Onset Of Ischemic Heart Disease Research Articles

Calculated Small Dense Low-Density Lipoprotein Cholesterol Level is A Predominant Predictor for New Onset of Ischemic Heart Disease.

A high level of directly measured small dense low-density lipoprotein cholesterol (sdLDL-C) is a strong risk factor for ischemic heart disease (IHD). However, it remains unclear whether estimated sdLDL-C level is a predictor for IHD. We investigated the associations of new onset of IHD with levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, triglycerides (TG), LDL-C and calculated sdLDL-C by Sampson's equation. After exclusion of subjects with IHD or those with TG ≥ 800 mg/dL, a total of 18,176 subjects (men/women: 11,712/6,464, mean age: 46 years) were recruited among 28,990 Japanese individuals who received annual health checkups. During the 10-year follow-up period, 456 men (3.9%) and 121 women (1.9%) newly developed IHD. Multivariable Cox proportional hazard analyses after adjustment of age, sex, obesity, smoking habit, family history of IHD, estimated glomerular filtration rate, hypertension and diabetes mellitus at baseline showed that the hazard ratio (HR) (1.38 [95% confidence interval: 1.03-1.85]) for new onset of IHD in subjects with the 4th quartile (Q4) of sdLDL-C (≥ 42 mg/dL) was significantly higher than that in subjects with the 1st quartile (Q1) (≤ 24 mg/dL) as the reference, though the adjusted HRs in subjects with Q2-Q4 of TC, HDL-C, non-HDL-C, LDL-C and TG were comparable with those in subjects with Q1 of the respective lipid fractions. The adjusted HR with a restricted cubic spline increased with a higher level of calculated sdLDL-C as a continuous value at baseline. sdLDL-C level calculated by Sampson's equation is a predominant predictor for the development of IHD in a general Japanese population.

Coexistence of Metabolic Dysfunction-Associated Fatty Liver Disease and Chronic Kidney Disease Is a More Potent Risk Factor for Ischemic Heart Disease.

Background Metabolic dysfunction-associated fatty liver disease (MAFLD), defined as fatty liver with overweight/obesity, type 2 diabetes, or metabolic abnormalities, is a newly proposed disease. However, it remains unclear whether the coexistence of MAFLD and chronic kidney disease (CKD) is a more potent risk factor for ischemic heart disease (IHD). Methods and Results We investigated the risk of the combination of MAFLD and CKD for development of IHD during a 10-year follow-up period in 28 990 Japanese subjects who received annual health examinations. After exclusion of subjects without data for abdominal ultrasonography or with the presence of IHD at baseline, a total of 14 141 subjects (men/women: 9195/4946; mean age, 48 years) were recruited. During the 10-year period (mean, 6.9 years), 479 subjects (men/women, 397/82) had new onset of IHD. Kaplan-Meier survival curves showed significant differences in rates of the cumulative incidence of IHD in subjects with and those without MAFLD (n=4581) and CKD (n=990; stages 1/2/3/4-5, 198/398/375/19). Multivariable Cox proportional hazard model analyses showed that coexistence of MAFLD and CKD, but not MAFLD or CKD alone, was an independent predictor for development of IHD after adjustment for age, sex, current smoking habit, family history of IHD, overweight/obesity, diabetes, hypertension, and dyslipidemia (hazard ratio, 1.51 [95% CI, 1.02-2.22]). The addition of the combination of MAFLD and CKD to traditional risk factors for IHD significantly improved the discriminatory capability. Conclusions The coexistence of MAFLD and CKD predicts new onset of IHD better than does MAFLD or CKD alone.

Parallel study of the rheological status, vascular changes and intracardiac hemodynamics in heart failure in coronary artery disease.

Ischemic heart disease is a pathological chronic and acute condition, which is provoked by insufficient blood supply or its complete cessation. To reduce the number of patients, all approaches and studies that can positively affect the prevention and treatment of the disease are important. This is very important in monitoring and treating diseases of all systems and organs, especially in diseases of the cardiovascular system. The aim of our work was to elucidate the relationship between the rheological status of blood, vascular changes and intracardiac hemodynamics in heart failure in coronary artery disease patients with different functional classes. The aim of our work was to elucidate the relationship between the rheological status of blood, vascular changes and intracardiac hemodynamics in heart failure in coronary artery disease patients with different functionalclasses. We examined 76 men and women patients with coronary artery disease - I-IV functional class (by New York Heart Association Functional Classification NYHA)), mean age - 59.2±4 years. The control group consisted of 20 apparently healthy volunteers (Woman: Man -1:1), whose average age was 52±3 years. Representatives of the control group did not take any medication during the study period and were apparently healthy. The electrocardiogram of the subjects in the control group corresponded to the norm. All subjects underwent clinical and laboratory studies in a standard way: to describe the rheological status of blood, the erythrocyte aggregability index (EAI), erythrocyte deformability index (EDI), and plasma viscosity were determined; to assess vascular changes - resistance index of resistive arteries (RIRA); to study intracardiac hemodynamics, echocardiology was performed according to the recommendations proposed by the American Association of Physicians. Rheological changes are present from the very beginning of the disease and progress along with the severity of the disease. Therefore, it is possible to assess the severity of the disease based on rheological disorders, which can precede the onset of ischemic heart disease. The vascular status resistance index increases in the early stages of the disease, with I functional class - RIRA increased by 46%. The cardiac index, which determines the adequacy of the global perfusion pressure, is the main indicator of hemodynamics and is negatively related to the increase in erythrocyte aggregation, although this indicator turned out to be statistically unreliable. The interpretation of our data will allow us to better understand the pathogenesis of heart failure, as well as recommend a list of tests, and methods that were discussed in the article to assess the clinical condition of patients. Continuing research in the same direction, we believe that we will be able to make adjustments to research methods and to the algorithm for drug therapy.

Impact of a Digitally Enhanced Diabetes Self-Management Program on Glycemia and Medical Costs.

To analyze economic savings and health impacts associated with a virtual digitally enhanced diabetes self-management education and support (DSMES) program. Participants (n = 1,494) were nonpregnant adults with diagnosed type 2 diabetes and baseline body mass index (BMI) of 25 kg/m2 (23 kg/m2 if of Asian descent) or higher who enrolled in virtual DSMES between February 2019 and April 2020 for at least 4 months. Participants' changes in glycated hemoglobin (A1C) and body weight were calculated as the difference between program start and last recorded values between months 4 and 6. Outcomes for all participants were analyzed; subanalyses were done on 628 participants with starting A1C >7% (53 mmol/mol), who could benefit most from DSMES. Markov-based microsimulation approach was used to model the potential reductions in diabetes sequalae and medical expenditures if observed improvements in A1C and BMI were maintained. DSMES participants with starting A1C >7% experienced average reductions of 0.9% A1C and 2.1 kg of body weight (-1.7% of BMI) within 6 months. If these improvements were maintained, simulated outcomes include reduced 5-year onset of ischemic heart disease by 9.2%, myocardial infarction by 10.6%, stroke by 12.1%, chronic kidney disease by 16.5%, and reduced onset of other sequelae. Simulated cumulative reduction in medical expenditures is $1160 after 1 year, $4150 after 3 years, $7790 after 5 years, and $18 020 after 10 years. Participation in virtual DSMES improves A1C and body weight, with the potential to slow onset of diabetes sequelae and reduce medical expenditures.

1148-P: Risk Factor Control and Risk of Hospitalization for Heart Failure in Diabetic Patients

Both diabetes and ischemic heart disease (IHD) are important risk factors for heart failure hospitalization. We investigated the association between the degree of risk-factor control and risk of heart failure in diabetic patients with and without IHD. A total of 20,9diabetic patients from UK Biobank were included, and matched with 82,582 controls based on age, sex, the presence of IHD, and assessment center. Risk-factor control was evaluated by 3 factors: glycated hemoglobin <53 mol/mol, blood pressure <140/90 mm/Hg and non-HDL-cholesterol <130 mg/dl. The Cox regression model was used to assess the association between the number of risk-factor control and the risk of heart failure. During a mean follow-up of 8.7 years, 1,139 incident heart failure hospitalization were documented. Higher degree of risk-factor control was significantly associated with a lower risk of heart failure in diabetic patients without IHD, but not in diabetic patients with IHD (P-interaction=0.008) . Moreover, as compared with non-diabetic controls, the diabetes-related excess risk of heart failure became diminished when all the three risk factors were under control in diabetic patients without IHD; the hazard ratio for heart failure was 1. (95%, CI, 0.85-1.49) . Our findings highlight the importance of early intervention for controlling cardiovascular risk factors in preventing heart failure, especially before the onset of IHD. Disclosure H.Ma: None. X.Wang: None. Y.Heianza: None. L.Qi: None.

High fibrosis-4 index predicts the new onset of ischaemic heart disease during a 10-year period in a general population.

AimsThe fibrosis-4 (FIB-4) index, calculated using age, platelet count, and levels of aspartate aminotransferase and alanine aminotransferase, is a non-invasive indicator for the detection of liver fibrosis. Advanced hepatic fibrosis is associated with morbidity and mortality in patients with non-alcoholic fatty liver disease. However, the relationship between liver fibrosis and the development of ischaemic heart disease (IHD) has not fully been addressed.Methods and resultsWe investigated the association between the FIB-4 index and the new onset of IHD during a 10-year period in a general population of subjects who received annual health examinations (n = 28 990). After exclusion of subjects with missing data and those with a history of IHD at baseline, a total of 13 448 subjects (men/women: 8774/4674, mean age: 48 years) were included. During the 10-year period, 378 men (4.3%) and 77 women (1.6%) had a new onset of IHD. Multivariable Cox proportional hazard models with a restricted cubic spline showed that hazard risk for the development of IHD increased with a higher FIB-4 index at baseline after adjustment of age, sex, fatty liver (FL) determined by ultrasonography, estimated glomerular filtration rate, habits of current smoking and alcohol drinking, family history of IHD, and diagnosis of hypertension, diabetes mellitus and dyslipidaemia. When divided by FL, the FIB-4 index becomes an independent predictor for the development of IHD in subjects with FL but not in those without FL. The addition of the FIB-4 index to traditional risk factors for IHD significantly improved the discriminatory capability.ConclusionA high level of the FIB-4 index predicts the new onset of IHD during a 10-year period.

Association between dairy consumption and ischemic heart disease among Chinese adults: a prospective study in Qingdao

BackgroundPrevious studies linking dairy consumption with ischemic heart disease (IHD) are almost from western countries, with little from China. The present study was to explore the relationship between dairy consumption and IHD among Chinese adults.MethodsThe data for the present study was from the prospective cohort study of China Kadoorie Biobank in Qingdao, a total of 33,355 participants in the present study. An interviewer-administered laptop-based questionnaire was used to collect information on the consumption frequency of dairy, incident IHD cases were identified through Disease Surveillance Point System and the new national health insurance databases. Cox regression analyses were performed to estimate adjusted hazard ratios (HRs) and confidence interval for the relationship between the incidence of IHD and dairy consumption.ResultsThe baseline survey reported that 32.4% of males and 34.6% of females consumed dairy regularly (i.e. ≥ 4 days/week). Over an average of 9.2 years follow-up, 2712 new-onset IHD were documented. Compared with participants who never or rarely consume dairy, the HR of consumed dairy regularly was 0.85(0.73–0.98) for males (P < 0.05), while no significant benefits were identified for females.ConclusionsRegular dairy consumption had an inverse association to the onset of IHD among males, with no similar findings for females.

MANAGING HEART FAILURE WITH REDUCED EJECTION FRACTION: WHAT TO KNOW?

The estimated population of congestive heart failure (CHF) patients in Pakistan is 28 millions.1 Besides epidemics of type 2 diabetes mellitus and coronary heart disease, South Asian countries are also be at an increased risk of heart failure at earlier ages than other racial/ethnic groups.2 Heart failure sub classified into three categories:&#x0D; &#x0D; With preserved ejection fraction (LVEF&gt;50%),&#x0D; Mid-range ejection fraction (LVEF41-49%),&#x0D; Reduced ejection fraction (LVEF&lt;40%).3&#x0D; &#x0D; According to studies in United States of American (USA) and United Kingdom (UK)4,5 heart failure with reduced ejection fraction (HFrEF) prevalence has increased due to ageing population, improved survival from myocardial infarction and high prevalence of co-morbid conditions like diabetes and obesity. With increasing number of young patients (&lt;40 years) with acute myocardial infarction (AMI) 12%6 in our population, prevalence of heart failure with predisposing factors need to be explored.&#x0D; Other than diagnosing and work up of these patients, the most challenging part is the pharmacological treatment by therapeutic agents proven to reduce morbidity and mortality in HRrEF. Registries have shown under-usage of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitor (ARNI), Beta-blockers and mineralocorticoid receptor antagonists (MRA) in such patients.7 Reason of not acheving the outcomes were due to not attaining the target levels of drugs dosages.8&#x0D; With recommendations from new guidelines new novel drug therapies i.e. sodium-glucose cotransporter-2 (SGLT2) inhibitors, most debatable questions from the physicians are keeping in view the hemodynamic status and kidney function. Questions coming to the Physicians minds include;9&#x0D; &#x0D; Should all guideline directed medical therapies be started together or stage wise?&#x0D; Which drugs should be titrated first?&#x0D; How quick can one up-titrate B-blockers and ARNI?&#x0D; At what level of kidney impairment should one stop ACE/ARB/ARNI/SGLT2 inhibitors?&#x0D; When should one refer these patients for cardiac resynchronization therapy device (CRTD) or Heart Transplantation?&#x0D; When should one repeat transesophageal echocardiography (TEE)?&#x0D; &#x0D; Physicians need to have clear answers and stance on the above queries.&#x0D; HFrEF is a major public health concern in our population especially with early onset of ischemic heart disease (IHD). Awareness, education and up to date knowledge regarding early diagnosis, work up and adjustments of drugs in such patients with proper follow up is important to reduce the ever rising morbidity and mortality in our population.&#x0D; &#x0D; References&#x0D; &#x0D; Sheikh SA. Heart failure in Pakistan: A demographic survey. J Card Fail. 2006;12(8):S157.&#x0D; Martinez-Amezcua P, Haque W, Khera R, Kanaya AM, Sattar N, Lam CS, et al. The upcoming epidemic of heart failure in South Asia. Circ Heart Fail. 2020;13(10):e007218.&#x0D; Yancy CW, Jessup M, Bozkurt B, Butler J, Casey Jr DE, Colvin MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017;70(6):776-803.&#x0D; Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139-596.&#x0D; Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Ccirculation. 2015;131(4):e29-322.&#x0D; Batra MK, Rizvi NH, Sial JA, Saghir T, Karim M. Angiographic Characteristics and in Hospital Outcome of Young Patients, Age Up to 40 Versus More Than 40 Years Undergoing Primary Percutaneous Coronary Intervention. J Pak Med Assoc. 2019;69(9):1308-12.&#x0D; Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI, et al. Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF registry. J Am Coll Cardiol. 2018;72(4):351-66.&#x0D; Konstam MA, Neaton JD, Dickstein K, Drexler H, Komajda M, Martinez FA, et al. Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial. Lancet. 2009;374(9704):1840-8.&#x0D; Murphy SP, Ibrahim NE, Januzzi JL. Heart failure with reduced ejection fraction: a review. JAMA. 2020;324(5):488-504.&#x0D;

Psychosocial and Behavioral Risk Factors of Early Onset of Ischemic Heart Disease among the Patients Presenting at a Tertiary Care Hospital

This study investigate the psychological, behavioral, anthropometric, and social factors that may cause a possible early onset of Ischemic Heart Disease (IHD) at a tertiary care hospital. Case-control research design was used in the present study. The present study was conducted in a tertiary care hospital in Lahore city, Punjab, Pakistan. Patients in the cardiology ward of a tertiary care hospital in Lahore City aged between 35-55 years were included in the study.

Evaluation of Ischemic Heart Disease Factors in Hemophilia Patients in Khorramabad.

Evaluation of risk factors associated with coronary artery disease and cardiac health in hemophilia patients is necessary to prevent the onset of ischemic heart disease. In this study, we evaluated the cardiovascular status of hemophilic patients in Lorestan province for the early onset of ischemic heart disease. In this cross-sectional descriptive study, a total of 80 patients presenting severe hemophilia, a detailed questionnaire-based investigation was conducted to analyze the prevalence of cardiovascular risk factors in severe hemophilic patients. In patients with hemophilia, body mass index (BMI), blood pressure, diabetes, LDL, cholesterol and HDL, the risk of cardiovascular death was estimated using a predictive risk predictor algorithm of Europe SCORE. The mean age of the patients was 25 years, where all the patients were non-diabetic. Echocardiography did not show any wall motion abnormality and changes in the T wave and dysrhythmia were also not seen by ECG. 7 patients had high blood pressure, 11 had abnormal HDL, and 1 had abnormal LDL. In this study, serum LDL and HDL levels were not significantly correlated with age and BMI. Conversely, age and BMI were significantly associated with hypertension. Hypertension was observed in people over the age of 25 years and in overweighed individuals. 78.8% had normal BMI and 21.3% were overweighed. There was no significant correlation between serum LDL, serum HDL, and blood pressure and sex. The levels of abnormal LDL and HDL were higher in men than in women. ECG findings from our study did not report any significant cardiac abnormalities among hemophilic patients. Cardiovascular risk factors were not significantly correlated in these patients.

Myocardial Infarction in Women of Reproductive age: Risk Factors, Clinical Picture, Prognosis

Aim To study risk factors (RF) and clinical and anamnestic features of the course and prediction in women with a preserved menstrual cycle and postmenopausal women after ST segment elevation (STEMI) and non-ST elevation myocardial infarction (NSTEMI).Material and methods This study included 121 women aged 32 to 55 years diagnosed with MI. The patients were divided into two groups, group 1 (study group) consisting of 60 women with preserved menstrual function (1А, STEMI; n=38; age, 48.3±5.7 years and 1B, NSTEMI; n=22; age. 49.0±4.8 years), and group 2 (control) consisting of 61 postmenopausal women (2А, STEMI; n=43; age, 49.05±4.9 years; 2B, NSTEMI; n=18; age, 49.9±3.5 years). Beside the analysis of RF and clinical features, a prediction was produced for each subgroup at one year after discharge from the hospital based on the following indexes: hospitalization for unstable angina, non-fatal MI, revascularization, cardiovascular (CV) death, and major adverse cardiac events (MACE), which included all these outcomes.Results In all subgroups, the most frequent RFs were arterial hypertension (AH), overweight and obesity, family history, smoking, and type 2 diabetes mellitus (DM2). Among patients with STEMI, smoking was significantly more frequently observed in the group with preserved menstrual function. Oral contraceptives were used by 3 and 6 women of reproductive age in the STEMI and NSTEMI subgroups, respectively. Incidence of STEMI as the onset of ischemic heart disease (IHD, 46.7%) was higher than in subgroup 2A (27.9 %; р=0.003). Early postinfarction angina was a more frequent complication of MI in subgroup 1A than in 2A (р=0.02).Conclusion The incidence rate of RFs, including AH, overweight and obesity, dyslipidemia, family history, and DM2, was similar in both STEMI and NSTEMI groups. Incidence rate of smoking was statistically significantly higher in subgroup 1A. One-year prediction for women with STEMI and NSTEMI was comparable irrespective of the presence or absence of the menstrual function.

Sports-related sudden cardiac death in Spain. A multicenter, population-based, forensic study of 288 cases

Introduction and objectivesTo determine the incidence of sports-related sudden cardiac death in Spain, and to identify the clinical-pathological characteristics, substance abuse, and sports activity associated with this entity. MethodsRetrospective, population-based, multicenter study of forensic autopsies conducted in 25 provinces during an 8-year period (2010-2017). ResultsWe investigated 288 cases (98.6% occurred in men with a mean age of 43.8±14.4 years). The incidence in the general population was 0.38 cases out of 100 000 inhabitants per year (0.82 among regular athletes), and most cases (54%) occurred in persons aged between 35 and 54 years. The most frequent sports (96% recreational) were cycling (28%), football (18%), and jogging (17%). Death was of cardiovascular origin in 99%. The main causes were ischemic heart disease (63%), cardiomyopathies (21%), and sudden arrhythmic death syndrome (6%). In young people, cardiomyopathies (38%) and ischemic heart disease (30%), present after the age of 20 years, were the most prevalent. The disease was diagnosed during life in 23 cases, relevant clinical antecedents were observed in 30 cases, and cardiovascular risk factors, mainly obesity, in 95 cases. Toxicological analysis detected cardiotoxic substances in 7%, highlighting the association between cannabis and acute ischemic heart disease. ConclusionsSports-related sudden cardiac death in Spain has a very low incidence and affects middle-aged men practicing recreational sports, mainly cycling, football, and jogging. This entity is of cardiovascular origin with early onset of ischemic heart disease. Clinical data and substance abuse should be taken into account to develop preventive strategies.

Muerte súbita relacionada con la actividad deportiva en España. Estudio poblacional multicéntrico forense de 288 casos

Introduction and objectivesTo determine the incidence of sports-related sudden cardiac death in Spain, and to identify the clinical-pathological characteristics, substance abuse, and sports activity associated with this entity. MethodsRetrospective, population-based, multicenter study of forensic autopsies conducted in 25 provinces during an 8-year period (2010-2017). ResultsWe investigated 288 cases (98.6% occurred in men with a mean age of 43.8±14.4 years). The incidence in the general population was 0.38 cases out of 100 000 inhabitants per year (0.82 among regular athletes), and most cases (54%) occurred in persons aged between 35 and 54 years. The most frequent sports (96% recreational) were cycling (28%), football (18%), and jogging (17%). Death was of cardiovascular origin in 99%. The main causes were ischemic heart disease (63%), cardiomyopathies (21%), and sudden arrhythmic death syndrome (6%). In young people, cardiomyopathies (38%) and ischemic heart disease (30%), present after the age of 20 years, were the most prevalent. The disease was diagnosed during life in 23 cases, relevant clinical antecedents were observed in 30 cases, and cardiovascular risk factors, mainly obesity, in 95 cases. Toxicological analysis detected cardiotoxic substances in 7%, highlighting the association between cannabis and acute ischemic heart disease. ConclusionsSports-related sudden cardiac death in Spain has a very low incidence and affects middle-aged men practicing recreational sports, mainly cycling, football, and jogging. This entity is of cardiovascular origin with early onset of ischemic heart disease. Clinical data and substance abuse should be taken into account to develop preventive strategies.

486 Elevated Lipoprotein(a) Predicts Premature Onset of Ischaemic Heart Disease in Patients With Type 2 Diabetes

Lipoprotein(a) [Lp(a)] and diabetes are associated with an increased lifetime risk of cardiovascular disease. However, there is an inverse relationship between Lp(a) concentration and risk of type 2 diabetes (T2D), where patients with low Lp(a) have a higher risk of T2D. We evaluated whether Lp(a) distribution in patients with premature coronary artery disease (pCAD) differs between those with T2D compared to those without diabetes, and whether elevated Lp(a) is associated with pCAD in patients with T2D. Consecutive patients with acute coronary syndrome at two tertiary hospital cardiac units had Lp(a) measured prospectively. Elevated Lp(a) was defined as ≥0.5 g/L and pCAD where age <60 years. Of 449 patients with Lp(a) measurements, 233 (51.9%) had pCAD. In patients with pCAD, T2D was associated with a lower median Lp(a) concentration (0.13 g/L versus 0.27 g/L, p=0.004), a greater proportion with undetectable Lp(a) (33.3% versus 17.8%, p=0.016), and a lower proportion with Lp(a) ≥0.3 g/L (32.0% versus 49.3%, p=0.012), Lp(a) ≥0.5 g/L (26.5% versus 38.4%, p=0.073) and Lp(a) ≥1.0 g/L (4.1% versus 15.1%, p=0.004). After adjusting for variables that were significantly associated with premature CAD on univariate analysis, elevated Lp(a) remained associated with pCAD (OR 2.895, 95% CI 1.427-5.876, p=0.003) in patients with T2D. T2D was associated with lower Lp(a) in patients with pCAD. However, despite this, elevated Lp(a) remained predictive of pCAD. Lp(a) measurement should be considered in younger adults with T2D to identify who may benefit from early aggressive preventative therapies to reduce the burden of pCAD.

Association between heat stroke and ischemic heart disease: A national longitudinal cohort study in Taiwan

The purpose of this study is to determine the relationship between heat stroke and ischemic heart disease (IHD), in a nationwide population using a longitudinal approach. We retrospectively examined the data from the National Health Insurance Research Database (NHIRD) in Taiwan, for patients examined between 2000 and 2013. In total, 628 patients with a heat stroke episode were enrolled and matched with 1256 patients without any history of a heat stroke episode by propensity score matching at a ratio of 1:2. The mean follow-up years of the heat stroke group was 11.89 years and the mean follow up of the control group was 11.51 years. An association between heat stroke episodes and IHD (log-rank p < .001) was found in a univariate cox regression analysis. After multivariate adjustment, age, comorbidities (hypertension, diabetes, stroke), and lower insurance premiums were associated with IHD events in patients who had a heat stroke. IHD was independently associated with heat stroke following cox multivariate regression analysis and patients with a heat stroke episode had a higher incidence of IHD events compared to those without any heat stroke episode (2598.41/105 person-years vs. 1286.14/105 person-years, adjusted hazard ratio 3.527, 95% CI: 2.078–4.032, p < .001). The onset of IHD in patients who suffered a heat stroke was earlier than in those without a heat stroke episode (2.08 ± 3.45 vs. 3.61 ± 3.25 years, p < .001). In conclusion, clinicians should be aware about evaluating the IHD risk following a heat stroke episode in a patient.

Análisis de epistasia de polimorfismos de genes metabólicos asociados a cardiopatía isquémica en Yucatán

ObjectiveEpistasis is a type of genetic interaction that could explain much of the phenotypic variability of complex diseases. In this work, the effect of epistasis of metabolic genes and cardiovascular risk on the susceptibility to the development of ischemic heart disease in Yucatan was determined. MethodsCase-control study in 79 Yucatecan patients with ischemic heart disease and 101 healthy controls matched by age and origin with cases. The polymorphisms -108CT, Q192R, L55M (paraoxonase 1; PON1), C677T, A1298C (methylenetetrahydrofolate reductase; MTHFR), and the presence/absence of the glutathione S-transferase T1 (GSTT1) gene were genotyped. Epistasis analysis was performed using the multifactorial dimensional reduction method. The best risk prediction model was selected based on precision (%), statistical significance (P<0.05), and cross-validation consistency. ResultsWe found an independent association of the null genotype GSTT1*0/0 (OR=3.39, CI: 1.29-8.87, P=0.017) and the null allele (OR=1.86, CI: 1.19-2.91, P=0.007) with ischemic heart disease. The GSTT1*0 deletion and the 677TT genotype (MTHFR) were identified as being at a high cardiovascular risk, whereas the GSTT1*1 wild type genotype and the CC677 variant were at low risk. The gene-environment interaction identified the GSTT1 gene, C677T polymorphism (MTHFR), and hypertension as the factors that best explain ischemic heart disease in the study population. ConclusionsThe interaction of the MTHFR, GSTT1 and hypertension may constitute a predictive model of risk for early onset ischemic heart disease in the population of Yucatan.

Family history of cardiovascular disease as a risk factor for coronary artery disease in adult offspring

There is controversy about the role of positive family history as an independent risk factor for coronary artery disease. The aim of this work was to investigate the influence of family history on presentation of coronary artery disease in adult offspring, and on its severity. In a retrospective cross-sectional study at Tehran Heart Center (University of Tehran Medical Sciences), 6399 patients with established coronary artery disease who underwent coronary angiography for standard indications were assessed. Coronary artery disease was defined as atherosclerotic involvement of more than 50% in at least one major coronary artery. 953 patients (14.9%) had a verified positive family history of coronary artery disease, of whom 193 patients (20.2%) and 215 patients (22.5%) had paternal and maternal positive history, respectively. The mean age of clinical onset of ischemic heart disease in patients with a positive history was significantly lower than patients with no history (p < 0.001). Left main coronary lesion was significantly more frequent in patients with positive history (p = 0.017). Multivariate logistic regression analysis demonstrated that presentation of coronary artery disease in the form of acute coronary syndrome was significantly more prevalent in the background of positive family history (odds ratio, OR = 1.44, 95% confidence interval, CI: 1.14-1.83, p = 0.002), especially above 45 years old. These findings indicate that positive family history is a major risk factor for coronary artery disease which strongly predisposes to the atherosclerotic process at younger ages; therefore, these patients should be evaluated and managed more intensively for other risk factors.

The significance of a 4,183 Da peptide of dermcidin protein in the early diagnosis and differential diagnosis of acute coronary syndrome

To investigate the predictive value of 4,183 Da peptide of dermcidin protein in the early diagnosis and differential diagnosis of ischemic heart disease. A prospective controlled study was conducted. Serum samples were drawn from 161 patients with acute coronary'syndrome [ACS, including 46 patients with unstable angina (UA), 23 with acute non-ST elevation myocardial infarction, and 92 with acute ST segment elevation myocardial infarction], 111 subjects for routine physical examination, including 45 patients with hypertension history, 42 with coronary heart disease, 22 with diabetes, and 54 patients with non-ACS (including pulmonary embolism, aortic dissection, aneurysm, arrhythmia, myocarditis, coronary myocardial bridge, pleurisy, pneumothorax pneumomediastinum, rib fracture, reflux esophagitis, peptic ulcer, and pancreatitis) to serve as controls. 4 183 Da peptide of dermcidin protein was assessed with matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) technology, and myeloperoxidase [MPO, determined by point-of-care testing (POCT) and enzyme linked immunosorbent assay (ELISA), respectively], high sensitive C-reactive protein (hs-CRP), heart type fatty acid binding protein (H-FABP), myoglobin (MYO), cardiac troponin I (cTnI), and MB isoenzyme of creatine kinase (CK-MB) were quantitated with biochemical analysis. The power of the biomarkers above for early diagnosis and differential diagnosis for ischemic heart disease were judged by comparison of their sensitivity and specificity. (1) It was showed by one-way ANOVA that 4,183 Da peptide was higher in ACS group than that in control group (relative abundance: 22.05 ± 16.97 vs. 15.52 ± 14.09, P = 0.001), but no difference was found between ACS group and non-ACS group (relative abundance: 22.05 ± 16.97 vs. 19.99 ± 17.63, P = 0.416). (2) The specificity and sensitivity of the 4 183 Da polypeptide and MPO for predicting ACS and UA were compared with the receiver operating characteristic curve (ROC). It was showed that the 4,183 Da polypeptide had predictive values for ACS and UA, and the areas under the ROC curve (AUC) was 0.625 and 0.651 (both P < 0.01), but MPO was not found to have predictive value (AUC was 0.440 and 0.336, respectively, both P > 0.05). (3) It was showed by the values of multi-markers in differential diagnosis of ACS and non-ACS disease that the specificity and sensitivity of 4 183 Da peptide in the differential diagnosis of acute myocardial infarction (AMI) and non-ACS disease were less than those of MYO, cTnI, H-FABP, markers of myocardial damage, which AUCs were 0.569 vs. 0.796, 0.833, 0.838, and equal to MPO (POCT/ELISA) and hs-CRP, AUC of which was 0.569 vs. 0.505 (POCT)/0.477 (ELISA) and 0.545. But both the value of 4 183 Da peptide and MYO, cTnI, H-FABP in the differential diagnosis of UA and non-ACS disease was not found, where AUC was 0.456, 0.525, 0.658, 0.568. 4,183 Da polypeptide, a fragment of dermcidin protein, may have association with the onset of ischemic heart disease, and may be helpful in the early diagnosis of ACS.

OP33 LOWER HDL CHOLESTEROL IS ASSOCIATED WITH THE RISK OF STROKE IN DIABETIC INDIVIDUALS WITH POOR GLYCEMIC CONTROL: 5.5-YEAR SURVEY OF CARDIOVASCULAR EVENTS

Background: The aim of this study was to identify factors that predict ischemic heart disease (IHD) or cerebrovascular accident (CVA) in diabetic individuals and to investigate their differences by age. We investigated the relationship between lipid levels and IHD and CVA in diabetic individuals according to glycated hemoglobin (HbA1c, 7.9% or <7.9%). Method: We performed a prospective cohort study (Japan Cholesterol and Diabetes Mellitus Study) with 5.5 years of follow-up. A total of 4,014 patients with type 2 diabetes (1,936 women; age 67.4±9.5 years, median 70 years; <65 years old, n=1,261; 65 to 74 years old, n=1,731; and 75 years old, n=1,016) were recruited on a consecutive outpatient basis from 40 hospitals throughout Japan. Patients with coronary artery disease, which was defined as previous myocardial infarction, coronary intervention, or confirmed angina pectoris and recent stroke, who had been admitted within the past 24 months were excluded. The primary end points were onset of IHD or CVA. Lipids, glucose and other factors related to IHD or CVA risk were investigated. Result: The diabetic participants were divided into those who were aged <65 years, 65–74 years and 75 years. 153 cases of IHD and 104 cases of CVA (7.8 and 5.7/1,000 people per year, respectively) occurred over 5.5 years. Lipid and glucose levels and other factors were investigated in relation to the occurrence of IHD or CVA. In this study, we focused on HbA1c levels. HDL-cholesterol (HDL-C) was significantly associated with risk of CVA in diabetic individuals with poor glycemic control (HbA1c 7.9%) who were aged <65 years. Triglyceride (TG) was significantly associated with risk of CVA in diabetic individuals with poor glycemic control (HbA1c 7.9%) who were aged 75 years. HDL-C, LDL-cholesterol (LDL-C) and TG were not significantly associated with risk of CVA in diabetic individuals (HbA1c <7.9%). HDL-C, LDL-C and TG were not significantly associatedwith risk of IHD in diabetic individuals (HbA1c, 7.9% and <7.9%). Risk factors for cardiovascular events appear to change with advancing age. The importance of HDL-C is different for each age-group. Conclusion: Lower HDL-C was an important risk factor for CVA in diabetic individuals with poor glycemic control who were aged <65 years. This result is important for developing individualized strategies to prevent atherosclerotic disease.

High efficient and cost-effective screening method for diabetic cardiovascular risk

BackgroundThe vascular complications of outpatients with diabetes at ordinary hospitals vary. Ischemic heart disease is barely predictable after treatment using previously reported therapeutic indices. We developed a simple and noninvasive screening method to evaluate the possibility of ischemic heart disease in patients with diabetes.MethodsFive years of clinical data from 337 outpatients (196 males and 141 females) with diabetes were analyzed. Twenty-three males and 14 females had ischemic heart disease. We examined the possibility of predicting ischemic heart disease after analyzing this population. The analyzed laboratory data included the following: minimum value of right or left ankle–brachial indices (ABI), maximum value of right or left pulse wave velocities (PWV), aortic calcification diagnosed on plain chest radiographs, plaque score (PS), maximum value of intima media thickness at the cervical artery (IMT), electrocardiographic (ECG) ischemic changes (including ST-T changes or abnormal Q waves, which were re-examined by a cardiologist), HbA1c, low-density lipoprotein cholesterol (LDL-C), uric acid (UA), urine albumin, age, sex, disease duration, and body mass index. All data were subjected to multivariate logistic regression analyses.ResultsThe presence of ECG ischemic changes, aortic calcification, minimum ABI, maximum IMT, LDL-C, and UA were evaluated in multivariate logistic regression analysis with the onset of ischemic heart disease. The receiver operating characteristic curve indicated an area under the curve of 0.879 (0.820 - 0.938; P = 0.00).ConclusionsIschemic heart disease could be predicted in patients with diabetes using a combination of results from conventional physical and laboratory tests.