS survey completion. The BMTSS survey asked participants to report chronic health conditions diagnosed by their healthcare provider (including CHD, diabetes, hypertension and dyslipidemia), along with age at diagnosis. The participants self-reported sociodemographics and health behaviors. Information regarding primary cancer diagnosis, therapeutic exposures, donor type, stem cell source, and history of chronic graft vs. host disease (GvHD; for allogeneic BMT recipients) was abstracted from medical records. A cohort of 1,131 siblings completed the BMTSS survey and served as a comparison group. We obtained informed consent from all participants. RESULTS: The study included 3,479 BMT survivors; 50.3% had received an allogeneic BMT, 54.8% were males, and 71.4% were non-Hispanic whites. Median age at study participation was 59 years (interquartile range [IQR]: 48-66 years) for BMT survivors and 57 years (IQR: 46-64 years) for siblings. BMT survivors were followed for a median of 9 years (range: 2-41 years) from BMT. CHD developed after BMT in 122 BMT survivors (52 allogeneic, 70 autologous). BMT recipients compared with siblings: After adjusting for sociodemographics and comorbidities, allogeneic BMT survivors were at a 7.2-fold higher odds (95%CI: 4.0-13.0, p&amp;lt;0.0001) and autologous BMT recipients at a 11.7-fold higher odds (95%CI: 6.8-20.2, p&amp;lt;0.0001) of reporting CHD as compared to siblings. Allogeneic BMT survivors: The 20 year cumulative incidence of CHD was 4.7% for allogeneic BMT recipients. Increasing age at BMT (HR=1.05/year, 95%CI: 1.02-1.07, p&amp;lt;0.0001), male sex (HR=2.09, 95%CI: 1.14-3.82, p=0.017), history of CVRFs (HR=3.6, 95%CI: 1.72-7.41, p=0.0006), and pre-BMT targeted chemotherapy such as tyrosine kinase inhibitors (HR=2.7, 95%CI: 1.10-6.77, p=0.030) were associated with increased CHD risk. The 20 year cumulative incidence of CHD among patients with CVRFs was 6.6% vs. 1.9% (p=0.005) among those who did not have CVRFs (Fig 1). Autologous BMT survivors: The 20 year cumulative incidence of CHD was 9.1% for autologous BMT recipients. The risk factors for CHD in autologous BMT survivors included: increasing age at BMT (HR=1.06/year, 95%CI: 1.03-1.09, p&amp;lt;0.0001), male sex (HR=2.3, 95%CI: 1.30-3.90, p=0.004), history of smoking (HR=1.66, 95%CI: 1.03-2.67, p=0.038), CVRFs (HR=1.77, 95%CI: 1.04-3.01, p=0.036), arrhythmia (HR=1.85, 95%CI: 1.01-3.42, p=0.048) and history of pre-BMT chest radiation (HR=4.56, 95%CI: 2.1-9.88, p=0.0001). For every 1 Gray increase in the dose of chest radiation, there was a 4% increase in the risk of CHD, p=0.0002. The 20 year cumulative incidence of CHD among patients with CVRFs was 10.2% vs. 7.4% among those who did not have CVRFs (p=0.04) (Fig 2). CONCLUSION: BMT survivors are at a 7-fold to 12-fold higher risk of CHD compared with a sibling comparison group. CVRFs are independent risk factors for CHD both among allogeneic and autologous BMT recipients. Pre-BMT chest radiation further increases this risk in autologous BMT recipients. These findings suggest a need for aggressive management of CVRFs in BMT recipients to prevent CHD-related morbidity. Disclosures Gangaraju: Sanofi Genzyme, Consultant for Cold Agglutinin Disease: Consultancy. Weisdorf:FATE Therapeutics: Consultancy; Incyte: Research Funding. Arora:Pharmacyclics: Research Funding; Kadmon: Research Funding; Syndax: Research Funding; Fate Therapeutics: Consultancy.

Plasma P-selectin level is associated with severity of coronary heart disease in Chinese Han population.

ObjectiveThis study aimed to evaluate the association between plasma P-selectin levels and the severity of coronary heart disease (CHD) in a Chinese Han population.MethodsWe enrolled 219 patients with CHD and 168 healthy individuals without CHD as a control group. Coronary stenosis was evaluated based on the number of diseased coronary arteries and the Gensini scoring system. P-selectin levels were quantified by enzyme-linked immunosorbent assay and the association between CHD and plasma P-selectin level was analyzed.ResultsP-selectin levels were significantly higher in CHD patients compared with controls. Levels were highest in patients with three-vessel disease and lowest in those with one-vessel disease, with significant differences among the groups. P-selectin levels were also highest in the high-score and lowest in the low-score group according to Gensini score, with significant differences among the groups. P-selectin level was significantly positively correlated with Gensini score and C-reactive protein level. Elevated P-selectin was identified as an independent risk factor for CHD.ConclusionP-selectin levels were increased in Chinese Han patients with CHD. P-selectin level is an independent risk factor for CHD and may serve as a biomarker reflecting the severity of CHD in the Chinese Han population.

Expression and clinical significance of serum cystatin C in patients with hypertension and coronary heart disease.

The aim of this study is to explore the potential association between cystatin C (Cys-c) and coronary heart disease (CHD) in hypertensive patients.In this study, circulating levels of Cys-c in 62 essential hypertension (EH) patients, 147 hypertension with coronary heart disease (EH + CHD) patients, and 60 healthy volunteers were investigated using immunoturbidimetry. Then, we analyzed the correlations between Cys-C and other clinical parameters.Serum Cys-C level was significantly higher in the EH and EH + CHD groups than in the control group, and higher in the EH + CHD group than in the EH group. Receiver operating characteristic curve (ROC) analysis showed that the diagnostic value of Cys-C for patients with hypertension combined CHD was 0.871(95% CI: 0.818-0.913). Serum Cys-C level was significantly higher in the double-vessel disease group and multi-vessel disease group than in the single-vessel disease group, and higher in the multi-vessel disease group than in the double-vessel disease group. Urinary albumin and CRP correlated positively with Cys-C, and HDL correlated negatively with Cys-C. Cys-C was an independent risk factor for CHD in hypertensive patients.Our results suggested that circulating Cys-C levels was up-regulated in patients with hypertension and CHD, and had correlation with the severity of coronary artery disease. As one of the important risk factors for CHD, Cys-C can predict the occurrence of CHD in patients with hypertension.

Effect of metabolic syndrome on coronary heart disease in rural minorities of Xinjiang: a retrospective cohort study

BackgroundMetabolic syndrome is diagnosed by a cluster of risk factors that associated with an increased risk of coronary heart disease (CHD). We aimed to explore the impact of and interactions between individual metabolic syndrome components on the risk of CHD in Xinjiang.MethodsThe baseline population included 7635 participants. The degree to which the components increase the risk of CHD and the multiplicative interactions between them were assessed using hazard ratios (HRs) and 95% confidence intervals (CIs). Additive interactions were appraised by the relative excess risk due to interaction, synergy index (SI), and attributable proportion of interaction.ResultsA total of 304 CHD patients were enrolled from rural residents of Xinjiang. Elevated blood pressure (HR 1.81; 95% CI 1.35–2.44) and elevated fasting blood glucose (FBG) (HR 1.82; 95% CI 1.38–2.38) increased the risk of CHD after adjustment for confounding factors. We found a positive additive interaction (SI 1.14; 95% CI 0.51–2.51) between elevated blood pressure and elevated FBG, but none were significant. As the number of components increased, the risk of CHD increased. The combinations of [high triglycerides (TG) + low high-density lipoprotein cholesterol (HDL-C) + elevated FBG + large waistline] (HR 4.26; 95% CI 1.43–12.73) and [elevated blood pressure + elevated FBG + low HDL-C + large waistline] (HR 1.82; 95% CI 1.38–2.38) increased the risk of CHD.ConclusionsWe provide evidence that elevated blood pressure and elevated FBG are independent risk factors for CHD and it might be necessary to maintain the normal waistline for preventing CHD.

Risk of coronary heart disease in the rural population in Xinjiang: A nested case-control study in China.

Coronary heart disease (CHD) is a chronic complex disease caused by a combination of factors such as lifestyle behaviors and environmental and genetic factors. We conducted this study to evaluate the risk factors affecting the development of CHD in Xinjiang, and to obtain valuable information for formulating appropriate local public health policies. We conducted a nested case-control study with 277 confirmed CHD cases and 554 matched controls. The association of the risk factors with the risk of CHD was assessed using the multivariate Cox proportional hazard model. Multiplicative interactions were evaluated by entering interaction terms in the Cox proportional hazard model. The additive interactions among the risk factors were assessed by the index of additive interaction. The risk of CHD increased with frequent high-fat food consumption, dyslipidemia, obesity, and family history of CHD after adjustment for drinking, smoking status, hypertension, diabetes, family history of hypertension, and family history of diabetes. We noted consistent interactions between family history of CHD and frequent high-fat food consumption, family history of CHD and obesity, frequent high-fat food consumption and obesity, frequent high-fat food consumption and dyslipidemia, and obesity and dyslipidemia. The risk of CHD events increased with the presence of the aforementioned interactions. Frequent high-fat food consumption, family history of CHD, dyslipidemia and obesity were independent risk factors for CHD, and their interactions are important for public health interventions in patients with CHD in Xinjiang.

Impact of NAFLD on the Incidence of Cardiovascular Diseases in a Primary Care Population in Germany.

Patients with NAFLD are considered at a high risk of cardiovascular events due to underlying metabolic risk factors. Currently, data related to the impact of NAFLD on cardiovascular risk in the general population are lacking. The aim of this study was to investigate the role of NAFLD on risk of myocardial infarction (MI), coronary heart disease (CHD), atrial fibrillation (AF), and stroke in primary care in Germany. The study included patients diagnosed with NAFLD in primary care between 2010 and 2015. NAFLD cases (n = 22,048) were matched to a cohort without NAFLD (n = 22,048) based on age, sex, treating physician, type 2 diabetes, arterial hypertension, and hyperlipidemia. The primary outcome of the study was the incidence of MI, CHD, AF, and stroke. Within 10years of the index date, 12.8% of patients with NAFLD and 10.0% of controls were diagnosed with CHD (p < 0.001). Additionally, frequency of MI was significantly higher in NAFLD (2.9% vs. 2.3%, p < 0.001). On regression analysis, HR for incidence of MI was 1.34 (p = 0.003) in all NAFLD patients and 1.35 (p = 0.013) for men. Incidence of AF was significantly higher in patients with NAFLD. On regression analysis, HR for incidence of AF was 1.15 (p = 0.005). NAFLD was not associated with a higher incidence of stroke (HR 1.09, p = 0.243). NAFLD constitutes an independent risk factor for CHD, MI, and AF in primary care in Germany. Identification of patients with NAFLD in primary care will allow specifically managing and modifying underlying risk factors to improve the overall prognosis.

P6225Uric acid visit-by-visit variability is an independent risk factor of CHD - and all-cause mortality

Abstract Variability of serum uric acid (SUA) has been seldom examined in connection with long-term morbidity and mortality. We present results from a study of male civil servants and municipal employees, estimating associations of visit-by-visit variability of SUA with long-term all-cause as well as cause-specific mortality. Patients and methods There were 10,059 men, aged 40–65, tenured civil servants and municipal employees in the territories of the three most populated urban areas. Of these, 8822 participated in three extensive examinations in 1963, 1965 and 1968 and underwent assessment of diabetes and coronary morbidity status. We conducted analysis examining whether the standard deviations of Z-scores of SUA (SUA-Z), across the three study visits, predicted fatal outcomes. SUA-Z was defined as the difference between the individual SUA and the mean of SUA, divided by the standard deviation (SD) for the pertinent examination, namely separately for the 1963, 1965 and 1968 means and SD. Hazard ratios (HR) associated with the SD of SUA-Z were calculated for 18-yr stroke and CHD mortality (1968 to 1986) and the 18-yr all-cause mortality associated with quartiles of the above variability. The lowest quartile served as the referent, adjusting for age. A subsequent model adjusted additionally for the baseline value of SUA as well as for baseline frequency of diabetes mellitus and coronary heart disease (CHD) Results Multivariate analysis of 18-yr CHD mortality (1968–1986, 906 deaths among 8822 men) yielded a significant association with the 1963–1968 SD of SUA-Z with age adjusted HR of CD mortality of 0.99, 1.12 and 1.43 for quartiles 2 to 4 respectively (P using Mantel trend test=0.0002). Further adjustment for baseline prevalence of diabetes and CHD somewhat decreased the above HR estimates to 0.98, 1.04 and 1.29, respectively, with a HR=1.15 (95% CI, 1.07–1.23) per 1 mg/Dl increment of the 1963 SUA serum level. The results for the 18-yr all-cause mortality (2836 deaths, 1968–1986) strongly indicated increasing age-adjusted mortality risk with increasing SD of SUA-Z: HRs= 1.08 (95% CI,0.97–1.21), 1.15 (1.03–1.28), and 1.37 (1.23–1.51). No association was observed between the SD of SUA-Z and 18 years stroke mortality. Sensitivity analysis, incorporating the last (1968) SUA levels assessed, rather than the 1963 ones, yielded virtually identical HRs. Conclusion In this cohort of tenured male workers, with diverse occupation, higher variability of SUA measurement taken in 1963–5-8 were clearly predictive of 18-year CHD and all-cause mortality, above and beyond the SUA levels proper.

Compare and correlate the levels of lipoprotein (a) and high-sensitive C-reactive protein in coronary heart disease with control

Background: The incidence of ischemic heart disease/ myocardial infarction is rapidly increasing in India. However, the traditional risk factors alone could not explain this excess of Coronary Heart Disease (CHD). So, we are in need of a tool to assess the severity and prognosis of these acute coronary syndromes. Lipoprotein (a) [Lp(a)] and High Sensitive C-Reactive Protein (hs-CRP) have been recognised as independent risk factors for CHD in many retrospective case control studies. As the data shows inconsistency in the prediction of risk by Lp(a) and hs-CRP, the study is carried out to compare and correlate the levels of Lp(a) and hs-CRP in coronary heart disease patients with controls.Methods: An observational case control study was conducted at Maharaja’s Institute of Medical Sciences, Nellimarla, with 120 participants. 80 admitted with CHD were categorised as type 2 diabetic and non-diabetic. Remaining 40 participants were age matched controls, who have attended the OP for general health check-up. Samples collected from the participants were analysed for Lp(a), hs-CRP and HbA1c.Results: Lp(a) levels were significantly elevated in CHD patients with diabetes (69.2±27.5) and non-significant in CHD patients without diabetes (50.4±24.3) as compared to their controls (36.6±22.5). There was significant correlation and elevation of hs-CRP in CHD patients with diabetes (6.0±2.6) and without diabetes (3.7±2.0) as compared to their controls (0.7±0.4).Conclusions: The present study shows a lack of association of Lp(a) levels in CHD patients with and without diabetes. A strong correlation of the inflammatory marker, hs-CRP was observed between the CHD patients with and without diabetes and even as compared to their controls. It may be concluded that hs-CRP is a better and independent marker than Lp(a) in patients with CHD.

The Expression and Clinical Significance of Spleen Tyrosine Kinase in Patients with Coronary Heart Disease.

BackgroundOur research was designed to investigate the relationship of spleen tyrosine kinase (Syk) and inflammatory factors with coronary heart disease (CHD) and the risk factors of CHD.Material/MethodsIn our study, 226 patients were enrolled, from October 2017 to March 2018. Clinical and biochemical data were collected. We collected samples of peripheral blood monocytes (PBMs) from the enrolled patients. The patients were divided in 4 groups: patients without coronary artery disease (control group), patients with stable angina pectoris (SAP group), patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS group), and patients with ST-segment elevation acute myocardial infarction group (STEMI group). We detect the protein levels of Syk and inflammatory factors expression by western blot.ResultsOur results found the protein levels of Syk and inflammatory factors expression in the NSTE-ACS and STEMI groups were higher than those in the SAP and control groups. The protein levels of Syk and inflammatory factors expression in the SAP group were higher than those in the control group. Moreover, there were many risk factors significantly associated with Syk. Besides that, these risk factors were also independent risk factors of CHD.ConclusionsOur results found that the level of Syk was associated with the severity of CHD. From our study, we found that higher levels of Syk and inflammatory factors protein were associated with worse results of the CHD. For the first time, Syk was reported to be a promising therapeutic factor for CHD patients.

Polymorphisms of T149C and T950C genes in osteoprotegerin promoter sites and the relationship between serum osteoprotegerin levels and coronary heart disease

To explore the polymorphisms of T149C and T950C gene in osteoprotectin (OPG) promoter sites and the levels of serum OPG and soluble nuclear factor-ΚB receptor activator ligand (sRANKL) and the incidence of coronary heart disease (CHD). 528 patients in Tianjin suspected of CHD and underwent coronary angiography (CAG) who admitted to the department of cardiology of Tianjin Chest Hospital from April 2017 to December 2018 were enrolled. According to the CAG results, they were divided into two groups: CHD group (n = 302) and non-CHD group (n = 226). The gender, age, history of hypertension, family history of CHD, diabetes, levels of blood lipid parameters in serum and other clinical data of patients were recorded. The levels of serum OPG and sRANKL were measured by enzyme-linked immunosorbent assay (ELISA). T149C and T950C gene polymorphisms were analyzed by polymerase chain reaction-restriction endonuclease fragment length polymorphism (PCR-RFLP) methods. Hardy-Weinberg genetic balance test was performed for alleles. Binomial classification multivariate non-conditional Logistic regression method was used to analyze the relationship between T149C and T950C gene polymorphisms, serum levels of OPG and sRANKL and CHD. All patients were enrolled in the final analysis. The serum level of OPG in CHD group was significantly higher than that in non-CHD group (μg/L: 1.76±0.49 vs. 1.47±0.29, P < 0.01), the serum level of sRANKL was significantly lower than that in non-CHD group (ng/L: 342.14±121.38 vs. 376.63±108.66, P < 0.05). Logistic regression analysis showed that after adjusting for age, gender, blood lipid parameters, diabetes and other factors, the increase in serum OPG level was an independent risk factor for CHD [odds ratio (OR) = 1.995, 95% confidence interval (95%CI) = 1.935-2.066, P = 0.012]. PCR-RFLP results showed that TT, TC and CC genotypes were found in T149C and T950C of OPG promoter. According to Hardy-Weinberg equilibrium test, the polymorphisms of OPG T149C and T950C accorded with Hardy-Weinberg law, achieving genetic balance with representative of the population. The frequencies of TT, TC, CC and alleles T and C in T149C genotypes of non-CHD group were 53.5%, 42.9%, 3.6%, 75.0% and 25.0%, respectively, and they were 43.1%, 50.3%, 6.6%, 68.2% and 31.8%, respectively in CHD group. There were statistically significant differences in genotype and allele frequencies between the two groups (all P < 0.05). It was shown by Logistic regression analysis that the risk of CHD in TC+CC genotype of T149C was 1.86 of TT genotype (OR = 1.86, 95%CI = 1.24-2.78, P = 0.003). It was suggested that C allele might be a susceptible gene for CHD. In non-CHD group, the frequencies of TT, TC, CC, and alleles T and C in T950C genotypes were 39.8%, 46.5%, 13.7%, 63.1% and 36.9%, respectively. They were 39.4%, 43.4%, 17.2%, 61.1% and 38.9%, respectively in CHD group. There were no significant differences in genotype and allele frequencies between the two groups (all P > 0.05). Logistic regression analysis showed that TC+CC genotype of T950C was not related with CHD. The increased level of serum OPG was closely related with CHD and could be used as a risk factor for CHD. The cases carried OPG T149C TC+CC genotype might have the risk suffering CHD. C allele is might be a susceptible gene.

SSema4D levels are increased in coronary heart disease and associated with the extent of coronary artery stenosis

ObjectiveThe aim of this study was to evaluate the association between serum soluble semaphorin4D (sSema4D) and coronary heart disease (CHD) and the extent of coronary artery stenosis. MethodsThe study included 188 cases that underwent coronary angiography because of precordial pain. One hundred and twenty-eight cases were diagnosed with CHD; 60 cases with negative coronary angiography served as controls. Coronary stenosis was evaluated by the number of diseased coronary artery and Gensini scoring system. Serum sSema4D and C-reactive protein (CRP) levels were measured. ResultsSerum sSema4D levels in CHD patients were significantly higher than those of controls (p < 0.001) and the levels in those with acute coronary syndrome (ACS) were significantly higher than those with stable angina pectoris (p < 0.05) and controls (p < 0.05). Higher levels of serum sSema4D were observed in the group with high Gensini scores. Serum sSema4D concentration was positively correlated with the Gensini score (r = 0.735, p < 0.001) and was the only independent factor that significantly influenced the Gensini score (p < 0.001). Serum sSema4D levels were positively correlated with CRP levels in all subjects (r = 0.182, p = 0.013). Elevated sSema4D and CRP levels were independently associated with the presence of CHD. ConclusionSerum sSema4D levels were increased in CHD patients, especially in those with ACS. Serum sSema4D may be an independent risk factor for CHD and reflect the extent of coronary artery stenosis to some extent.

Ezetimibe Monotherapy Reduces Serum Levels of Platelet-Activating Factor Acetylhydrolase in Patients With Dyslipidemia.

BackgroundThe combination of ezetimibe with statin therapy reduced cardiovascular events compared to statin monotherapy in IMPROVEIT study, and ezetimibe monotherapy attenuated atherosclerosis in basic study. We previously showed ezetimibe monotherapy was especially effective for metabolic syndrome (MetS) patients. We investigated the effects of ezetimibe monotherapy for high-density lipoprotein cholesterol (HDL-chol) function and platelet-activating factor acetylhydrolase (PAF-AH) activity.MethodsForty-two patients who initially received ezetimibe (10 mg/day) without statin treatment for 16 weeks from January 2009 to August 2011 were enrolled. Patients were divided into MetS and non-MetS groups, and serum levels of lipids, PAF-AH, and HDL-chol efflux capacity (HDL-CEC) at baseline and after 16 weeks of treatment were investigated. Serum PAF-AH, HDL-associated PAF-AH (HDL-PAF-AH), and LDL-associated PAF-AH (LDL-PAF-AH) were measured.ResultsIn all patients, age, the percentages of males, and body mass index were 61.0 ± 8.8 years, 59.5% and 26.3 ± 3.4 kg/m2, respectively. Total cholesterol and low-density lipoprotein cholesterol (LDL-chol) were significantly decreased by ezetimibe monotherapy. Serum PAF-AH and LDL-PAF-AH were significantly decreased by ezetimibe monotherapy, whereas HDL-PAF-AH and HDL-CEC were not. There was no difference in the results of PAF-AH and HDL-CEC between MetS and non-MetS groups.ConclusionsEzetimibe monotherapy might prevent coronary heart disease (CHD) regardless of the presence of MetS, because PAF-AH was independent risk factor for CHD.

Expression of Hcy and blood lipid levels in serum of CHD patients and analysis of risk factors for CHD.

Expression of homocysteine (Hcy) and blood lipid levels in serum of atherosclerotic coronary heart disease (CHD) patients was investigated and the related risk factors were analyzed. A total of 148 CHD patients were selected as study group and another 120 healthy people attending Weifang People's Hospital for physical examination in the same period as control group. Hcy and blood lipid levels in serum were measured in the two groups, including total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). At the same time, analysis of risk factors for CHD was performed. The levels of Hcy, TC, TG and LDL-C in patients in the study group were significantly higher than that in control group, while the HDL-C level was significantly lower than that in control group, and the differences were statistically significant (P<0.001). The difference was statistically significant in the levels of Hcy, TC, TG and LDL-C between acute and old myocardial infarction and angina pectoris group (P<0.05), and the difference was statistically significant in the levels of Hcy, TC, TG and LDL-C between old and acute myocardial infarction group (P<0.05). Analysis of risk factors for the disease was performed using logistic regression. The results of univariate analysis showed that CHD was associated with Hcy, hyperlipidemia, smoking, hypertension and diabetes (P<0.05), but had no relationship with drinking and obesity (P>0.05). The results of multivariate analysis showed that Hcy, hyperlipidemia, hypertension and diabetes were independent risk factors for CHD, and the difference was statistically significant (P<0.05). The Hcy level increased and the HDL-C level decreased in serum of CHD patients. Hcy, hyperlipidemia, hypertension and diabetes are independent risk factors for CHD, which can provide practical basis for the diagnosis, treatment and prevention.

Menopausal symptoms and risk of coronary heart disease in middle-aged women: A nationwide population-based cohort study.

ObjectiveTo assess the relationship between coronary heart disease (CHD) and menopausal symptoms in middle-aged women in Taiwan.Patients and methodsThe present study identified 14,340 symptomatic menopausal women without a history of CHD from the Taiwan National Health Insurance Research Database from January 1, 2000, to December 31, 2013. A total of 14,340 age- and Charlson-comorbidity-index-score-matched asymptomatic women were used as controls. Possible comorbidity-attributable risks of CHD were surveyed to assess whether the symptomatic menopausal cohort had a higher incidence of CHD.ResultsThe incidence of CHD was higher in the symptomatic menopausal cohort than in the control cohort (17.18 vs. 12.05 per 1000 person-years). After adjustment in multivariate Cox analysis, the risk of CHD was significantly higher in the symptomatic menopausal cohort (adjusted hazard ratio = 1.344, 95% confidence interval [CI] = 1.262–1.43, P < 0.001) than in the control cohort. In the symptomatic menopausal cohort, the risk of CHD was significantly higher in all subgroups, except for the hormone therapy (HT) subgroup. Patients undergoing HT had a nonsignificantly higher risk of CHD, regardless of the presence or absence of menopausal symptoms.ConclusionThis large-scale longitudinal retrospective cohort study revealed that menopausal symptoms are an independent risk factor for CHD. Moreover, our findings indicate that HT has a nonsignificant effect on the risk of CHD.

The study on the association between tissue plasminogen activator-plasminogen activator inhibitor-1 complex and risk of coronary disease

Objective The aim of this study was to discuss the effect and clinical value of plasma Tissue Plasminogen Activator-Plasminogen Activator Inhibitor-1 Complex (t-PAIC) in the coronary heart disease (CAD). Methods This is a retrospective study. From January 2017 to March 2018, 203 patients with CAD were recruited from Renmin Hospital of Wuhan University. 130 cases were selected for control group at the same period. Plasma concentrations of t-PAIC, blood RBC, Hb, WBC and other routine biochemical markers were quantified. Results The plasma t-PAIC level in CAD group 12.75(9.0-17.93) ng/ml was significantly higher than that in healthy control group 7.70(6.10-9.41) ng/ml (Z=9.208, P<0.001). Logistic regression analysis showed that the TG, LPa, t-PAIC were independent risk factors for CAD[OR(95%CI)], [1.762(1.076-2.884); 1.002(1.000-1.003); 1.338 (1.171-1.529)]. The t-PAIC level was positively correlated with the severity of CAD. Compared with control group, the level of t-PAIC was higher in mild group(11.64±0.59)ng/ml and severe group(15.84±0.72)ng/ml, and the plasma t-PAIC level was positively correlated with Gensini score(r=0.471, P<0.001). Multiple linear regression analysis showed that there was a positive correlation among the plasma t-PAIC and LDL-C, Glu, WBC (β coefficient=0.673, 0.305, 0.263, P=0.037, 0.002, 0.006). In addition, there was abnormal increase of plasma t-PAIC in CAD patients with poor prognosis (H=82.210, P<0.001). Conclusion Plasma t-PAIC is an independent risk factor of CAD. The significantly increase of plasma t-PAIC might be an important predictor of incidence of CAD and unfavourable prognosis. (Chin J Lab Med, 2018, 41: 420-424) Key words: Coronary disease; Tissue plasminogen activator; Plasminogen activator inhibitor 1; Risk factors

Association between urinary sodium excretion and coronary heart disease in hospitalized elderly patients in China.

ObjectiveThis study was performed to evaluate the association between urinary sodium excretion and coronary heart disease (CHD) in hospitalized elderly patients in China.MethodsThe 24-h urinary excretion specimens of 541 patients were collected, and the serum creatinine concentration and urinary sodium/potassium ratio were measured. Associations were explored by multivariate logistic regression analysis.ResultsThe mean 24-h urinary sodium excretion was 200.4 mmol, corresponding to 11.7 g of salt intake. Both of these values were higher in men than in women. The salt intake of 80- to 89-year-old patients was significantly lower than that of 70- to 79-year-old patients. The 24-h urinary sodium excretion and spot urine Na/K ratios were significantly higher in overweight/obese and hypertensive patients. The 24-h urinary sodium excretion of men who smoked was significantly higher than that of women. The spot urine Na/K ratio was significantly higher in patients with cerebral thrombosis. The urinary Na/K ratio, smoking status, and hypertension were independent risk factors for CHD.ConclusionsThis cross-sectional survey suggests that the Na/K ratio may better represent salt loading than Na excretion alone in studying the association between sodium intake and CHD. There was no association between sodium and CHD prevalence.

Metabolic inflammatory syndrome: a novel concept of holistic integrative medicine for management of metabolic diseases

Background: The clinical value of the clustering of metabolic diseases linked by the common pathogenesis of metabolic inflammation has not been clarified. Methods: We named the cluster of metabolic inflammatory diseases as ‘metabolic inflammatory syndrome (MIS)’ and included atherosclerosis, type 2 diabetes (T2D), non-alcoholic fatty liver disease (NAFLD) and obesity/overweight as its components. We studied the participants with T2D from six medical centers in China (4,711 participants). MIS, metabolic syndrome (MS) defined by Chinese Diabetes Society and coronary heart disease (CHD) were assessed according to records from the medical centers. We calculated the detective rate of MIS and analyzed its risk for CHD by binary logistic analysis, comparing with MetS. Results: In the participants with T2D, MIS had a detective rate of 96.2%, more highly than MIS (57.0%). MIS components had high detective rates (atherosclerosis: 80.9%, NAFLD: 57.3%, obesity/overweight: 61.7%), compared with MetS components (hypertension: 64.4%, dyslipidemia: 38.2%). MIS had a greater odds ratio to predict CHD than MS [MIS: odds ratio, 4.71; 95% confidence interval (CI), 2.31 to 9.62; P Conclusions: MIS had a high detective rate and appeared to be an independent risk factor of CHD. Therefore, this concept might be used for screening, prevention and researches for metabolic diseases at their early stages. A person who has one of the MIS components, especially atherosclerosis, should screened for the other MIS components, for their high detective rates and the relationship between meta-inflammation and them which was like the melons on one vine.

Increased risk of coronary heart disease among patients with primary Sj\xf6gren\u2019s syndrome: a nationwide population-based cohort study

To investigate the association between primary Sjögren’s syndrome (pSS) and coronary heart disease (CHD), and the influence of medications for pSS patients on risk of CHD. The authors identified 4175 patients with a new diagnosis of pSS between 2002 and 2013 from the National Health Insurance Research database. The control-to-case ratio was 4:1. The risk and cumulative incidences of CHD were calculated. The adjusted hazard ratio (HR) of CHD for pSS patients was 1.17 (1.03–1.34) after adjusting for age, sex, comorbidities, and medications. The cumulative incidence for CHD in the pSS group was significantly higher than that in the control group (log-rank p < 0.0001). The risk of CHD in pSS patients was increased with age by 4% per year, and 45- to 59-year-olds were at the highest risk (HR = 1.464, 1.195–1.794). The application of corticosteroids (HR = 1.45, 1.07–1.97) as well as NSAIDs (HR = 1.31, 1.05–1.65) both increased the risk of CHD among pSS patients. pSS is associated with an increased risk of subsequent CHD in Taiwan. Primary Sjögren’s syndrome might be an independent risk factor for CHD. Use of corticosteroids and NSAIDs in the treatment of pSS patients increased the risk of developing CHD.

Independent and combined effects of environmental factors and miR-126, miR-143, and miR-145 on the risk of coronary heart disease.

ObjectiveTo evaluate the effects of environmental factors and microRNAs (miRNAs) (miR-126, miR-143, and miR-145) on the risk of coronary heart disease (CHD).MethodsA frequency-matched case-control study (450 patients, 450 controls) was conducted from April 2014 to December 2016 in Fuzhou City, China. Environmental factors were investigated using a self-administered questionnaire, and the expression levels of miR-126, miR-143, and miR-145 were determined by quantitative real-time Polymerase Chain Reaction (PCR) in peripheral blood mononuclear cells. Unconditional logistic regression models were used for statistical evaluation.ResultsAlcohol consumption, high-salt diets, high-intensity work, and lack of physical activity were significantly associated with increased CHD risk, whereas light diet was significantly associated with decreased risk. MiR-126, miR-143, and miR-145 were highly expressed in the CHD group compared with the control group. After adjustment for other environmental factors, unconditional logistic regression results revealed that miR-126, miR-143, and depression were the independent risk factors of CHD, and light diet was the independent protective factor of CHD.ConclusionsOur data suggest that a family history of CHD, anxiety, and alcohol consumption was significantly associated with increased CHD risk, whereas light diet was significantly associated with decreased risk. Furthermore, miR-126 and miR-143 in combination with several risk factors, could play a joint role in the development of CHD. Therefore, it is necessary to manage patients with CHD in all directions and multiple level.