Coronary Risk Markers Research Articles

Usefulness of Serum Testosterone Concentration and Skin Autofluorescence as Coronary Risk Markers in Male Patients With Type 2 Diabetes Mellitus.

No studies have reported simultaneous evaluation of the two coronary risk markers of testosterone and skin autofluorescence (SAF) as a marker of advanced glycation end products in patients with type 2 diabetes mellitus (T2DM) at present. This study aimed to clarify the clinical significance of both indicators as risk markers of coronary artery disease (CAD), including the association and background factors between testosterone and SAF in male patients with T2DM. This study enrolled 162 male patients with T2DM (CAD: n = 35). Testosterone was evaluated by serum total testosterone concentration (T-T). Various analyses related to T-T and SAF as coronary risk markers were performed. T-T was significantly lower, and SAF was significantly higher in patients with CAD than in patients with non-CAD. A significant negative correlation was found between T-T and SAF (r = -0.45, P < 0.001), and the correlation was stronger in patients with CAD than in patients with non-CAD (non-CAD, r = -0.27, P = 0.003; CAD, r = -0.51, P < 0.001). However, both T-T and SAF had significant associations with triglyceride-glucose index as an insulin resistance marker and cardio-ankle vascular index as an arterial function marker. Multiple regression analysis revealed that both T-T and SAF were selected as independent variables to the presence of CAD as a dependent variable. However, the odds ratio increased due to the merger of two coronary risk markers, low T-T and high SAF (odds ratio: one risk marker: 3.24, 95% confidence interval: 1.01 - 10.50, P = 0.045; two risk markers: 13.22, 95% confidence interval: 3.41 - 39.92, P < 0.001). The results of this cross-sectional study indicate that T-T and SAF are closely related in CAD patients with T2DM. It also shows that insulin resistance and arterial dysfunction are in the background of both indicators. Additionally, not only are both indicators independent coronary risk markers, but the overlap of both indicators increases their weight as coronary risk markers.

The Emerging Role of CT-Based Imaging in Adipose Tissue and Coronary Inflammation.

A large body of evidence arising from recent randomized clinical trials demonstrate the association of vascular inflammatory mediators with coronary artery disease (CAD). Vascular inflammation localized in the coronary arteries leads to an increased risk of CAD-related events, and produces unique biological alterations to local cardiac adipose tissue depots. Coronary computed tomography angiography (CTA) provides a means of mapping inflammatory changes to both epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT) as independent markers of coronary risk. Radiodensity or attenuation of PCAT on coronary CTA, notably, provides indirect quantification of coronary inflammation and is emerging as a promising non-invasive imaging implement. An increasing number of observational studies have shown robust associations between PCAT attenuation and major coronary events, including acute coronary syndrome, and ‘vulnerable’ atherosclerotic plaque phenotypes that are associated with an increased risk of the said events. This review outlines the biological characteristics of both EAT and PCAT and provides an overview of the current literature on PCAT attenuation as a surrogate marker of coronary inflammation.

Immunonutritional Bioactives from Chenopodium quinoa and Salvia hispanica L. Flour Positively Modulate Insulin Resistance and Preserve Alterations in Peripheral Myeloid Population.

Innate immunity plays a determinant role in high fat diet (HFD)-induced insulin resistance. This study compares the effects of immunonutritional bioactives from Chenopodium quinoa (WQ) or Salvia hispanica L. (Ch) when used to partially replace wheat flour (WB) into bread formulations. These flours were chosen to condition starch and lipid content in the products as well as because their immunonutritional activity. To be administered with different bread formulations, HFD-fed C57BL/6J mice were distributed in different groups: (i) wild type, (ii) displaying inherited disturbances in glucose homeostasis, and (iii) displaying dietary iron-mediated impairment of the innate immune TLR4/TRAM/TRIF pathway. We analyze the effects of the products on glycaemia and insulin resistance (HOMA-IR), plasmatic triglycerides, intestinal and hepatic gene expression and variations of myeloid (MY), and lymphoid (LY) cells population in peripheral blood. Our results show that feeding animals with WQ and Ch formulations influenced the expression of lipogenic and coronary risk markers, thus attaining a better control of hepatic lipid accumulation. WQ and Ch products also improved glucose homeostasis compared to WB, normalizing the HOMA-IR in animals with an altered glucose and lipid metabolism. These positive effects were associated with positive variations in the peripheral myeloid cells population.

Amelioration of hyperlipidemia and coronary risk markers with supplementation of Cinnamomum zeylanicum bark extracts on Triton WR-1339 induced hyperlipidemia in Wistar albino rats

Introduction: Cinnamomum zeylanicum bark used in Indian traditional medicine to treat hyperlipidemia and cardiovascular diseases. Hyperlipidemia is a major risk factor for coronary heart disease and metabolic syndrome. Objective: The present study was to evaluate the antihyperlipidemic effect of ethanolic and aqueous extracts of Cinnamomum zeylanicum bark against Triton induced hyperlipidemia in Wistar albino rats. Materials and Methods: Thirty rats (200-230gm) were randomly divided into five groups of six rats in each, received standard diet and water daily. Normal control (5% CMC), positive control (Triton 400mg/kg), standard control (atorvastatin 40mg/kg), ethanolic and aqueous extracts of Cinnamon groups (CZEE and CZAE 500 mg/kg of each) were assigned and treated respectively. All the groups except normal control were administered triton to induce hyperlipidemia. Both the standard and plant extracts were administered for seven days orally. At the end of the study, fasting blood was collected and serum was separated out to estimate the lipid profile and various markers of coronary heart diseases. Results:Post supplementation of atorvastatin, CZEE and CZAE significantly (P Conclusion: From the observations, it can be concluded that supplementation of Cinnamon extracts can significantly decline the lipid abnormalities and ameliorate the markers of coronary heart disease and provides the scientific evidence for their traditional claims. Further molecular studies are warranted to evaluate the causative molecule for antihyperlipidemic effect. Keywords: Hyperlipidemia, Cardiovascular diseases, Triton, Atorvastatin and Cinnamon extracts

Abstract 16281: Non-calcified Coronary Plaque Burden is Related to Epicardial Adipose Tissue and Peri-coronary Adipose Tissue Attenuation in Heart Failure With Preserved Ejection Fraction

Introduction: Coronary inflammation may be a factor in developing heart failure with preserved ejection fraction (HFpEF). Epicardial fat volume (EFV) measured using non-contrast computed tomography (CT) and pericoronary adipose tissue (PCAT) attenuation on coronary CT angiography (CCTA) are considered to be inflammatory mediators, which play an important role in the development of coronary plaque. Hypothesis: We hypothesize that there is an interrelationship between these measures in HFpEF and no obstructive coronary artery disease (CAD). Methods: 28 subjects with HFpEF (European Society of Cardiology criteria), with coronary CCTA-documented absence of obstructive CAD. Non-calcified plaque (NCP), low-density non-calcified plaque (LDNCP), PCAT attenuation were quantified using semi-automated software and EFV was quantified using QFAT software. PCAT attenuation in Hounsfield Units (HU) was measured in a standardized 40 mm segment around the proximal right coronary artery. Statistical analysis was performed using Spearman correlation and multivariable regression models adjusted for age, BMI, EFV, and PCAT tested relations to NCP burden. Results: Overall, the mean age of 64.8±12 years, 74% women, BMI 29.3±4, total cholesterol 162±41mg/dl, LDL 85±29 mg/dl, HDL 55±14 mg/dl, systolic BP 132±22mmHg, diastolic BP 77±12mmHg, EFV 139±73 cm 3 and, PCAT attenuation -78±8 HU. Mean total NCP burden 34±13%, total LDNCP burden 3±1.8 %, and coronary calcium score (CCS) 414±920. EFV and PCAT attenuation correlated with the coronary risk markers including CCS and NCP burden variables (Table). In multivariable analysis, age and PCAT (β±SE=0.43±0.2, p=0.04, 0.64±0.3, p=0.03 per 1%-change in NCP burden respectively) were related to NCP burden. Conclusions: EFV and PCAT attenuation are associated with non-calcified plaque burden and may play an important role in the pathophysiological process of HFpEF. Further studies are needed to further understand these findings.

Screening for Obstructive Sleep Apnea in the Assessment of Coronary Risk

There is increasing awareness that health screening may prevent some acute coronary events. Yet, obstructive sleep apnea (OSA) is seldom screened for and its relation with coronary risk markers is not well established. Consecutive adults (n= 696) enrolled in a cardiovascular health screening program were approached to determine the feasibility of incorporating OSA screening. Screening included questionnaires and a home-based sleep study. High-sensitivity C-reactive protein was the primary coronary risk marker, and other laboratory- and exercise treadmill-based markers were also reported. Two thirds of the participants (66%) agreed to undergo OSA screening and most (78%) successfully completed the sleep study. The prevalence of OSA (apnea-hypopnea index ≥15/hour) was38.0%. The Berlin Questionnaire (53%) and Epworth Sleepiness Scale (26%) had lowsensitivity in identifying OSA. After full adjustment for age, gender, body mass index,hypertension, and diabetes mellitus, OSA remained an independent predictor of serum levels of high-sensitivity C-reactive protein (relative mean difference 1.29, 95% CI 1.03 to 1.62; p= 0.025), triglyceride (relative mean difference 1.15, 95% CI 1.03 to 1.28; p= 0.014), and exercise time (mean difference-26.4seconds; 95% CI-51.6 to-1.2; p= 0.04). The INTERHEART Risk Score analysis suggested more participants with (31%) than without (14%, p <0.001) OSA will develop future cardiovascular events. In conclusion, based on the acceptance for OSA screening, high prevalence of OSA and independent associations between OSA and coronary risk markers, incorporation of sleep studies into cardiovascular health screening programs appears feasible.

A Comparison of the Abdominal Fat Distribution and Coronary Risk Markers in Body Mass Index-matched Subjects with and without Fatty Liver.

Objective The close relationship between fatty liver and metabolic syndrome suggests that individuals with fatty liver may have multiple coronary risk factors. In the present study, we investigated the relationships among fatty liver, abdominal fat distribution, and coronary risk markers. Methods and Results Eighty-seven pairs of men and 42 pairs of women who were matched for age and body mass index were enrolled in the present study. The obesity-related markers, abdominal fat distribution (examined by CT), and coronary risk markers were compared in subjects with and without fatty liver. The visceral fat area was significantly larger in the men with fatty liver than in the men without fatty liver. The plasma levels of triglyceride and low-density lipoprotein cholesterol (LDL-C), as well as the homeostasis model assessment-insulin resistance level, were higher in both males and females with fatty liver than in those without fatty liver, while the plasma levels of high-density lipoprotein cholesterol (HDL-C) and adiponectin were lower in the males and females with fatty liver. The plasma levels of apolipoprotein B, remnant-like particle cholesterol (RLP-C), and oxidized LDL were higher in men with fatty liver, but not in women with fatty liver. Conclusion Both males and females with fatty liver had lower insulin sensitivity, lower plasma levels of HDL-C and adiponectin, and higher triglyceride and LDL-C levels. However, the plasma levels of apolipoprotein B, RLP-C, and oxidized LDL were only higher and closely associated with fatty liver in men. Men with fatty liver had a higher risk of coronary disease than women with fatty liver.

Reduction of C-reactive protein is not associated with reduced cardiovascular risk and mortality in patients treated with statins. A meta-analysis of 22 randomized trials

BackgroundThe association between C-reactive protein (CRP) levels and risk of cardiovascular (CV) events has been reported in several studies. However, it is unclear whether a reduction in CRP is associated with a reduction in risk of clinical events. Therefore we sought to investigate, in a meta-regression analysis of randomized studies enrolling patients treated by statins, whether changes in CRP are associated with changes in risk of CV events or overall survival. MethodsRandomized trials enrolling patients treated by statins, reporting CRP at baseline and at end of follow-up, CV events [myocardial infarction (MI) and stroke], CV and all-cause mortality were selected. ResultsTwenty-two trials enrolling 54,213 participants were included in the analysis. Meta-analysis showed that active treatment significantly reduced risk of all-cause death by 8%, myocardial infarction by 11%, stroke by 10.3% and the composite outcome (including CV death, MI and stroke) by 8%, whereas risks of CV mortality was not significantly reduced. Meta-regression analysis revealed that reduction in CRP levels was significantly associated only with the reduction of MI, whereas no relationship was identified between changes in CRP and risk of stroke, CV and all-cause mortality, and the composite outcome. ConclusionsThese findings demonstrate that statin-induced changes in CRP do not correlate with major CV events apart from the risk of MI nor with overall survival in high-risk patients. These data suggest that although CRP may be a surrogate marker for coronary risk, it should not be used for predicting the effectiveness of statin therapy.

Assessment of Coronary Risk Based on Cumulative Exposure to Lipids in Systemic Lupus Erythematosus

To quantify the independent role of each of low-density lipoprotein cholesterol (LDL-C), total cholesterol:high-density lipoprotein cholesterol ratio (TC:HDL-C), triglyceride (TG) level, and HDL-C as a marker of coronary risk in systemic lupus erythematosus (SLE). Patients with lipid measurements taken before a coronary event (or last clinic visit) were included. Mean and time-adjusted mean (TAM) levels were calculated for each lipid variable in each patient. Time-dependent proportional hazards regression models were used to quantify the risk of coronary event [myocardial infarction (MI) or angina], after adjustment for age. Among 384 patients, over a mean (SD) followup of 3.81 (2.58) years, there were 21 "first" coronary events (6 MI, 15 angina). Mean and TAM LDL-C (HR 1.83, 95% CI 1.19-2.81, p = 0.006), TC:HDL ratio (HR 1.43, 95% CI 1.02-2.00, p = 0.04), and TG (HR 2.11, 95% CI 1.32-3.39, p = 0.0019) were predictive of coronary event at subsequent visits. In contingency table analysis, TAM LDL-C cutpoint of 2.0 mmol/l had a sensitivity and negative predictive value for coronary event of 85.7% (95% CI 63.7-97.0) and 93.9% (95% CI 83.1-98.7), respectively. However, at this cutpoint the specificity was only 12.7% (95% CI 9.4-16.5). This study links LDL-C, TC:HDL-C ratio, and TG to coronary risk in patients with SLE and quantifies the magnitude of this risk. SLE-specific risk assessment levels for lipids may be selected to optimize positive or negative predictive values.

Association between LDL-C and risk of myocardial infarction in CKD.

LDL cholesterol (LDL-C) is an important marker of coronary risk in the general population, but its utility in people with CKD is unclear. We studied 836,060 adults from the Alberta Kidney Disease Network with at least one measurement of fasting LDL-C, estimated GFR (eGFR), and proteinuria between 2002 and 2009. All participants were free of stage 5 CKD at cohort entry. We followed participants from first eGFR measurement to March 31, 2009; we used validated algorithms applied to administrative data to ascertain primary outcome (hospitalization for myocardial infarction) and Cox regression to calculate adjusted hazard ratios (HRs) for myocardial infarction by LDL-C categories within eGFR strata. During median follow-up of 48 months, 7762 patients were hospitalized for myocardial infarction, with incidence highest among participants with the lowest eGFR. Compared with 2.6-3.39 mmol/L (referent), the risk associated with having LDL-C above 4.9 mmol/L seemed greatest for GFR≥90 ml/min per 1.73 m(2) and least for eGFR=15-59.9 ml/min per 1.73 m(2). Specifically, the adjusted HRs (95% confidence intervals) of myocardial infarction associated with LDL-C of ≥4.9 compared with 2.6-3.39 mmol/L in participants with eGFR=15-59.9, 60-89.9, and ≥90 ml/min per 1.73 m(2) were 2.06 (1.59, 2.67), 2.30 (2.00, 2.65), and 3.01 (2.46, 3.69). In conclusion, the association between higher LDL-C and risk of myocardial infarction is weaker for people with lower baseline eGFR, despite higher absolute risk of myocardial infarction. Increased LDL-C may be less useful as a marker of coronary risk among people with CKD than the general population.

The Southern European Atlantic Diet is associated with lower concentrations of markers of coronary risk

ObjectiveThe Southern European Atlantic Diet (SEAD) is the traditional diet of Northern Portugal and Galicia, a region in northwest Spain. The SEAD has been associated with a lower risk of non-fatal acute myocardial infarction, but the mechanisms of this association have not yet been investigated. Thus, we examined the association between the SEAD and numerous biomarkers of coronary risk, blood pressure and anthropometrics. MethodsCross-sectional study conducted in 2008–2010 among 10,231 individuals representative of the population aged 18 years and older in Spain. Diet was assessed with a validated computerized diet history. SEAD adherence was measured with an index including 9 food components (fresh fish, cod, red meat and pork products, dairy products, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and wine), which ranges from 0 (lowest adherence) to 9 (highest adherence). C-reactive protein, uric acid, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, glucose, glycated hemoglobin, insulin, leptin, fibrinogen, were determined in 12-h fasting blood samples, while creatinine and urine albumin were determined in urine. ResultsMean SEAD score was 2.9 points (inter-quartile range 2–4 points). Higher SEAD adherence was associated with a lower level of plasma C-reactive protein (adjusted difference in geometric means between the highest and lowest SEAD quartiles −0.2 mg/l; p for trend <0.001), plasma triglycerides (−3.4 mg/dl; p for trend 0.012), insulin (−0.5 mU/l; p for trend <0.001), HOMA-IR (−0.12; p for trend <0.001), urine albumin (−0.8 mg/l; p for trend <0.001), urine albumin-creatinine ratio (−0.3 mg/g creatinine; p for trend <0.034), and systolic blood pressure (−1.6 mm Hg; p for trend <0.001). ConclusionsThis study identifies possible mediators of the effect of SEAD on myocardial infarction, because SEAD is associated with a lower concentration of markers of inflammation and with reduced triglycerides, insulin, insulin resistance, and systolic blood pressure.

Correlation between Apolipoprotein B-to-Apolipoprotein A1 Ratio and Total-to-HDL-Cholesterol Ratio in a Healthy Population: Should Castelli Index be Updated?

SUMMARY The total cholesterol/HDL cholesterol ratio (TC/HDL-Cr) was proposed as a marker of coronary risk about 25 years ago by Dr. William Castelli and the suggested target was 0.43; and propose an updated CI target. Material and Methods Apolipoprotein levels were measured by immnuno-phelometry in samples obtained from blood donors. Models of simple linear regression were made to analyze the relationship between the ApoB/ApoA and TC/HDL ratios. A ROC analysis was carried out to evaluate the accuracy of the CI to distinguish between subjects with ApoB / ApoAr ≤0.43 and > 0.43. Subjects with hypertension, vascular disease, diabetes or treated with lipid-lowering drugs were excluded. Results A total of 283 subjects were included, 64% men, 31% smokers. General characteristics (mean ± SD): age 41.8 ± 14 years, BMI 26.2 ± 4, TC 199.5 ± 48 mg / dl, HDL 49 ± 13 mg / dl, CI 4.31 ± 1.3, ApoB 95.2 ± 28 mg / dl, ApoA 157.4 ± 32 mg / dl, ApoB / ApoAr 0.62 ± 0.21. In the overall population, the correlation between ApoB / ApoAr and the CI was 0.90 and the ApoB / ApoAr of 0.43 corresponded to an CI of 3.22. The area under the ROC curve of the CI to distinguish between subjects with ApoB/ApoAr  0.43 and > 0.43 was 0.936 (CI 95% 0.897- 0.975) and OPC was 3.238. Background

Lipoprotein(a) levels in coronary heart disease-susceptible and -resistant patients with familial hypercholesterolemia

ObjectiveFamilial hypercholesterolemia (FH) is caused by defects in genes coding for proteins involved in low density lipoprotein (LDL) metabolism, and is associated with increased risk of premature coronary heart disease (CHD). The clinical phenotype of FH exhibits marked variability due to additional metabolic and environmental factors, and further biomarkers are required for appropriate risk assessment. The aim of the present study was to search for risk markers among FH patients. Methods and resultsClinical and biochemical parameters of FH subjects with early CHD events (CHD-susceptible) and FH subjects with late or no CHD events (CHD-resistant) were compared. Our data show that CHD-susceptible FH patients had significantly higher Lipoprotein (Lp) (a) levels compared to CHD-resistant FH patients. When subdividing by gender, the main findings were that (i) CHD-susceptible women had significantly higher levels of both Lp(a), low density lipoprotein (LDL) cholesterol and apolipoprotein (apo) B as compared to CHD-resistant women, and (ii) CHD-resistant women had significantly lower Lp(a) levels and higher high density lipoprotein (HDL) cholesterol and apoA–I levels compared to CHD-resistant men. ConclusionsThe data suggest that Lp(a) may be an important coronary risk marker in FH patients, in particular in combination with elevated LDL cholesterol levels among female subjects. Thus, measurement of Lp(a) levels may help identifying high-risk individuals who could benefit from an aggressive therapy, including statins to reduce LDL-cholesterol to guideline-recommended levels.

Vitamin D is associated with atheroprotective high-density lipoprotein profile in postmenopausal women

Low vitamin D has been associated with low levels of high-density lipoprotein (HDL) cholesterol, a marker of coronary risk. Whether atheroprotective HDL particle composition accounts for this association and whether fat affects this association is not known. To explore the association between HDL particle composition and 25-hydroxy vitamin D (25[OH]D) in post-menopausal women. Vitamin D levels and lipoprotein composition were assessed in fasting blood samples of apparently healthy women from a diverse Chicago community. Visceral (VAT) and subcutaneous (SAT) abdominal fat area were assessed using computed tomography. Total body fat mass was measured by dual-energy X-ray absorptiometry. We enrolled 78 women (50% black; 50% white), age 48 to 64 years, all of whom were participants in a longitudinal study of fat patterning. They had a mean 25[OH]D of 31 ± 15 μg/L, HDL cholesterol 57±11 mg/dL, and large HDL particle subclass 8.6±3.4 μmol/L. In a multivariable-adjusted regression model, each 5 μg/L higher 25[OH]D predicted 0.57 μmol/L (95%CI 0.20-0.95) higher large HDL particles, independent of race, season, and total HDL particle concentration. This association was only partially confounded by total body fat mass (0.49, 95%CI 0.10-0.89), SAT (0.50, 95%CI 0.11-0.90), or VAT (0.37, 95%CI 0.01-0.74). Age did not significantly influence the strength of associations. Higher 25[OH]D levels are associated with large HDL particles. This association is stronger than that of HDL cholesterol and only partially confounded by body fat. Theoretically, vitamin D may protect against cardiovascular risk by promoting formation of large HDL particles, affecting reverse cholesterol transport.

Socioeconomic inequalities in coronary heart disease risk in older age: contribution of established and novel coronary risk factors.

Background:Evidence on socioeconomic inequalities in coronary heart disease (CHD) and their pathways in the elderly is limited. Little is also known about the contributions that novel coronary risk factors (particularly inflammatory/hemostatic markers) make to socioeconomic inequalities in CHD. Objectives:To examine the extent of socioeconomic inequalities in CHD in older age, and the contributions (relative and absolute) of established and novel coronary risk factors. Methods:A population-based cohort of 3761 British men aged 60–79 years was followed up for 6.5 years for CHD mortality and incidence (fatal and non-fatal). Social class was based on longest-held occupation recorded at 40–59 years. Results:There was a graded relationship between social class and CHD incidence. The hazard ratio for CHD incidence comparing social class V (unskilled workers) with social class I (professionals) was 2.70 [95% confidence interval (CI) 1.37–5.35; P-value for trend = 0.008]. This was reduced to 2.14 (95% CI 1.06–4.33; P-value for trend = 0.11) after adjustment for behavioral factors (cigarette smoking, physical activity, body mass index, and alcohol consumption), which explained 38% of the relative risk gradient (41% of absolute risk). Additional adjustment for inflammatory markers (C-reactive protein, interleukin-6, and von Willebrand factor) explained 55% of the relative risk gradient (59% of absolute risk). Blood pressure and lipids made little difference to these estimates; results were similar for CHD mortality. Conclusions:Socioeconomic inequalities in CHD persist in the elderly and are at least partly explained by behavioral risk factors; novel (inflammatory) coronary risk markers made some further contribution. Reducing inequalities in behavioral factors (especially cigarette smoking) could reduce these social inequalities by at least one-third.

Serum insulin-like growth factor binding protein-1 (IGFBP-1) phosphorylation status in subjects with and without ischaemic heart disease

BackgroundInsulin-like growth factor binding protein-1 (IGFBP-1) modulates the activity of IGF-I. It exists in serum as phosphorylated and less phosphorylated forms. We wished to measure serum levels of both these forms of IGFBP-1, using a novel assay, in subjects with, or without ischaemic heart disease (IHD). MethodsWe measured serum concentrations of the phosphorylated and less phosphorylated forms of IGFBP-1 in 75 subjects (36 with and 39 without IHD). Two immunoassays were used, one which detects non-, and less-phosphorylated forms (LpIGFBP-1), and another which specifically detects the serine phosphorylated form of IGFBP-1 (pIGFBP-1). ResultsLpIGFBP-1 concentrations were significantly higher in subjects without IHD than in those with IHD (5.3±0.5μg/L vs. 2.7±0.4μg/L, p<0.001). pIGFBP-1 levels were also significantly higher in subjects without IHD compared to those with IHD (33.3±2.0μg/L vs. 25.3±2.2μg/L, p<0.01). The correlation between LpIGFBP-1 and pIGFBP-1 for all subjects was (r=0.71, p<0.001). This association was stronger in subjects without IHD (r=0.76, p<0.001) than for those with IHD (r=0.60, p<0.001). A significant negative association was observed between IGF-I and the ratio between the two forms (r=−0.45, p<0.0001). Receiver-Operating Characteristic (ROC) curve showed the highest area under the curve for LpIGFBP-1 (0.75) [95% CI: 0.63–0.86] and optimum cut-off value of 2.83μg/L with 75% sensitivity and 74% specificity. ConclusionsWe propose that low serum concentrations of IGFBP-1 forms could be a marker of coronary risk, and the LpIGFBP-1:pIGFBP-1 ratio may be an index of biologically active IGF-I.

Epidemiology of atherosclerosis in systemic lupus erythematosus

Patients with systemic lupus erythematosus (SLE) have a significantly increased risk of atherosclerotic coronary events. Traditional risk factors, such as hypertension and hypercholesterolemia, only partly account for the increased risk of coronary disease in SLE. Other important risk factors include disease and treatment-related factors. Novel markers of coronary risk in SLE are being investigated. Several methods have been used to detect subclinical atherosclerosis in patients with SLE. Among these, scintigraphic myocardial perfusion defects have been shown to be predictive of subsequent coronary events, independent of traditional Framingham risk factors. Although the aggressive treatment of reversible risk factors, such as lipids and blood pressure, is advocated by many, no published studies have yet demonstrated a clear reduction in risk of coronary events with this approach. Elucidation of risk factors and preventive strategies for accelerated atherosclerosis in SLE is the subject of ongoing research.

Television viewing, leisure-time exercise and acute coronary syndrome in transitional Albania

Objective To assess the association of leisure-time exercise and television (TV) viewing, a sedentary marker, with acute coronary syndrome (ACS) in Albania, a transitional country in Southeast Europe. Methods A population-based case-control study was conducted among Tirana residents in 2003–2006. Information on leisure-time exercise (transformed into kilocalories of energy expenditure) and daily hours of TV viewing was obtained by interviewer-administered questionnaire. 460 non-fatal ACS patients (368 men, 92 women) and 628 coronary heart disease-free controls (413 men, 215 women) were studied. Results Adjusted for socio-demographic characteristics, conventional coronary risk factors and leisure-time exercise, TV viewing was associated with ACS in women (OR = 1.66, 95%CI = 1.12–2.46 per hour/day viewing), but not in men (OR = 0.93, 95%CI = 0.81–1.07; P for sex-interaction = 0.02). A low level of leisure-time exercise (adjusted also for TV viewing) was associated with ACS similarly in men and women (pooled sexes OR = 2.03, 95%CI = 1.29–3.22 for bottom vs top tertile of energy expenditure). Conclusions Leisure-time inactivity is confirmed as an important risk factor for ACS also in Southeastern Europe. TV viewing may be an informative coronary risk marker in transitional societies, especially in women.

Endothelial dysfunction, intima-media thickness, ankle-brachial pressure index, and pulse pressure in young post-myocardial infarction patients with various expressions of classical risk factors

Coronary risk assessment based on the presence of classical risk factors may be insufficient. Several markers of arterial function and morphology, such as endothelial dysfunction (ED), intima-media thickness (IMT), ankle-brachial pressure index (ABPI), and pulse pressure (PP) may be useful in coronary risk estimation. To investigate their usefulness, we compared them in young post-myocardial infarction (MI) patients with various expressions of classical risk factors. Young male patients (on average 44 years old) in the stable phase after MI were included in the study. Twenty patients had high and 21 patients low expression of risk factors, while 25 healthy age-matched males served as controls. Endothelial dysfunction (estimated by ultrasound measurement of the flow-mediated dilation [FMD] of the brachial artery), IMT (of common carotid arteries), ABPI, and PP were compared between both groups of patients and controls. Compared with the control group, endothelial function and IMT were significantly impaired in both groups of patients, whereas ABPI was significantly reduced only in high-risk patients, and PP was similar in patients and controls. In all subjects, the level of FMD was significantly negatively related to IMT (r = -0.38, P = 0.01). Our study showed that endothelial function and IMT (but not ABPI and PP) are impaired in young post-MI patients independently of presence or absence of classical risk factors. Thus, we conclude that in young patients ED and IMT better assess coronary disease than classical risk factors, and are probably better markers of coronary risk.

Toll-like receptor 4 expressions on peripheral blood monocytes were enhanced in coronary artery disease even in patients with low C-reactive protein

Toll-like receptors (TLRs) play important roles in the pathogenesis of atherosclerosis. On the other hand, serum high sensitivity C-reactive protein (hsCRP) is known as an independent coronary risk factor, but cardiovascular events do occur even in low hsCRP levels. We investigated whether the TLR4 expression levels on human peripheral blood monocytes were associated with serum hsCRP levels or the occurrence of coronary artery diseases (CAD). One hundred CAD patients and 100 non-CAD subjects were enrolled. There were 72 non-CAD subjects and 53 CAD patients with low serum hsCRP levels. Among the low-hsCRP subjects, the TLR4 expression levels were higher in CAD patients than in non-CAD subjects ( P < 0.05, after being adjusted for other risk factors). Moreover, TLR4 expression levels in stable angina pectoris (SAP) patients were elevated compared with those in non-CAD subjects ( P < 0.05), and those in acute coronary syndrome patients were higher than SAP patients even in low-hsCRP subjects ( P < 0.01). In conclusion, the TLR4 expression levels on peripheral blood monocytes in CAD patients were higher than those in non-CAD subjects and correlated with disease activity, even in low-hsCRP subjects. The combined measurement of serum hsCRP and the TLR4 expression on peripheral blood monocytes, especially among low-hsCRP subjects, may become a new coronary risk marker.