Predictor Of Ischemic Heart Disease Research Articles

Contributions of elevated CRP, hyperglycaemia, and type 2 diabetes to cardiovascular risk in the general population: observational and Mendelian randomization studies

ObjectiveTo investigate the contributions of low-grade inflammation measured by C-reactive protein (CRP), hyperglycaemia, and type 2 diabetes to risk of ischemic heart disease (IHD) and cardiovascular disease (CVD) death in the general population, and whether hyperglycaemia and high CRP are causally related.Research design and methodsObservational and bidirectional, one-sample Mendelian randomization (MR) analyses in 112,815 individuals from the Copenhagen General Population Study and the Copenhagen City Heart Study, and bidirectional, two-sample MR with summary level data from two publicly available consortia, CHARGE and MAGIC.ResultsObservationally, higher plasma CRP was associated with stepwise higher risk of IHD and CVD death, with hazard ratios and 95% confidence intervals (95%CI) of 1.50 (1.38, 1.62) and 2.44 (1.93, 3.10) in individuals with the 20% highest CRP concentrations. The corresponding hazard ratios for elevated plasma glucose were 1.10 (1.02, 1.18) and 1.22 (1.01, 1.49), respectively. Cumulative incidences of IHD and CVD death were 365% and 592% higher, respectively, in individuals with both type 2 diabetes and plasma CRP ≥ 2 mg/L compared to individuals without either. Plasma CRP and glucose were observationally associated (β-coefficient: 0.02 (0.02, 0.03), p = 3 × 10− 20); however, one- and two-sample MR did not support a causal effect of CRP on glucose (−0.04 (−0.12, 0.32) and − 0.03 (−0.13, 0.06)), nor of glucose on CRP (−0.01 (−0.08, 0.07) and − 0.00 (−0.14, 0.13)).ConclusionsElevated concentrations of plasma CRP and glucose are predictors of IHD and CVD death in the general population. We found no genetic association between CRP and glucose, or vice versa, suggesting that lowering glucose pharmacologically does not have a direct effect on low-grade inflammation.

Optimal Cut-off Points of Nonfasting and Fasting Triglycerides for Prediction of Ischemic Heart Disease in Japanese General Population: The Circulatory Risk in Communities Study (CIRCS).

We investigated the optimal cut-off points of nonfasting and fasting triglycerides in Japanese individuals with lower average triglyceride levels than westerners. Residents aged 40-69 years without a history of ischemic heart disease or stroke were enrolled between 1980 and 1994 and followed. Serum triglyceride concentrations were measured from 10851 nonfasting (＜8 h after meal) and 4057 fasting (≥ 8 h) samples. As a prerequisite, we confirmed the shape of a receiver operating characteristic (ROC) curves, the area under ROC curves (AUC), and the integrated time-dependent AUC. We identified optimal cut-off points for incident ischemic heart disease based on C-statistic, Youden index, and Harrell's concordance statistic. We used dichotomized concentrations of triglycerides via the univariate logistic regression and Cox proportional hazards regression models. We also calculated multivariable hazard ratios and population attributable fractions to evaluate the optimal cut-off points. Nonfasting and fasting optimal cut-off points were 145 mg/dL and 110 mg/dL, with C-statistic of 0.594 and 0.626, Youden index of 0.187 and 0.252, and Harrell's concordance statistic of 0.590 and 0.630, respectively. The corresponding multivariable hazard ratios of ischemic heart disease were 1.43 (95%CI 1.09-1.88)and 1.69 (1.03-2.77), and the corresponding population attributable fractions were 16.1% (95%CI 3.3-27.2%) and 24.6 (-0.3-43.3). The optimal cut-off points of nonfasting and fasting triglycerides in the Japanese general population were 145 mg/dL and 110 mg/dL, respectively, lower than the current cut-off points recommended in the US and Europe.

High fatty liver index is an independent predictor of ischemic heart disease during a 10-year period in a Japanese population.

Fatty liver index (FLI), which is calculated by using body mass index, waist circumference and levels of γ-glutamyl transferase and triglycerides, is a validated surrogate marker of nonalcoholic fatty liver disease. We retrospectively investigated the relationship between FLI and the development of ischemic heart disease (IHD) during a 10-year period. Among subjects who received annual health checkups (n= 28 990), a total of 18851 subjects (men/women: 11659/7192) were enrolled after exclusion of subjects with missing data and those with IHD at baseline. FLI at baseline was significantly higher in men than in women. During the 10-year period, 450 men (3.9%) and 123 women (1.7%) had new onset of IHD determined by a self-reported questionnaire survey. Multivariable Cox proportional hazard models with a restricted cubic spline showed that hazard risk (HR) for the development of IHD increased with a higher FLI at baseline after adjustment of age, sex, current smoking habit, family history of IHD and diagnosis of diabetes mellitus, hypertension, dyslipidemia and chronic kidney disease at baseline. There was no significant interaction between FLI and sex for the adjusted HR. When divided by tertiles of FLI at baseline (T1∼T3), the adjusted risk for development of IHD in the T3 group (HR [95% confidence interval]: 1.34 [1.05-1.71]) was significantly higher than that in the T1 group as the reference. The addition of FLI into traditional risk factors for IHD significantly improved the discriminatory capability. A high level of FLI is an independent predictor of new onset of IHD during a 10-year period.

Role of HEART score in prediction of coronary artery disease and major adverse cardiac events in patients presenting with chest pain

Introduction. Chest pain (CP) diagnostics accuracy remains debatable for both general practitioners (GP) or emergency department (ED) physicians for patients in HEART score (HS) low- and intermediate-risk groups which prompted us to review our electronic database for all patients admitted via our center?s ED during 2014 to 2020 for CP and suspect acute coronary syndrome. Methods. Patients were divided in function of low- or intermediate-risk HS and assessed during a three month follow up for angiogram results, major adverse cardiac events (MACE), lab results and echo parameters. Results. Of 585 patients included, low-risk HS group (21,4%, 36% were women) had significant coronary disease on angiogram in 68%, while for intermediate-risk HS group (78.6%, with 32.6% women) it was for 18.4% of patients (p < 0,0005). Area under the ROC curve of HS in detecting patients with ischemic heart disease as a cause of CP was 0.771 (95% CI: 0.772?0.820) with best cut-off point HS was calculated at 3.5. Sensitivity and specificity were 89.2% and 57.6% respectively. Adjusting for sex, lab results and HS, AUROC curve of this model was 0.828 (95% CI: 0.786?0.869; p < 0,0005) with cut-off of 77.95. Sensitivity and specificity were 84.9% and 68% respectively. In the three-month follow-up post-discharge, there was a significant difference in MACE between groups (low- vs. intermediate-risk HS was 3.4 vs. 16.7% p < 0.05). Conclusion. HS for our CP patients admitted via our ED by GP and ED physicians? referral, provides a quick and reliable prediction of ischemic heart disease and MACE.

Prevalence of the presystolic wave in echocardiography and its association with the extent of coronary artery disease in patients with chronic stable angina.

Since mortality and morbidity of coronary artery disease are high, there is a need for non-invasive diagnostic methods for early diagnosis and prediction of ischemic heart disease (IHD) outcome. This study aimed to assess the relationship between angiographic findings, the Presystolic wave (PSW) and some of the ischemic related parameters in echocardiography of the patients with chronic stable angina. This cross-sectional study was conducted on the patients with chronic angina pectoris who referred to a tertiary hospital for coronary angiography in Mashhad, Iran. Demographic and medical history of the patients, as well as echocardiography findings, including ejection fraction (EF), regional wall motion abnormalities (RWMA), PSW and diastolic function were recorded. Angiographic findings, including SYNTAX score were also assessed. A total of 220 patients (132 males and 88 females) with the mean age of 62.43±11.40years old participated in this study. The prevalence of PSW was 49.1%. The absence of the PSW was related to more RWMA (P=.002), and higher stages of left ventricular diastolic dysfunction (LVDD) (P=.029) and higher SYNTAX score (P=.001). There was a significant association between the absence of the PSW and EF categories, especially in severe LV systolic dysfunction (LVEF<30%) (P=.001). The findings of this study revealed that PSW is strongly associated with the SYNTAX score. The absence of the PSW may indicate patients at high-risk clinical status (higher SYNTAX score, severe systolic dysfunction, more RWMA, and higher stages of LVDD).

Multi-modality biomarkers in the early prediction of ischaemic heart disease in middle-aged men during a 21-year follow-up

BackgroundIschaemic heart disease (IHD) often develops after decades of preceding subclinical coronary atherosclerosis. Biomarkers are useful prognostic predictors of IHD, but their long-term predictive value in a general population has not been adequately studied.PurposeTo investigate the early predictive value of multi-modality biomarkers in addition to clinical risk factors in incident IHD in a random male general population sample followed from 50 to 71 years of age.Method“The Study of Men Born in 1943” is a longitudinal cohort study during follow-up. All the men underwent a baseline examination in 1993, where a panel of biomarkers were analysed and incident IHD was registered during 21-year follow-ups.ResultsOf 739 participants, 97 men (13.1%) developed an IHD event. For time to first occurrence of IHD, univariable analyses showed that elevated levels of high sensitivity troponin T (hs-TNT), high sensitivity-C reactive protein (hs-CRP) and interleukin-6 (IL-6) were significant predictors of IHD. In addition, a high number of biomarkers with elevated levels (hs-TNT > 10 ng/L, hs-CRP > 1 mg/L, IL-6 > 8 ng/L and N-terminal pro b-type natriuretic peptide (NT-proBNP) > 100 pg/mL) increased predictive ability. In univariable and multivariable analysis high-density lipoprotein-cholesterol (HDL-C) had the highest predictive ability. Hs-TNT provided better predictive ability than smoking, body mass index and glucose, and was an independent significant predictor when adjusted for HDL-C, total cholesterol and hypertension. Addition of biomarkers on top of clinical risk factors provided significantly better prediction as tested by likelihood ratio test (p = 0.033), but did not significantly enhance the model’s discriminative ability However, it appeared contributing to higher sensitivity in the late phase of follow-up.ConclusionIn this random, middle-aged male population sample, the addition of biomarker hs-TNT was an independent significant predictor of IHD and significantly improved prediction, indicating the probability of a better prediction of long-term risk of IHD in a low-risk population.Trial registration: The study is registered at Clinical Trials.gov Identifier number: NCT03138122

Lipoprotein (a) level and hsCRP as risk markers in Myocardial Ischemia

Cardiovascular diseases are the major cause of death globally. Hyperlipidemias and hyperlipoproteinemias are the most important risk factors for atherosclerosis. Inflammation plays a major role in atherothrombosis, and measurement of inflammatory biomarkers like High Sensitive C- reactive protein (hsCRP) can provide detection of high risk for Ischemic Heart Disease (IHD). Lipoprotein (a) [Lp (a)] is a low density lipoprotein like particle synthesized by the liver. There is a strong association between circulating Lp(a) levels and IHD. Objectives: To estimate the serum levels of lipoprotein (a) and lipid profile in ischemic heart disease patients and healthy subjects and to show that serum hsCRP as a better predictor of ischemic heart disease than low density lipoprotein cholesterol. Materials and Methods: A total number of 100 subjects were studied comprising of 50 controls and 50 IHD subjects. Total cholesterol (TC), triglycerides (TGL) and HDL-C, were estimated by enzymatic methods, LDL-C and VLDL-C were estimated by calculation, Lp(a) was estimated by immunoturbidimetric methods and hsCRP was estimated by chemiluminiscence method. Appropriate statistical analysis was done. Results: TC, TGL, LDL-C, VLDL-C, Lp(a) and hsCRP were increased whereas HDL-C was decreased in IHD subjects when compared to controls. Diagnostic validity test revealed that hsCRP to be a better discriminator of IHD than LDL-C. Conclusion: The results of the current study support the concept that the levels of Lp(a), and hsCRP are strongly related to ischemic heart disease in addition to the levels of serum lipids. Keywords: Ischemic heart disease, High sensitive C-reactive protein, Lipoprotein (a), Hyperlipoproteinemia.

Abstract 14635: The Fib-4 Index is a Risk Factor for Incident Cardiovascular Disease in Urban Male Residents: The Suita Study

Introduction: The fibrosis index based on four factors (FIB-4 index) is a score that predicts liver fibrosis easily, quickly, and inexpensively, but there is little evidence of its relationship with the onset of cardiovascular disease in general population in Japan. Therefore, we examined the relationship between incident cardiovascular disease (CVD) by the FIB-4 index level in urban area residents. Methods: We studied 5,333 follow-up Japanese individuals (2,478 men, 2,855 women) with no history of CVD in the Suita Study. The platelet count was measured at the time of medical examination. The FIB-4 index was calculated using age (yrs), alanine aminotransferase (ALT, IU/L), aspartate aminotransferase (AST, IU/L), and platelet count (PLT, 10^9/L) as follow: FIB-4 index = (AST x Age) / (PLT x (square root of ALT)). The primary endpoint was CVD events, including stroke or ischemic heart disease. The risk of CVD was analyzed by the FIB-4 index level using the Cox proportional hazards model adjusted by the components of the ischemic heart disease risk score in the Suita Study. Results: The percentage of the FIB-4 index ≥2.67 in the 30s to 80s at the baseline survey was 0%, 1%, 2%, 7,%, 21%, 43% for men, and 0%, 0%, 1%, 5%, 16%, 39% for women, respectively. During the mean follow-up period of 9.3 years, 195 strokes and 137 ischemic heart diseases were observed. Based on men with FIB-4 index &lt;1.30, the adjusted hazard ratio (95% confidence interval) for incident CVD in men with FIB-4 index ≥2.67 was 1.91 (1.05-3.47), those for incident ischemic heart disease in men with FIB-4 index 1.30-2.66 and ≥2.67 were 2.49 (1.33-4.64) and 3.29 (1.32-8.16), respectively. Conclusion: The FIB-4 index was considered to be useful as a predictor of ischemic heart disease in urban men in Japan.

Does infection prolong the QT interval?

The corrected QT (QTc) interval is a strong predictor of ischaemic heart disease and cardiovascular mortality. It may trigger lethal arrhythmias and sudden death. Risk factors include electrolyte disorders, medications, prior cardiovascular disease and genetic predisposition. We previously demonstrated that QTc intervals are prolonged in patients hospitalised with pneumonia, regardless which antibiotics were given. It is unclear whether QTc prolongation is associated with pneumonia itself or whether it occurs with other infections. To investigate any association between hospitalisation for infection and QTc prolongation. We enrolled 169 patients, 160 of whom were used for analysis. QTc was measured in seconds by routine electrocardiogram (ECG) on admission. Subsequently, daily ECG were performed for 3 days, or until discharge (whichever occurred sooner). When clinically significant QTc prolongation was detected, possible causes were investigated. Clinically significant prolongation was not observed in any patient. The QTc was slightly longer in patients hospitalised for pneumonia or upper respiratory tract infections on admission. It was also prolonged in men, in patients with ischaemic heart disease, hypertension, history of cerebrovascular accident or cancer. A very slight trend for prolongation was observed between the first and second day of monitoring, however it later returned to baseline levels. Nearly 54% of study participants had positive systemic inflammatory response syndrome scores, however no association was detected between their score and baseline QTc, or any subsequent prolongation. We found no association between hospitalisation due to infection and prolongation of the QTc interval.

Fragmented QRS in prediction of ischemic heart disease diagnosed by stress cardiovascular magnetic resonance imaging.

BackgroundIn patients with ischemic heart disease (IHD), many studies demonstrated an association between fragmented QRS complex (fQRS) on 12‐lead ECG and myocardial scar, heart failure, and increased mortality. However, data in adults without history of IHD is limited. We aimed to evaluate whether there is an association between fQRS and IHD diagnosed by stress cardiac MRI.MethodWe retrospectively reviewed demographic data, 12‐lead ECG, and stress cardiac MRI data from 604 patients. Fragmented QRS was defined as the presence of additional R wave (R’), notching in the nadir of R or S wave, or the presence of more than one R’ in any ECG leads. Both cardiac MRI and ECG were analyzed by two independent observers.ResultFinal analysis included 554 patients, 39% were male, with a mean age of 67.8 ± 11.1 years. There was positive stress cardiac MRI in 219 patients (39.5%). Older age, diabetes mellitus, and hypertension were more frequent in the positive group (p < .05). fQRS was identified in 300 patients (54.2%). Baseline characteristic did not differ significantly between patients with and without fQRS. There is an association between fQRS and IHD, OR 1.605 (95% CI 1.14–2.27), p = .007. After adjustment for age, diabetes, hypertension, renal function, and left ventricular ejection fraction, the strong association between fQRS and IHD persisted, OR 1.71 (95% CI 1.18–2.47), p = .004.ConclusionIn patients without known history of coronary artery disease, fragmented QRS is independently associated with ischemic heart disease diagnosed by stress cardiac MRI.

P251 Fragmented QRS in prediction of ischemic heart disease diagnosed by stress cardiovascular magnetic resonance imaging

Abstract Funding Acknowledgements None Background Fragmented QRS complex (fQRS) on 12-lead EKG is not uncommon in general population. Previous studies found an association between fQRS and myocardial scar, heart failure, and increased cardiac mortality. However, data in adults without history of coronary artery disease is limited. We aimed to evaluate whether there is an association between fQRS and ischemic heart disease (IHD) diagnosed by stress cardiac MRI. Method We retrospectively reviewed data from 604 patients who underwent stress cardiac MRI, in which 50 patients were excluded due to known history of coronary artery disease or incomplete stress test. A positive result was defined as stress-induced perfusion defect in at least 2 contiguous myocardial segments corresponding to epicardial coronary territory, or a presence of ischemic scar. The 12-lead EKG done on the same day with MRI, prior to stress testing, were analyzed. Fragmented QRS was defined as the presence of additional R wave (R’), notching in the nadir of R or S wave, or the presence of more than one R’ in any EKG leads. Both cardiac MRI and EKG were analyzed by two independent observers. Result Final analysis included 554 patients, 39% were male, with a mean age of 67.8 ± 11.1 years. There was positive stress cardiac MRI in 219 patients (39.5%). Older age, diabetes mellitus, and hypertension were more frequent in the positive group (p &amp;lt;0.05). fQRS was identified in 300 patients (54.2%). Baseline characteristic did not differ significantly between patients with and without fQRS. There is an association between fQRS and IHD, OR 1.605 (95% CI 1.136-2.269), p = 0.007. Using linear regression, the number of leads with presence of fQRS showed an association with IHD (OR 1.204, p = 0.005). After adjustment for age, diabetes, hypertension, renal function, and left ventricular ejection fraction, the strong association between fQRS and IHD persisted, OR 1.709 (95% CI 1.182-2.470), p = 0.004. Conclusion In patients without known history of coronary artery disease, fragmented QRS is independently associated with ischemic heart disease diagnosed by stress cardiac MRI. Multiple regression analysis OR 95% CI p-value Age (years) 1.013 0.992 - 1.035 0.234 Diabetes mellitus 1.532 1.032 - 2.274 0.034 Hypertension 1.194 0.737 - 1.935 0.471 GFR (ml/min/1.73m&amp;sup2;) 0.999 0.987 - 1.011 0.904 LV ejection fraction (%) 0.972 0.950 - 0.994 0.014 fragmented QRS 1.709 1.182 - 2.470 0.004

Elaboration of New Medical Technology for Predicting the Risk of Ischemic Heart Disease in the Workers of the Coal Industry

Background. Ischemic heart disease is the leading cause of death in the majority of developed countries, including Russia. It determines the importance of elaboration of individual risk prediction of ischemic heart disease for primary prevention.Aim: to develop a strategy for predicting the ischemic heart disease in coal industry workers.Materials and methods. Ischemic heart disease incidence and its risk factors were studied in 196 coalmine workers (sinkers, stope miners). Rose Questionnaire, daily ECG monitoring and bicycle ergometry were used to detect angina. The indices of lipid metabolism, hemostatic system, the level of homocysteine, uric acid, C-reactive protein, constitutional-morphological type by Rees – Eysenck, genetic markers of blood groups of AB0, P and MN systems were studied.When elaborating the prognostic system, we used the Bayes method. A prognostic coefficient was calculated for each factor. Prediction of ischemic heart disease was carried out according to the sum of prognostic coefficients.Results. Ischemic heart disease was detected in 18 (9.2 %) miners. According to the above mentioned indices, a medical technology was elaborated to predict the ischemic heart disease, based on the determination of the most significant risk markers: age, work experience in harmful working conditions, type A behavior, arterial hypertension, fasting hyperglycemia, metabolic syndrome, hypercholesterolemia, decrease in the level of high density lipoprotein cholesterol, increase in the value of low density lipoprotein cholesterol, hypertriglyceridemia, hyperhomocysteinemia, hyperfibrinogenemia, increase in the level of soluble fibrin monomer complexes and C-reactive protein, abdominal obesity, hypersthenic constitutional-morphological type by Rees – Eysenck, genetic markers of blood groups of AB0, P and MN systems.Conclusion. Based on the most significant markers, a personalized strategy for ischemic heart disease prediction in miners was elaborated, which allowed timely undertaking therapeutic and preventive measures.

Carotid plaque and type 2 diabetes mellitus

Atherosclerosis is the basic cause of macrovasular complications of diabetes mellitus. It affects all parts of the circulatory tree. An easy and reliable method of diagnosing atherosclerosis is Carotid Doppler ultrasonography. Increased Carotid Intima-Medial thickness (CIMT) and presence of carotid plaque is an important predictor of ischemic heart disease and cerebrovascular accidents. The purpose of this study was to find the association of carotid plaque with cardio-metabolic risk factors in type 2 diabetes mellitus. Study Design: Cross-sectional study. Setting: Medical Out-patient Department of Creek General Hospital, Karachi. Period: One year from June 2015 to May 2016. Subjects and Methods: The study population included 119 cases of type 2 diabetes mellitus. All subjects underwent Carotid Doppler ultrasonography. The demographic, anthropometric, clinical and laboratory data was collected and analyzed through SPSS ver.20.0. The relationship of carotid plaque with different atherosclerotic variables was assessed by Student’s t-test and Chi-square test. P-value of &lt;0.5 was considered significant. Results: Out of 119 patients with type 2 diabetes mellitus, 18.5% had a carotid plaque. The presence of plaque was associated with duration of diabetes, presence of hypertension, BMI, diastolic blood pressure, total cholesterol, triglyceride levels and CIMT. Conclusion: We need to focus on management of the multiple metabolic abnormalities associated with diabetes mellitus in order to prevent atherosclerosis and its associated cardiovascular disease.

A machine learning-based approach for predicting the outbreak of cardiovascular diseases in patients on dialysis

Background and Objective: Patients with End- Stage Kidney Disease (ESKD) have a unique cardiovascular risk. This study aims at predicting, with a certain precision, death and cardiovascular diseases in dialysis patients.Methods: To achieve our aim, machine learning techniques have been used. Two datasets have been taken into consideration: the first is an Italian dataset obtained from the Istituto di Fisiologia Clinica of Consiglio Nazionale delle Ricerche of Reggio Calabria; the second is an American dataset provided by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) repository. From each one we obtained 5 datasets, according to the outcome of interest. We tested different types of algorithm (both linear and non-linear), but the final choice was to use Support Vector Machine. In particular, we obtained the best performances using the non-linear SVC with RBF kernel algorithm, optimizing it with GridSearch. The last is an algorithm useful to search the best combination of hyper-parameters (in our case, to find the best couple (C, γ)), in order to improve the accuracy of the algorithm.Results: The use of non-linear SVC with RBF kernel algorithm, optimized with GridSearch, allowed to obtain an accuracy of 95.25% in the Italian dataset and of 92.15% in the American dataset, in a timeframe of 2.5 years,in the prediction of Ischaemic Heart Disease. A worse performance was obtained for the other outcomes.Conclusions: The machine learning-based approach applied in our study is able to predict, with a high accuracy, the outbreak of cardiovascular diseases in patients on dialysis.

ST/HR variables in firefighter exercise ECG - relation to ischemic heart disease.

Exercise electrocardiography (ExECG) is regularly performed by Swedish firefighters by law. Heart rate‐corrected analysis of ST segment variables (ST/HR) has shown improved prediction of ischemic heart disease (IHD) compared to ST depression alone. This has not previously been extensively studied in asymptomatic persons with a low probability of IHD. We therefore evaluated the predictive performance of ST/HR analysis in firefighter ExECG. ExECG was studied in 521 male firefighters. During 8.4 ± 2.1 years, 2.3% (n = 12) were verified with IHD by catheterization or myocardial scintigraphy (age 51.5 ± 5.5 years) and were compared with firefighters without imaging proof of IHD (44.2 ± 10.1 years). The predictive value of ST depression, ST/HR index, ST/HR slope, and area and rotation of the ST/HR loop was calculated as age‐adjusted odds ratios (OR), in 10 ECG leads. Predictive accuracy was analyzed with receiver operating characteristics (ROC) analysis. ST/HR index ≤−1.6 μV/bpm and ST/HR slope ≤−2.4 μV/bpm were associated with increased IHD risk in three individual leads (all OR > 1.0, P < 0.05). ST/HR loop area lower than the fifth percentile of non‐IHD subjects indicated IHD risk in V4, V5, aVF, II, and –aVR (P < 0.05). ST depression ≤−0.1 mV was associated with IHD only in V4 (OR, 9.6, CI, 2.3‐40.0). ROC analysis of each of these variables yielded areas under the curve of 0.72 or lower for all variables and leads. Clockwise‐rotated ST/HR loops was associated with increased risk in most leads compared to counterclockwise rotation. The limited clinical value of ExECG in low‐risk populations was emphasized, but if performed, ST/HR analysis should probably be given more importance.

Serum vaspin: as a predictor of ischemic heart disease in Egyptian hemodialysis patients

BackgroundVaspin is a compensatory adipokine with anti-inflammatory properties that can improve insulin sensitivity and plays a cardioprotective role.AimThe aim of this study was to evaluate the level of vaspin in patients with end-stage renal disease on hemodialysis (HD) and to determine whether it has any relation to the presence of ischemic heart disease (IHD) in these patients.Patients and methodsThe study was carried out on 45 HD patients who were divided into 15 patients with risk factors of developing IHD (group I) and 30 patients (group II) proved to have IHD by echocardiography and ECG compared with 20 healthy individuals (group III).ResultsWe found that the mean±SD of serum vaspin was significantly lower in HD patients with IHD (0.57±0.27) ng/ml compared with the control group (0.74±0.20) ng/ml and there was a negative correlation between serum vaspin and serum creatinine in group I and group II. Also, an receiver operating characteristics study for patients with IHD (group II) yielded a vaspin cut-off value of 0.410 ng/ml with a sensitivity of 40%, a specificity of 100%, a positive predictive value of 100%, and an negative predictive value of 53%, whereas the cut-off value for serum vaspin was 0.485 ng/ ml in patients at risk of developing IHD, with a sensitivity of 100%, a specificity of 85%, a positive predictive value of 83%, and an negative predictive value of 100%.ConclusionLower vaspin level is associated independently with IHD in HD patients and can be used as a predictor of IHD in patients with end-stage renal disease.

Prediction of Ischemic Heart Disease and Stroke in Survivors of Childhood Cancer.

Purpose We aimed to predict individual risk of ischemic heart disease and stroke in 5-year survivors of childhood cancer. Patients and Methods Participants in the Childhood Cancer Survivor Study (CCSS; n = 13,060) were observed through age 50 years for the development of ischemic heart disease and stroke. Siblings (n = 4,023) established the baseline population risk. Piecewise exponential models with backward selection estimated the relationships between potential predictors and each outcome. The St Jude Lifetime Cohort Study (n = 1,842) and the Emma Children's Hospital cohort (n = 1,362) were used to validate the CCSS models. Results Ischemic heart disease and stroke occurred in 265 and 295 CCSS participants, respectively. Risk scores based on a standard prediction model that included sex, chemotherapy, and radiotherapy (cranial, neck, and chest) exposures achieved an area under the curve and concordance statistic of 0.70 and 0.70 for ischemic heart disease and 0.63 and 0.66 for stroke, respectively. Validation cohort area under the curve and concordance statistics ranged from 0.66 to 0.67 for ischemic heart disease and 0.68 to 0.72 for stroke. Risk scores were collapsed to form statistically distinct low-, moderate-, and high-risk groups. The cumulative incidences at age 50 years among CCSS low-risk groups were < 5%, compared with approximately 20% for high-risk groups ( P < .001); cumulative incidence was only 1% for siblings ( P < .001 v low-risk survivors). Conclusion Information available to clinicians soon after completion of childhood cancer therapy can predict individual risk for subsequent ischemic heart disease and stroke with reasonable accuracy and discrimination through age 50 years. These models provide a framework on which to base future screening strategies and interventions.

The association between insulin resistance, metabolic syndrome, and ischemic heart disease among Rumoi residents.

BackgroundIt has widely been proven that metabolic syndrome (MetS) increases the risk of ischemic heart disease (IHD). MetS is confirmed based upon insulin resistance (IR). Our aim of this study is to evaluate the role of MetS and IR in the prediction of IHD incidence.MethodsA total of 404 non‐diabetic participants who underwent 75 g oral glucose tolerance test (75 g OGTT) were enrolled from 2001 to 2009. Risk factors for IHD were measured as well. The homeostatic index of IR (HOMA‐IR) and the homeostatic model assessment beta cell function (HOMA‐β) were calculated according to the homeostasis model assessment. Cox proportional‐hazard regression model was used to estimate hazard ratio (HR). All data were analyzed using SPSS 21 software (IBM, Armonk, NY, USA).ResultsIn our study, the average follow‐up period was 6.7 years. Eighteen subjects of IHD incidence were recorded. After adjusting for age and sex, subjects with IR or hyperinsulinemia had a high risk of IHD, the hazard ratio (95% confidence intervals) for IHD were 4.58 (1.59‐13.15), 4.25 (1.64‐11.91), respectively. The highest hazard ratio was 7.56 (2.27‐25.18) which was found among the subjects with both IR and hyperinsulinemia. In addition, the hazard ratio (95% confidence intervals) of subjects with MetS was 2.80(1.10‐7.09).Conclusions IR and hyperinsulinemia are related to the risk of IHD. IR combined with hyperinsulinemia may be superior to MetS for predicting the IHD incidence.

Abstract WP219: The Relationship of Low-Density Lipoprotein (LDL) Particle Number (LDL-P) and LDL Particle Size and Incident Stroke Events: The Multi-Ethnic Study of Atherosclerosis

Background &amp; Objectives: The role of lipid and lipoprotein biomarkers in risk prediction of ischemic heart disease is well established, but their value as independent predictors for ischemic stroke is less certain. Certain LDL subclasses based on particle sizes are associated with atherosclerotic risk. However, there is little information available on the relation of LDL particle number (LDL-P, nmol/L), LDL particle size (nm) with stroke. We evaluated associations between LDL-P and LDL particle size with the risk of ischemic stroke (IS) and transient ischemic attack (TIA). Methods: We studied US adults aged of 45-84 years not on lipid-lowering medications enrolled in the Multi-Ethnic Study of Atherosclerosis between 2000 and 2002 with follow-up through December 2011. We evaluated associations of LDL-P (total LDL-P, large LDL-P and small LDL-P) and LDL particle size measured by NMR with, (1) composite of incident IS and TIA, and (2) IS alone. Standardized hazard ratios (HRs) were adjusted for age, sex, race (model 1), plus diabetes, hypertension medication, systolic and diastolic blood pressure, family history, smoking, HDL (model 2), and plus LDL concentration (model 3). Results: We identified 129 subjects with incident IS, 61 with TIA and 5,328 without any type of stroke during follow-up; mean ages were 67.4, 66.7 and 61.2 years, respectively (p&lt;0.0001). White ethnicity was 37.2%, 42.6% and 37.6%), respectively. For the composite outcome of IS and TIA, while small LDL-P (HR 1.20, 95%CI 1.04 to 1.39) was predictive in model 1, this was attenuated after additional adjustment in models 2 and 3. For the outcome of IS alone, total LDL-P (HR 1.25, 95% CI 1.06 to 1.48) and small LDL-P (HR 1.34, 95% CI 1.13 to 1.60) were associated with incident IS in model 1, but there was no significant association of large LDL-P or LDL size with IS. Only small LDL-P remained predictive of IS in model 2 (HR 1.32, 95% CI 1.05 to 1.65) and in model 3 (HR 1.31, 95% CI 1.03 to 1.67). Conclusions: Increased small LDL-P, not particle size, is most closely associated with incident IS and could be useful in risk stratification beyond standard risk factors and lipid measures.

Эректильная дисфункция как ранний предиктор ишемической болезни сердца

Эректильная дисфункция как ранний предиктор ишемической болезни сердца