Proven Coronary Artery Disease Research Articles

Patients with Coronary Heart Disease with Lipid Profile

Background: The lipid profile and their ratio are important in management and follow up of patients with coronary heart disease. We studied the lipid profile and their ratios with proven coronary artery disease. Methods: It was retrospective study to determine the lipid profile and their ratios in patients with proven coronary artery disease at Shakuntala Pathology Lab., Nagpur. 200 patients were studied. Results: Out of 200 patients studied, 126 (63%) were males while 74 (37%) were females. out of 126 males,12 (9.52%) had raised cholesterol values of >200 mg/dL. 20 (15.87%) had raised triglyceride values of >200 mg/dL. 30 (23.80%) had lower HDL values of 150 mg/dL. 90 (71.42%) had raised values of >3.5 for cholesterol to HDL ratio. Out of 74 female patients, 20 (27.02%) patients had raised cholesterol values. 12 (16.21%) patients had raised triglycerides values. 13 (17.56%) patients had lower HDL values. 6 (8.10%) patients had raised LDL values. 50 (67.56%) patients had raised values for cholesterol to HDL ratio. Conclusions: Our study shows more prevalence of coronary heart disease in males than females. Hypercholesteremia and hypertriglyceridemia was more prevalent in females. HDL values were lowered in more number of males than females. LDL values were raised in more number of females than males. Total cholesterol to HDL ratio was raised in more number of males than females.

MARKED INCREASES IN PROXIMAL AORTIC CHARACTERISTIC IMPEDANCE AND HENCE FORWARD WAVE PRESSURES BEYOND BRACHIAL BLOOD PRESSURE IN ANGIOGRAPHIC PROVEN CORONARY ARTERY DISEASE

Objective: Although indexes of aortic stiffness increase the risk for coronary artery disease (CAD), the extent to which proximal aortic stiffness increases enhance central arterial forward wave pressures beyond changes in peripheral pressures, is uncertain. We aimed to determine whether increases in proximal aortic stiffness, as indexed by aortic characteristic impedance (Zc) translate into an enhanced central arterial pressure for a given brachial BP. Design and method: From central pressure, aortic velocity and outflow tract diameter measurements and echocardiography, we determined Zc and arterial pressure wave morphology in 71 patients with angiographic proven CAD and all other cardiac pathology excluded. We compared central arterial function in these patients with 230 age and sex-matched controls from a community study, and in patients with stroke and CLI (n = 287) diagnosed in a hospital setting. Results: Adjusting for confounders, including mean arterial pressure, and aortic root diameter, as compared to controls, both Zc and the pressures generated by the product of peak aortic flow (Q) and Zc (PQxZc) were markedly increased in patients with CAD (p<0.0001) and those with stroke or CLI (p<0.005). Moreover, compared to patients with stroke and CLI, those with CAD also had marked increases in both Zc and PQxZc (p<0.0001). Consequently, with adjustments for the same confounders, pressures generated by forward wave pressures (Pf) were markedly increased in patients with CAD as compared to controls and to patients with alternative arterial diseases (p<0.0001). Importantly, after further adjustments for brachial PP or SBP, the higher Pf values in patients with CAD were retained (p<0.005 to <0.0001). However, with adjustments for brachial SBP and confounders, central aortic PP did not differ between groups. Conclusions: Independent of confounders and aortic root diameter, a marked increase in proximal aortic Zc occurs in patients with CAD as compared to both controls and patients with arterial disease in alternative beds. This translates into a greater central arterial pulsatile load determined by forward travelling pressure waves, but not peak central PP than that predicted by brachial BP measurements. These data support a need for intense brachial BP lowering in CAD.

Significance of Beta-Blocker in Patients with Hypertensive Left Ventricular Hypertrophy and Myocardial Ischemia.

Arterial Hypertension (HTN) is a key risk factor for left ventricular hypertrophy (LVH) and a cause of ischemic heart disease (IHD). The association between myocardial ischemia and HTN LVH is strong because myocardial ischemia can occur in HTN LVH even in the absence of significant stenoses of epicardial coronary arteries. To analyze pathophysiological characteristics/co-morbidities precipitating myocardial ischemia in patients with HTN LVH and provide a rationale for recommending beta-blockers (BBs) to prevent/treat ischemia in LVH. We searched PubMed, SCOPUS, PubMed, Elsevier, Springer Verlag, and Google Scholar for review articles and guidelines on hypertension from 01/01/2000 until 01/05/2022. The search was limited to publications written in English. HTN LVH worsens ischemia in coronary artery disease (CAD) patients. Even without obstructive CAD, several pathophysiological mechanisms in HTN LVH can lead to myocardial ischemia. In the same guidelines that recommend BBs for patients with HTN and CAD, we could not find a single recommendation for BBs in patients with HTN LVH but without proven CAD. There are several reasons for the proposal of using some BBs to control ischemia in patients with HTN and LVH (even in the absence of obstructive CAD). Some BBs ought to be considered to prevent/treat ischemia in patients with HTN LVH (even in the absence of obstructive CAD). Furthermore, LVH and ischemic events are important causes of ventricular tachycardia, ventricular fibrillation, and sudden cardiac death; these events are another reason for recommending certain BBs for HTN LVH.

Antioxidant activity in off and on-pump coronary artery bypass grafting and valve replacement surgery.

Cardiac surgeries initiate oxidative stress, increasing organ dysfunction development and mortality. The present study investigated the superoxide dismutase (SOD) activity, as an antioxidant enzyme, in patients undergoing coronary artery bypass (CABG) and heart valve replacement surgeries. A prospective study was performed on patients with proven coronary artery disease (CAD) or valvular heart disease (VHD) candidates for on- or off-pump CABG andvalve replacement surgery. Serum SOD activity was measured preoperatively, at 24h postoperatively, and at thetime of discharge. In addition, echocardiography was performed before surgery and at discharge. A total of 48, 51, and 47 patients were enrolled in theon-pump, off-pump CABG, and valve replacement groups, respectively. Baseline serum SOD activity showed no significant association with BMI, age, and blood pressure in either CAD or VHD patients. The SOD values decreased at the 24h postoperative time and then increased at the time of discharge in all groups, except for a slight decrease in the on-pump group. The changes in serum SOD values were not significantly different for the three surgical groups. The serum SOD activities fell significantly after CABG and valve replacement surgery. Further investigation is emphasized for the role of SOD in oxidative stress after cardiac surgery.

Comparison of serum copper levels between coronary artery disease patients and normal individuals: a case-control study

Cardiovascular diseases (CVD) are the leading causes of death in technologically developed and developing countries. Copper, an active redox element, is involved in energy production through various mechanisms. Copper and coronary artery disease can be associated directly, through its direct effect on the vascular endothelium, or indirectly through lipoprotein metabolism. Hence an evaluation of copper in the coronary artery disease individual is important.
 The aim is to compare the relationship of serum copper levels between coronary artery disease patients and control individuals based on age, sex, hypertension and diabetes mellitus.
 Materials and methods: The study design was a case-control study in which proven coronary artery disease patients attending cardiology OPD were selected as cases. Control individuals were mainly selected from the master health check-up. Serum copper levels, plasma glucose, cholesterol, serum triglycerides, and serum HDL & LDL cholesterol were done. Glycated haemoglobin (HbA1C) was also measured. The data were analyzed using IBM SPSS software version 24.
 Result: The correlation of serum copper level with other quantitative parameters is determined by calculating Pearson’s correlation coefficient among cases and controls.
 Conclusion: The serum copper level is significantly (p=0.001) higher in CAD patients than in age, sex, DM, and HT-matched controls. The serum copper level has a significant (p=0.001) effect on disease, and the adjusted odds ratio is 1.032 (CI 1.011–1.054). In addition, the serum copper level has a significant (0.01) negative correlation with LDL cholesterol and total cholesterol.

The Prevalence of Obstructive Airway Disease by Spirometric Indices in Nonsmoker Patients with Catheter-Diagnosed Coronary Artery Disease

Aim: The aim of this study was to assess the prevalence of obstructive airway disease (OAD) in coronary artery disease (CAD) patient's using spirometric indices. Patients and Methods: The prospective study was conducted between June 2014 and June 2015. Patients admitted to the intensive coronary care unit having a proven diagnosis of CAD (single or multiple vessel disease) on coronary angiography were undergone spirometry examination. Results: This study included a total of 80 patients of proven CAD. Sixty-one patients were male and 19 were female. The mean age of the cases was 59.29 years. In our study, 37.5% had triple-vessel disease, 33.8% had double-vessel disease, and remaining 28.8% had single-vessel disease. Eighteen patients (22.5%) were found to have OAD. On comparison of severity of OAD with the severity of CAD, no statistically significant association was found. Conclusion: It is imperative to carry out inexpensive investigations such as spirometry in all the patients with CAD so that both the conditions can be managed adequately with better outcomes.

Pengukuran Penyakit Arteri Koroner Dengan Menggunakan Ankle-Brachial Index (ABI)

Background: Coronary artery disease (CAD) is the main cause of death in the world. In this study we assessed the ankle-brachial index (ABI) as a screening tool for CAD. Methods: Between 2020 and 2023, a large population-based cross-sectional study was conducted on 4,207 new patients referred to Harapan Kita Hospital. The patients underwent selective coronary angiography via a radial artery approach. ABI was calculated for all patients. Researchers compared ABI with coronary angiography results to determine the specificity and sensitivity of ABI as a screening tool. Results: Abnormal ABI was significantly more common in patients with proven severe CAD (893, 54.8%) than in patients with proven mild CAD (33, 4.7%) or no CAD (94, 5.3% ). The specificity of the ABI was 95.3% and the sensitivity was 54.8%. ABI is associated with risk factors such as smoking, male gender, hypertension, diabetes mellitus and dyslipidemia. Conclusion: ABI can be used as a screening test to prevent CAD with a specificity of 95.3%. We need to consider risk factors other than ABI to improve screening sensitivity. Multidimensional scoring systems should consider risk factors and other noninvasive tests in addition to ABI to develop an ideal screening system for CAD

Serum esterified cholesterol subfractions as a risk marker for coronary artery disease

Objectives: The aim of this study was to evaluate the total esterified cholesterol and non-HDL esterified cholesterol as a risk marker for coronary artery disease and compare it with the classical risk factors. Methods: Fifty-six patients with proven coronary artery disease as assessed by angiography and 40 healthy controls were subjects for study. Total esterified cholesterol, Non-HDL esterified cholesterol and the classic lipid profile parameters were measured for both groups. Results: Total Esterified Cholesterol was not found to be significantly associated with CAD. However Non-HDL esterified cholesterol was found to be having statistically significant association. Using Receiver Operator Characteristics (ROC) Curve it was found that Non-HDL esterified cholesterol at a cut off value of 107mg/dl, has a sensitivity of 57% and specificity of 66.6%, as a risk marker for the coronary artery disease. Conclusion: Evaluation of coronary artery disease by measuring esterified cholesterol fraction of Non-HDL cholesterol may help in risk assessment and will provide more data to understand the mechanisms of cholesterol homeostasis.

The value of microRNA-122 in the diagnosis of coronary heart disease

Abstract Funding Acknowledgements Type of funding sources: None. Background. Patients with ischemic heart diseases form the majority group of cardiac diseases. Studies on the roles and mechanisms of microRNAs taking part in cardiac pathophysiology have become the focus of research worldwide. Purpose. To elucidate whether microRNAs could be markers of atherosclerotic lesions, and further explore the mechanism of microRNAs in ischemic heart diseases. Methods. In general, 40 patients were investigated in our Clinic. Blood tests, echocardiography (with two-dimensional speckle tracking echocardiography), ECG, coronary angiograms, microRNA detection were conducted. The patients were divided into two groups, i.e., a control group (Group A) without atherosclerotic lesion and a group with proven coronary artery disease (Group В). The data were analyzed using SPSS Statistics 20.0 Results. According to the level of circulating microRNA, a significant association between miR-122 and coronary artery lesion was identified (р=0.033). The results are shown in Figure 1. Besides, the positive moderate correlation was also revealed (r= 0.337, р=0.036). These data show miR-122 as a robust biomarker for predicting atherosclerosis lesions, and it plays certain role in pathogenesis of atherosclerosis. Conclusion. Particularly, microRNA-122 fulfils the criteria of good biomarkers due to their key-role in severity assessment. The correlation between obtained coronary artery lesion results and epigenetic markers was found. The circulating microRNA has also improved the predictive power for diagnostics of ischemic heart disease, which is crucially important for patients and possible biochemical markers for control of treatment. Abstract Figure.

Ankle-Brachial Index: A Simple and Inexpensive Screening Test for Coronary Artery Disease (ABI goes beyond the foot)

Background: Coronary artery disease (CAD) is the leading cause of death in the world. In this study we assessed ankle-brachial index (ABI) as a screening tool for CAD. Method: Between 2019 and 2020, large cross-sectional population-based study of 4207 new patients referred to cardiovascular Clinic was enrolled. The patients underwent selective coronary angiography via radial artery approach. ABI was calculated for all patients. We compared ABI with the results of coronary angiography to determine the specificity and sensitivity of ABI as a screening tool for CAD. Results: Abnormal ABI was significantly more frequent in patients with proven severe CAD (893, 54.8%) than in patients with proven mild CAD (33, 4.7%) or no CAD (94, 5.3%). The specificity of ABI was 95.3%, and its sensitivity was 54.8%. ABI was associated with risk factors such as smoking, male gender, hypertension, diabetes mellitus and dyslipidemia. Conclusion: ABI can be used as a screening test to rule out CAD with 95.3% specificity. We need to consider risk factors other than ABI to increase screening sensitivity. A multidimensional scoring system should consider risk factors and other noninvasive tests in addition to ABI to develop and ideal screening system for CA. (Clinical trial registration number NCT04667832)

Assessment of exercise training program effects on ischemia modified albumin serum levels by 4 different laboratory methods

Abstract Background Ischemia modified albumin (IMA) is an FDA approved marker of ischemia that is produced when serum albumin contacts ischemic tissues. Albumin modification reduces its binding affinity to heavy metal ions such as Cobalt and can be measured by the albumin cobalt binding (ACB) assay and with an enzyme-linked immunosorbent assay (Elisa) for N-terminal-modified Albumin as well. A transient increase in albumin levels at peak exercise due to hemoconcentration is frequently found with resultant decrease in the non-bound portion of cobalt, therefore the ratio IMA/Albumin is often tested as well after exercise. Aim To evaluate the effect of 12 weeks exercise training program on IMA levels in patients with proven coronary artery disease (CAD), by four different laboratory methods. Methods 40 patients were enrolled to study, with either a recent (<1 month) myocardial infarction (MI), percutaneous coronary intervention (PCI), or an aorto-coronary by-pass surgery (CABG). All underwent a 12 weeks aerobic exercise program, 50 minutes sessions, 3–4/week, at 75–80% of their maximal exercise test (EXT) heart rate. IMA assessment was done with the ELISA and the ACB assay, IMA-Elisa/Serum Albumin, and ACB-IMA/Serum Albumin ratios, pre and post EXT, at baseline (BL-EXT1 & 2), and at end program (EP-EXT1&2). The Generalized Linear Mixed Model (GLMM) was used to determine the intervention time effect, for the time variant exercise measures and for time invariant measures (age, gender, risk factors, EF%). Results In three out of the four methods a time effect (program effect) was found, EP-EXT2 IMA levels were lower than BL-EXT2 (ACB = p<0.01; ACB/ALB = p<0.01; IMA/ALB = p<0.05), meaning a beneficial effect of exercise program. In post CABG patients, the IMA-ELISA levels were higher only at BL, p<0.05. When PCI was applied, only ACB/ALB ratio was lower, p<0.001. Exercise duration and METS had similar effect, reducing only ACB/ALB ratio, p<0.01 & p<0.05 respectively. The only time invariant measurement that proved to have an effect on IMA was the %EF, as detected only by the IMA-Elisa method and by the IMA-Elisa/Albumin ratio along the intervention program time, p<0.05 & p<0.05, respectively. EF% was negatively associated with these outcome differences, the lower the EF%, the higher was the IMA level. When EXT was diagnosed positive for of ischemia, then a positive association with the ΔIMA-ACB levels (p<0.05) was found. Conclusions Exercise training program effects on IMA levels in chronic IHD patients could be detected by the accepted IMA laboratory tests however when time variant and time invariant measures were analyzed with the use of one or two methods only several program effects could have been missed. The inclusion of the two IMA/Albumin ratios using the same blood samples offered additional important information. Funding Acknowledgement Type of funding sources: None.

Serum Vitamin D Level in Patients Undergoing Coronary Artery Catheterization

Background: Vitamin D deficiency may be a risk factor for coronary artery disease (CAD). We aimed to measure the prevalence of vitamin D deficiency in CAD and its association with severity of angiographic proven CAD.
 Methods: This prospective, cross-sectional study included 106 consecutive patients who were admitted for typical angina and had signs of myocardial injury (ECG findings and/ or elevated troponin I or CK-MB) and who underwent coronary angiography at the university hospital of BPKIHS from August 2020 to April 2021. Patients were categorized into angiographic proven CAD group and angiographic normal coronary artery group. Serum vitamin D level was classified as normal (≥ 30 ng/ml) and deficiency (< 30 ng/ml).
 Results: Out of 106 patients, 78 patients (73.6%) had vitamin D deficiency and 28 (26.4%) had normal vitamin D level (p = 0.39). Vitamin D level (mean ± SD) in patients with angiographic normal coronary artery and angiographic proven CAD were 25.94 ± 11.63 ng/ml and 26.07 ± 12.90 ng/ml respectively (p = 0.97). Prevalence of vitamin D deficiency was 75.0% and 64.3% in significant CAD group and normal coronary artery group respectively (p = 0.39). Similarly, frequency of vitamin D deficiency were 68.6%, 78.3% and 88.90% in single, double, and triple vessel disease respectively (p = 0.21). The vitamin D level (mean ± SD) in single, double and triple vessel disease were 27.31 ± 14.02 ng/ml, 25.69 ± 12.72 ng/ml, 23.08 ± 9.45 ng/ml respectively.
 Conclusion: The prevalence of vitamin D deficiency in both angiographic normal coronary artery and angiographic proven CAD were high but comparable. There was no association of vitamin D deficiency with severity of angiographic proven CAD.

Role for PARS and Thrombin-Gpibα Interaction for Thrombin Induced Procoagulant Platelet Formation

Procoagulant platelets, a subpopulation of platelets which support thrombin generation, play a role in regulating pathological thrombosis. Using a novel flow cytometry assay (Hua et at, Blood 2015) to identify procoagulant platelets based upon the cell death marker GSAO and activation marker P-selectin, we found that patients with angiogram proven coronary artery disease had heightened thrombin procoagulant platelet formation compared to healthy controls, (25.2% vs 12.2%, p<0.001). Inhibition of this is an attractive target for atherothrombosis prevention. However, the mechanism of thrombin induced procoagulant platelet formation remains controversial with discrepant results regarding requirement for the thrombin binding domain of N terminal GPIbα (Dorman et al, Blood 2000 and Ravanat et al, Blood 2010) and recent reports implicating PAR4 (French et al JTH, 2016). Here we use a recently described novel assay to investigate the roles of PARs and GPIbα measuring procoagulant platelets by FACS (GSAO+/P-selectin+) in whole blood, plasma and washed platelets after treatment with heparin, PAR and GPIbα inhibitors prior to thrombin or PAR agonist stimulation.First, using active site inhibited PPACK-thrombin we demonstrated that catalytically active thrombin is required for procoagulant platelet formation in our in vitro system. PAR1 and PAR4 are implicated in procoagulant platelet formation, however, preincubation with combination of PAR1 and PAR 4 inhibitors (vorapaxar and a PAR4 polyclonal inhibitory antibody), resulted in only partial inhibition of thrombin induced procoagulant platelets (reduction 40%±5.7%, p<0.01) suggesting a role for an additional non-PAR pathway. Thrombin-GPIbα interaction was implied when competition studies with recombinant soluble GPIbα, glycocalicin showed a 49%±7.7% reduction. Involvement of the N-terminus of GPIbα was confirmed by a 39.5%±2.9% reduction after cleavage of GPIbα proximal to the thrombin binding site by NK protease. Pretreatment with PAR1 inhibitor after NK protease cleavage of GPIbα reduced thrombin stimulated procoagulant platelet formation to unstimulated levels implying both PAR cleavage and GPIbα-thrombin interaction is required for thrombin induced procoagulant platelet formation.Consistent with a role of thrombin-GPIbα interaction, we noted a reduction in thrombin induced procoagulant platelets after heparin bolus in patients undergoing coronary angiogram (16.3±10.5% vs 6.1%±2.4%, p<0.001). Heparin is known to known to displace thrombin from GPIbα in addition to anti-thrombin effects via enhancement of antithrombin (AT). Using platelets resuspended in AT-deficient plasma, we demonstrated high dose heparin suppressed procoagulant platelet formation via an AT-independent mechanism, this was confirmed by heparin suppression of thrombin induced procoagulant platelets in washed platelets. In similar experiments, the heparinoid danaparoid, which has no anti-thrombin effect, also inhibited thrombin induced procoagulant platelet formation. Heparin inhibition was not due to PAR inhibition as heparin had no effect on direct PAR activation by PAR1 agonist TRAP or PAR4 agonist AYPGKF. These data suggest heparin has a direct effect on platelets in suppression of thrombin induced procoagulant platelet formation, most likely relating to displacement of thrombin from GPIbα.Together this data indicates that a thrombin-GPIbα interaction via the N terminal fragment is required in addition to thrombin mediated PAR activation. This mechanism is a potential target for modifying atherothrombotic risk.Figure 1: Whole blood was treated with PAR1 and PAR4 inhibitors and washed platelets were treated with glycocalicin, NK protease or NK and PAR1 inhibitor prior to thrombin stimulation (2 U/mL). Data are expressed as fold change from vehicle control ((*p<0.05; **p<0.01, statistics are calculated for n≥3). Figure 2: Plasma, washed platelets or whole blood were treated or not with heparin (12.8 U/ml) prior to thrombin stimulation (2 U/mL), PAR1 (20 µM) or PAR4 (300 µM) agonists. Data are expressed as the ratio of heparin-treated sample to untreated (***p<0.001, statistics are calculated for n≥3). [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

The Role of Carotid Stenosis in a Prediction of Prognosis of Coronary Artery Disease.

Aims: The aim of this paper is to indicate if carotid stenosis is predictive for the prognosis of coronary artery disease.Method and materials: Our study is a prospective cohort study. 1031 patients with proven coronary artery disease (CAD) were recruited consecutively. Carotid ultrasound was used to assess IMT, plaque, or stenosis. They were followed for 24 months for adverse cardiovascular events. Selected demographic date such as smoking history, dyslipidemia, hypertension, laboratory values, and clinical data (associated diseases and risk) were collected from each patient. Total cardiovascular events and mortality rate were followed up for the study population. The results were collected prospectively and retrospectively. The study was organized as a clinical, cross-sectional study and comparative study.From the data collected with the clinical research, a file was formed in the statistical program with the help of which the data were statistically analyzed.From the methods of descriptive statistics, absolute frequencies, percentages, arithmetic mean, median, measures of variability, minimum, maximum, standard deviation and logistic regression models were used.Result: Of the total number of patients 1026 had arterial hypertension (HTA). Data on hyperlipidemia (HLP) had been reported in 895 patients. 1.023 patients had peripheral artery disease (PAB). 1031 patients were presented with multivessel coronary artery disease (CAD). There were 1,029 patients with diabetes mellitus (DM), while 1,013 patients had coronary artery by-pass (CABG), and 1,012 had stroke (CVI). Elevated systolic blood pressure was reported in 966 patients. 184 patients had elevated triglycerides and 187 had elevated cholesterol. 1,008 patients have had a history of myocardial infarction. Carotid artery stenosis (CAS) has been found in 1,009 patients, increased body mass index (BMI) in 270 patients.1.031 patients were followed for 24 months. Cardiovascular events were reported in 54 patients (or 5.2%). Revascularization was performed in 28 (4.1%) patients, while 12 (1.8%) of patients died. Diabetes mellitus (OR 1.878 95% CI 0.491 7.184) and Carotid stenosis (OR 2.185 95% CI 0.731 6.53) were found to be predictive factors for future cardiovascular events.Conclusion: Due to our results carotid ultrasound may be a useful tool for risk stratification of coronary artery disease pts.

Évaluation des lésions artérielles périphériques chez le coronarien avéré à l’Institut de cardiologie d’Abidjan en Côte d’Ivoire

BackgroundCoronary artery disease is mainly due to atherosclerosis. The aim of this study was to evaluate the frequency of peripheral arterial disease in proven coronary artery disease and to determine the associated factors in our context. Material and methodsWe included in a cross-sectional descriptive and analytical study 224 patients with proven coronary artery disease confirmed on coronary angiography from March 1 to October 30, 2019. It took place in the external exploration department of the Abidjan Heart Institute. An ultrasonographic exploration of the supra-aortic trunks and arteries of the lower extremity with measurement of the ankle brachial index (ABI) was carried out. ResultsThe mean age was 57.4±10.9 years (27–81years). There was a clear male predominance with a sex-ratio of 5. The prevalence of carotid artery disease was 56.4% of patients. The main factors associated with elevated Intima Media Thickness (IMT) and the presence of carotid plaques were male sex (OR=8.8; P=0.038), smoking (OR=2.5; P=0.049) and multi-truncular involvement (OR=3.2; P=0.014). In the lower extremities, there was a prevalence of peripheral arterial disease of 48.5%. The main factors associated with the decrease of ABI were age ≥50 years (OR=2.6; P=0.043), diabetes (OR=2.8; P=0.02), dyslipidemia (OR=3.8; P=0.001) and pluri-truncular involvement (OR=4.5; P<0.0001). ConclusionThe presence of significant coronary artery disease in our context is associated with a high prevalence of peripheral carotid artery and lower extremity artery disease. This is all the more so as we are male, over 50 years old, pluri-truncular with many cardiovascular risk factors.

Study on Vitamin D deficiency in patients of diabetes mellitus presenting with Acute Coronary syndrome in a tertiary care hospital in South India

Background: Vitamin D, a fat-soluble vitamin has its receptor present in myriad of tissues and it modulates multiple cellular processes. Vitamin D deficiency is reported to be associated with coronary artery disease. Cardiovascular disease is the leading cause of mortality worldwide.&#x0D; Aims and Objective: The primary outcome was to investigate if there is a correlation of 25-OH levels with the percentage of luminal stenosis, as measured with coronary angiogram. The secondary outcome was to determine the differences in angiographically proven luminal stenosis across categories of 25-OH vitamin D levels.&#x0D; Materials and Methods: Thirty patients with acute coronary syndrome with diabetes mellitus were included in this cross-sectional descriptive study. All patients were tested for fasting vitamin D levels, fasting blood sugar, HbA1C and serum creatinine. Detailed history of the patients was recorded. Data was analyzed by the statistical software SPSS version 19 and p value &lt;0.05 was considered significant. Statistical tests like Chi- square, independent t test and log regression was used.&#x0D; Results: In this study 30 patients undergoing coronary angiography for acute coronary syndrome, Vitamin D levels showed severe deficiency in 6.7% (2) cases while mild deficiency was seen in 50% of the cases. Patients with single vessel disease on the coronary angiogram had lower mean HbA1C (9.18) levels in our study. Patients with triple vessel disease had poorly controlled mean HbA1C levels (10.42).&#x0D; Conclusion: In this study we did not find any significant difference between the serum Vitamin D deficiency levels with patients with angiographic severity of the coronary artery disease. Patients with poorly controlled diabetes mellitus had more severe angiographic proven coronary artery disease.

Association of small dense low-density lipoprotein with cardiovascular outcome in patients with coronary artery disease and diabetes: a prospective, observational cohort study

BackgroundElevation in small dense low-density lipoprotein (sdLDL) is common in patients with diabetes mellitus (DM), which has already been reported to be associated with incidence of coronary artery disease (CAD). The aim of the present study was to investigate the prognostic value of plasma sdLDL level in patients with stable CAD and DM.MethodsA total of 4148 consecutive patients with stable CAD were prospectively enrolled into the study and followed up for major cardiovascular events (MACEs) up to 8.5 years. Plasma sdLDL level was measured in each patient by a direct method using automated chemistry analyzer. The patients were subsequently divided into four groups by the quartiles of sdLDL and the association of sdLDL level with MACEs in different status of glucose metabolism [DM, Pre-DM, normal glycaemia regulation (NGR)] was evaluated.ResultsA total of 464 MACEs were documented. Both Kaplan–Meier analysis and Cox regression analysis indicated that the patients in quartile 4 but not quartile 2 or 3 of sdLDL level had significantly higher rate of MACEs than that in lowest quartile. When the prognostic value of high sdLDL was assessed in different glucose metabolism status, the results showed that the high sdLDL plus DM was associated with worse outcome after adjustment of confounding risk factors (hazard ratio: 1.83, 95% confident interval: 1.24–2.70, p < 0.05). However, no significant association was observed for high sdLDL plus Pre-DM or NGR.ConclusionsThe present study firstly indicated that elevated levels of plasma sdLDL were associated with increased risk of MACEs among DM patients with proven CAD, suggesting that sdLDL may be useful for CAD risk stratification in DM.

Histopathology and Morphometric Analysis of the Internal Mammary Artery to Study the Incidence of Atherosclerosis and Its Associated Risk Factors

Background: The left internal mammary artery (IMA) is widely used as a conduit for coronary revascularization. The incidence of atherosclerosis is known to be lower in the IMA than in the coronary artery. The aim of this study was to evaluate the reliability of the use of the distal section of the IMA as an anastomotic site for bypass grafting and morphometric studies of IMA in patients with proven coronary artery disease and their associated risk factors. Methods: Patients who underwent Coronary Artery Bypass Graft (CABG) from June 2010 to November 2012 were chosen in this retrospective study and the discarded distal segments of the internal mammary artery were analyzed. The potential risk factors for atherosclerosis considered were age, sex, diabetes mellitus, history of cigarette smoking, hypertension and hypercholesterolemia. The samples were analyzed for the degree of intimal thickening and atherosclerosis by calculating the percentage of Luminal Narrowing, Intimal Thickness Index (ITI) and Intima-to-Media Ratio (IMR). Results: There were seven cases of intimal hyperplasia and two cases of focal medial and intimal hyperplasia with fatty streak and no cases of atherosclerosis and medial calcification. ITI was higher in males when compared to females. There was a strong relationship between IMR and smokers when compared to nonsmokers. Conclusion: In our study, when ITI was used as the dependent variable, diabetes was the most important factor. When IMR was used, the strongest predictor was hypercholesterolemia. There was a strong relationship between IMR and smokers when compared to nonsmokers.

Depressive disorders in angiographic-proven coronary artery disease: A Cross Sectional Study

Objective: Depressive disorders are a common and unrecognized entity in the patients of coronary artery disease (CAD). This study aimed at detecting the prevalence of depressive disorder in patients of angiographic proven CAD and to assess the correlation between depression and various coronary risk factors and clinical variables in patients of CAD. Materials and Methods: We did a prospective, observational study in patients of angiographic proven CAD attending cardiology outpatient department services in a tertiary care hospital. We studied patients in the age group of 25–80 years of CAD. A detailed history clinical evaluation was done, and the prevalence of depression was detected with the help of a questionnaire as per becks depression inventory. Results: A total of 150 patients were studied. Out of these, 113 (75.33%) were male and 37 (24.66%) were female. The mean age of the patients was 54.85 years. In the questionnaire-based screening for depression, 16.6% had normal score, 30% had mild mood disturbance, whereas 26% had borderline clinical depression and another 25.3% had moderate depression. A total of 03 patients (2%) had severe depression and none had extreme depression. Among the associations with depression, the presence of female sex, New York Heart Association class and educational status was shown to have significant association with depression in CAD patients. Conclusions: Our study shows a high prevalence of depression in patients of CAD. This generally goes unnoticed and untreated and can lead to poor quality of life and also increases mortality risk. Thus, the features of depressive disorder should be actively screened and treated in patients of CAD.

Frequency of Hypogonadism in Type 2 Diabetes Mellitus Patients with and without Coronary Artery Disease.

IntroductionHypogonadism is characterized by clinical and biochemical evidence of testosterone deficiency. Low testosterone levels have been reported in patients with type 2 diabetes mellitus (T2DM), which can predispose to coronary artery disease (CAD). It has been proposed that diabetic men with proven CAD have lower androgen levels than patients with normal coronary arteriograms. We conducted this study with the objective to determine the frequency of hypogonadism in patients with diabetes mellitus and its relationship with CAD.Materials and MethodsIt was a comparative cross-sectional study conducted at a tertiary care hospital. We recruited a total of 108 patients, divided into two groups, 54 patients in each arm of the study. Group A comprised patients with CAD, whereas group B consisted of diabetic patients without CAD. Hypogonadism was defined on the basis of erectile dysfunction clinically and total testosterone levels biochemically. CAD was diagnosed on the basis of findings of coronary angiography. Fasting blood samples were drawn and evaluated for fasting plasma glucose, HbA1c, fasting lipid profile, thyroid-stimulating hormone (TSH), serum prolactin, blood urea, serum creatinine, liver function tests (LFT), total testosterone, luteinizing hormone (LH), and follicle‑stimulating hormone (FSH) levels. Hypogonadism among two study groups was compared using chi-square and serum testosterone level was compared using independent t-test with p < 0.05 considered as statistically significant.ResultsThere were 108 subjects in the study with the mean age of 54.4 ± 4.29 (range: 22 to 68) years. The mean duration of T2DM was 12.6 ± 8.2 years. The mean BMI of patients with and without CAD was 25.7 ± 2.37 and 26.9 ± 4.21 kg/m2, respectively. There was no significant difference in waist circumference and obesity between both the groups (p-value > 0.05). Fasting plasma glucose and HbA1c in both groups were not significantly different. Testosterone levels and erectile dysfunction score were found lower in T2DM with CAD compared to T2DM patients without CAD, although this difference was not statistically significant (p-value: 0.051). The majority of the subjects with hypogonadism in both groups had a hypogonadotrophic hypogonadism (39/42, 92.9% versus 16/20, 80.0%). No statistically significant difference was seen in serum levels of LH and FSH between the study groups. The frequency of hypogonadism was found higher in the group with CAD (72.2%, 39/54) as compared with T2DM patients without CAD (37.03%, 20/54; p-value = 0.000). ConclusionTestosterone deficiency is a significant problem of males with T2DM. Patients with CAD have markedly low levels of testosterone as compared with patients without any CAD.