Significant Risk Factor For Coronary Artery Disease Research Articles

Exploring the predictive values of CRP and lymphocytes in coronary artery disease based on a machine learning and Mendelian randomization

PurposeTo investigate the predictive value of leukocyte subsets and C-reactive protein (CRP) in coronary artery disease (CAD).MethodsWe conducted a Mendelian randomization analysis (MR) on leukocyte subsets, C-reactive protein (CRP) and CAD, incorporating data from 68,624 patients who underwent coronary angiography from 2010 to 2022. After initial screening, clinical data from 46,664 patients were analyzed. Techniques employed included propensity score matching (PSM), logistic regression, lasso regression, and random forest algorithms (RF). Risk factors were assessed, and the sensitivity and specificity of the models were evaluated using receiver operating characteristic (ROC) curves. Additionally, survival analysis was conducted based on a 36-month follow-up period.ResultsThe inverse variance weight (IVW) analysis showed that basophil count (OR 0.92, 95% CI: 0.84–1.00, P = 0.048), CRP levels (OR 0.87, 95% CI: 0.73–1.00, P = 0.040), and lymphocyte count (OR 1.10, 95% CI: 1.04–1.16, P = 0.001) are significant risk factors for CAD. Using LASSO regression, logistic regression, and RF analysis, both CRP and lymphocyte counts were consistently identified as risk factors for CAD, prior to and following PSM. The ROC curve analysis indicated that the combination of lymphocyte and CRP levels after PSM achieves a higher diagnostic value (0.85). Survival analysis revealed that high lymphocyte counts and low CRP levels are associated with a decreased risk of Major Adverse Cardiovascular Events (MACE) (P < 0.001). Conversely, a higher CRP level combined with lymphocyte counts correlates with a poorer prognosis.ConclusionThere is a causal relationship between lymphocytes, CRP and CAD. The combined assessment of CRP and lymphocytes offers diagnostic value for CAD. Furthermore, high CRP levels coupled with low lymphocyte counts are associated with a poor prognosis.

Prevalence and risk factors associated with coronary artery disease in Iranian patients with peripheral artery disease

IntroductionIt is well known that peripheral artery disease (PAD) and coronary artery disease (CAD) coexist and therefore, patients diagnosed with PAD have an increased chance of developing concomitant CAD. CAD-related complications could be a leading cause of postoperative mortality in individuals with PAD undergoing vascular surgery. We present a case series of 48 patients who underwent coronary angiography before vascular surgery and an updated review of previous reports to determine the prevalence of concomitant CAD in a convenience sample of Iranian patients. MethodsThis cross-sectional study was performed on 48 patients with confirmed PAD admitted to Imam Ali Hospital, affiliated with the Kermanshah University of Medical Sciences (KUMS), Kermanshah Province, Iran. A vascular surgeon diagnosed PAD based on the patient's symptoms, Doppler ultrasound, and CT angiography (CTA). All patients underwent coronary angiography to determine if they also had CAD. We defined significant CAD as a ≥70% luminal diameter narrowing of a major epicardial artery or a ≥50% narrowing of the left main coronary artery. ResultsOf 48 patients, 35 (72.9%) were male, 13 (27.1%) were female, and the mean age was 64.18±12.11 years (range, 30 to 100 years). The incidence of CAD in patients with PVD was 85.42% (41/48). The patients with CAD were more likely to be hypertensive than those without CAD (80.5 vs. 14.3, p-value<0.001). Of 41 patients with CAD, 9 (22.0%) had one-vessel disease, 10 (24.3%) had two-vessel disease, and 22 (53.7%) had three-vessel disease. ConclusionHypertension was a significant risk factor for CAD. Patients with hypertension and multiple major coronary risk factors scheduled for PVD surgery should be carefully evaluated for concomitant CAD.

Association of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio and Coronary Artery Disease Among the Physicians.

Cardiovascular diseases (CVDs) are major global health problem and are the third leading cause of death in the world. Most studies found the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were correlated with myocardial infarction and heart failure. Previous studies reported a higher risk of CVD among physicians but no study concerns NLR and the PLR to predict coronary artery disease (CAD) among the physicians. This study aimed to evaluate the role of blood features in the CBC, with a particular focus on NLR and PLR levels, in predicting the presence of CAD. Data of Thai physicians who participated in the "Save Doctors' Heart" project which was conducted between February 14 and October 31, 2022, were collected from personal information, work and health habits, physical examination, white blood cell (WBC), laboratory, cardiac testing, and presence of CAD. Prior to studying their association with CAD, optimal values of age and each blood parameter, NLR, and PLR were determined. Of 1161 physicians mean age was 47.7 ± 10.16 years. By cardiac tests, CAD was identified in 11.3%. Significantly higher levels of WBC, neutrophils, NLR, and lower platelets were found in physicians with CAD. Except for lymphocytes and platelets which exhibited a reverse association with CAD, other factors were found as significant risk factors for CAD by univariate analysis. By multivariate analysis, the independent risk factors for CAD in order of their adjusted odds ratio (aOR) were age ≥50 years (aOR 9.34), NLR ≥ 1.87 (aOR 2.75), CAC score > 1 (aOR 2.39), and PLR ≥ 161.66 (aOR 2.32). NLR and PLR, older age and CAC score were found as independent factors predicting CAD. The findings of this study could potentially provide valuable insights into the relationship between blood parameters and CAD risk among physicians.

Worse cardiovascular and renal outcome in male SLE patients

Systemic lupus erythematosus (SLE) in males is rare and poorly understood. Thus, still little is known about sex differences in SLE. We set out to identify sex differences regarding clinical manifestations as well as renal and cardiovascular outcomes of SLE. We analyzed patient data from the Swiss SLE Cohort Study. Cumulative clinical manifestations according to the updated American College of Rheumatology criteria were recorded at inclusion. Cardiovascular events were recorded within Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC-SDI). Renal failure was defined as eGFR < 15 ml/min/1.73 m2, initiation of renal replacement therapy or doubling of serum creatinine which were all assessed yearly or documented as end stage renal disease in SLICC-SDI. Risk differences were calculated using logistic regression and cox regression models. We analyzed 93 men and 529 women with a median follow up time of 2 years. Males were significantly older at diagnosis (44.4 versus 33.1 years, p < 0.001) and had less often arthritis (57% versus 74%, p = 0.001) and dermatological disorders (61% versus 76%, p < 0.01). In multivariate analysis female sex remained a significantly associated with arthritis and dermatological disorders. In multivariate analysis men had a significantly higher hazard ratio of 2.3 for renal failure (95% confidence interval (95%-CI) 1.1–5.2, p < 0.04). Total SLICC-SDI Score was comparable. Men had significantly more coronary artery disease (CAD) (17% versus 4%, p < 0.001) and myocardial infarction (10% versus 2%, p < 0.01). In multivariate analysis, male sex remained a significant risk factor for CAD (odds ratio (OR) 5.6, 95%-CI 2.3–13.7, p < 0.001) and myocardial infarction (OR 8.3, 95%-CI 2.1–32.6, p = 0.002). This first sex study in a western European population demonstrates significant sex differences in SLE. Male sex is a risk factor for cardiovascular events and renal failure in SLE. Potential etiological pathomechanisms such as hormonal or X-chromosomal factors remain to be further investigated.

A Curious Case of Acute STEMI in a Young Patient; Things are Not Always What They Seem

BACKGROUND: Acute myocardial infarction (MI) is a rare occurrence in patients under 40 years of age without positive family history for coronary artery disease (CAD). Genetic conditions as inherited thrombophilia can lead to a hypercoagulable state, resulting in thromboembolic events and arterial thrombosis. CASE SUMMARY: We present a case of a 35-year-old male patient who presented to the emergency room with an inferior MI after a strenuous cycling exercise. An urgent coronary angiography showed thrombotic formations in the right coronary artery without atherosclerotic plaques. Plain old balloon angioplasty and thrombus aspiration were performed, which was followed by GP IIb/IIIa inhibitor infusion and unfractionated heparin for 24 h. From past medical history, the patient had COVID-19 like symptoms 20 days before the event and had his first dose of anti- COVID vaccine 2 weeks prior. After additional testing, molecular genetic analysis results revealed the patient to be heterozygous for factor V Leiden (FVL) and homozygous for methylenetetrahydrofolate reductase C677T gene mutation. The patient was discharged on direct oral anticoagulant and antiplatelet therapy. After 1-year follow-up, he had no symptoms or recurrent cardiovascular events. CONCLUSION: Inherited thrombophilia is а significant risk factor for CAD and performing genetic testing in younger patients with a cardiovascular event and plays an important role for adequate treatment and prophylaxis from recurrent complications. The use of oral anticoagulation for prophylaxis is shown to be effective in these patients. However, further studies are needed to prove their exact role and duration of treatment.

Sub-group analysis of inflammatory cytokines IL-1 and IL-6 in association with lipid profiles of coronary artery disease patients

IntroductionAlthough possible effects of lipid parameters, and several important genetic factors, and cytokines on the development of coronary artery disease (CAD) have been demonstrated, there is still debate about how the lipid profile affects the sub-group of patients in a specific population. This study aimed to evaluate age- and gender-based effect of lipid profile in correlation with their IL-1 and IL-6 cytokine levels in South Indian population. MethodsAngiographically confirmed 150 CAD patients' with or without hypertension and 150 healthy control individuals of both the genders between 18 and 70 years of age were enrolled. Quantitative estimation of IL-1 and IL-6 protein in each serum sample was evaluated using ELISA. The plasma concentrations of cholesterol, HDL, LDL, VLDL and triglycerides were determined using different biochemical tests. Correlation was established between cytokines and lipid profile of patients in different sub-groups using Pearson's linear regression analysis. ResultsSub-group analysis showed VLDL and triglyceride levels as significant risk factors for CAD, especially in women patients. Older men (>40 years) and younger women (<40 years) reported with the highest negative correlation of IL-1 with lipid parameters, while older women showed strong positive correlation. Both younger and older men (<40 years) showed the strongest negative correlation of IL-6 with lipid parameters. Younger women showed the strongest negative correlation, while older women had the strongest positive correlation of IL-6 with lipid parameters. ConclusionOverall, this study indicates the importance of sub-group analysis in identifying comprehensive association of different parameters with the risk of CAD.

Deciphering correlation and causation in risk factors for heart disease with Mendelian randomization

In this analysis, we studied the use of Mendelian randomization to identify the risk factors of coronary artery disease (CAD), a major cause of cardiovascular disease. Identifying risk factors of CAD are critical to understanding and managing the disease. Our analysis combined results from 28 genetic analyses from 12 unique studies. For each genetic variation, we obtained the variant ID, chromosome, base-pair position, reference and alternative alleles of the genetic variation, and estimated effect and p-value of the genetic variation on the outcome. We hypothesized that traits which are correlated with CAD outcomes will be causally associated with CAD risk in a genetic Mendelian randomization analysis. Our analysis showed that several traits such as blood pressure readings (systolic, OR 0.51 (95% CI: 0.34-0.69), p-value = 5.4x10-9) and (diastolic, OR 0.56 (95% CI: 0.41-0.71), p-value = 7.6x10-14), LDL cholesterol levels (OR 0.54 (95% CI: 0.47-0.60), p-value = 4.4x10-56), and BMI (OR 0.41 (95% I: 0.35-0.48), p-value = 6.30x10-33) were significant risk factors for CAD. C-reactive protein (OR -0.09 (95% CI: -0.18–0.00), p-value = 0.05) was a protective risk factor of CAD due to its negative odds ratio. In contrast, eosinophil count (OR -0.007 (95% CI: -0.06-0.04), p-value = 0.79) had no statistically significant association. Blood cells had weak associations with CAD, and uric acid’s role as a causal or reversible risk factor of CAD was inconclusive, requiring further study.

Celiac Disease Patients With Coronary Artery Disease: A Nationwide Population-Based Study.

BackgroundCoronary artery disease (CAD) is associated with celiac disease (CD) with limited evidence. However, the common risk factors linking CD and CAD are still lacking in the literature. Known CAD risk factors include hypertension, hyperlipidemia, type 2 diabetes, obesity, and tobacco use. Common risk factors linking CD and CAD are poorly documented.ObjectiveThere are three objectives: Firstly, to evaluate potential demographic differences between CD patients with CAD and without CAD. Secondly, to analyze the risk factors of CAD in CD patients. Lastly, to compare CD-CAD and matched non-CD CAD to determine whether there are additional CAD risks in individuals with CD.MethodsThe study is a nationwide retrospective case-control study. The National Inpatient Sample (NIS) database was used to identify patients admitted between 2016 and 2018 with a principal or secondary diagnosis of CD. We analyzed sociodemographic and clinical risk factors of CAD in CD patients and compared the CD-CAD population with the matched non-CD CAD cohort.ResultsOut of 23,441 hospitalizations with CD in 2016-2018, 4244 (18%) were found to have CAD. Established CAD risk factors identified in CD patients included hypertension, hyperlipidemia, type 2 diabetes, and a family history of CAD. In contrast, tobacco use is not a CAD risk factor in CD patients. Female patients with CD had 55% lesser odds of CAD than male patients. The odds of CAD in CD patients with hyperlipidemia were five times higher, 1.2 times higher with essential hypertension, and two times higher with type 2 diabetes. Patients with CAD had a higher prevalence of iron deficiency anemia (9.33% CD-CAD and 8.28% non-CAD CD Vs. 7.32% non-CD CAD).ConclusionsOur study confirms that, as with non-CD individuals, males and the White race are at increased CAD risk in the CD population. CD-CAD patients have a higher hyperlipidemia prevalence than non-CD CAD patients. CD patients with type 1 diabetes have an early diagnosis of CAD compared to CD patients with type 2 diabetes. Iron deficiency anemia is a statistically significant risk factor for CAD in CD patients.

The role of Dobutamine stress echocardiography in patients evaluated for liver transplant to predict latent cardiac disease

BackgroundDobutamine stress echocardiography (DSE) is a frequently used diagnostic tool in the cardiac assessment of patients evaluated for liver transplant. But it's precision to predict obstructive coronary artery disease (CAD) or cardiomyopathy has been subject to much debate. AimThe aim of this study is to assess the efficacy of DSE in diagnosing latent CAD in pre-liver transplant evaluation. MethodsThis is a prospective, single center, observational study. 109 patients with no prior history of CAD, and baseline normal left ventricular function, who underwent DSE as a part of pre-transplant work-up from December 2016 to June 2018 were included in our study. Left ventricular ejection fraction (LVEF) at peak stress, new wall motion abnormalities, achievement of contractile reserve (CR) were noted. Coronary angiography (CAG) was performed in patients who had either positive DSE or significant risk factors for CAD. Patients were observed post operatively up to their discharge for cardiac events. ResultsOnly one patient with positive DSE had CAD by angiogram (16.6%) whereas 46.4% (n=13) with negative DSE had CAD. Among the patients with normal epicardial coronaries, 83.3% (n=5) had positive DSE (‘p’=0.016). The sensitivity of DSE was 7%, specificity of DSE was 64%, positive predictive value was 16% and negative predictive value was 40 %. In-hospital mortality was 16% (n=15). Among them none had a positive DSE and all 6 patients with positive DSE were alive at the time of discharge (p= 0.26). ConclusionThe performance accuracy of DSE to detect latent CAD in patients undergoing liver transplant is poor.

Mechanism of the switch from NO to H2O2 in endothelium-dependent vasodilation in diabetes.

Coronary microvascular dysfunction is prevalent among people with diabetes and is correlated with cardiac mortality. Compromised endothelial-dependent dilation (EDD) is an early event in the progression of diabetes, but its mechanisms remain incompletely understood. Nitric oxide (NO) is the major endothelium-dependent vasodilatory metabolite in the healthy coronary circulation, but this switches to hydrogen peroxide (H2O2) in coronary artery disease (CAD) patients. Because diabetes is a significant risk factor for CAD, we hypothesized that a similar NO-to-H2O2 switch would occur in diabetes. Vasodilation was measured ex vivo in isolated coronary arteries from wild type (WT) and microRNA-21 (miR-21) null mice on a chow or high-fat/high-sugar diet, and B6.BKS(D)-Leprdb/J (db/db) mice using myography. Myocardial blood flow (MBF), blood pressure, and heart rate were measured in vivo using contrast echocardiography and a solid-state pressure sensor catheter. RNA from coronary arteries, endothelial cells, and cardiac tissues was analyzed via quantitative real-time PCR for gene expression, and cardiac protein expression was assessed via western blot analyses. Superoxide was detected via electron paramagnetic resonance. (1) Ex vivo coronary EDD and in vivo MBF were impaired in diabetic mice. (2) Nω-Nitro-L-arginine methyl ester, an NO synthase inhibitor (L-NAME), inhibited ex vivo coronary EDD and in vivo MBF in WT. In contrast, polyethylene glycol-catalase, an H2O2 scavenger (Peg-Cat), inhibited diabetic mouse EDD ex vivo and MBF in vivo. (3) miR-21 was upregulated in diabetic mouse endothelial cells, and the deficiency of miR-21 prevented the NO-to-H2O2 switch and ameliorated diabetic mouse vasodilation impairments. (4) Diabetic mice displayed increased serum NO and H2O2, upregulated mRNA expression of Sod1, Sod2, iNos, and Cav1, and downregulated Pgc-1α in coronary arteries, but the deficiency of miR-21 reversed these changes. (5) miR-21-deficient mice exhibited increased cardiac PGC-1α, PPARα and eNOS protein and reduced endothelial superoxide. (6) Inhibition of PGC-1α changed the mRNA expression of genes regulated by miR-21, and overexpression of PGC-1α decreased the expression of miR-21 in high (25.5mM) glucose treated coronary endothelial cells. Diabetic mice exhibit a NO-to-H2O2 switch in the mediator of coronary EDD, which contributes to microvascular dysfunction and is mediated by miR-21. This study represents the first mouse model recapitulating the NO-to-H2O2 switch seen in CAD patients in diabetes.

The traditional and modifiable risk factors of coronary artery disease - a community-based cross-sectional study among 2 populations.

A community-based cross-sectional study was undertaken by the Cardiology Society of India (Kerala Chapter) to determine the prevalence of coronary artery disease (CAD) and its risk factors. The periodontal health status of the rural and urban participants in the Thiruvananthapuram district of Kerala was evaluated to document any association between periodontal disease (PD) and CAD and to describe any shared risk factors.The participants were selected using a multistage cluster random sampling method. Socio-demographic data and personal histories were collected using a structured interview schedule and validated tools. Body mass index, blood pressure, electrocardiogram, and biochemical investigations were recorded and analyzed using standard protocols. A modification of the Ramfjord periodontal disease index was used to assess periodontal health.PD was more frequent among rural (61.4%) than in the urban population (35.5%). The frequencies of CAD associated with PD in the rural and urban populations were 82.6% and 40.5%, respectively. PD was not found to be a significant risk factor for CAD in the univariate regression analysis of urban populations. In the rural population, the odds of PD as a risk factor for CAD were found to be 3.08 (95% CI [1.38–8.38]) and significant (P = .043) in univariate regression analysis and 1.54 (95% CI: 0.44–5.4) and non-significant (P = .503) in the multivariate regression analysis.In rural areas, male sex and dyslipidemia demonstrated borderline significance as risk factors for CAD. PD was not found to be an independent risk factor after adjusting for age, sex, tobacco use, hypertension, sedentary lifestyle, and dyslipidemia. Male sex and dyslipidemia were identified as shared risk factors between PD and CAD, which could have confounded the significant association between the latter. In urban areas, age, male sex, and dyslipidemia demonstrated an independent association with CAD. This study could not establish an independent association between PD and CAD in either community. Future epidemiological studies should identify and recruit novel environmental factors to understand the interrelationships between PD and CAD and focus on the role of effect modifiers that may have a protective role against PD colluding with CAD.

The painful chest pain history: improving risk stratification with coronary calcium score

Abstract One of the commonest presentations to the Cardiology outpatient clinic is chest pain. Conventional risk scores for predicting coronary artery disease (CAD) depend greatly on chest pain histories which can be subjective and disadvantage individuals who present with less typical symptoms. The coronary calcium score (CACS) has a quick turnabout time and is an objective marker of atherosclerosis which can provide actionable information on presence of coronary artery disease. This study aims to explore a) if CACS can be a surrogate for chest pain history to better manage patients with atypical presentations, and b) determine the feasibility of utilising CACS in a new risk model as a form of triage for chest pain in the outpatient specialist setting. Two cohorts of patients who underwent CT Coronary angiogram (CTCA) were used: Asymptomatic patients with no obstructive coronary artery disease (CAD) and patients with symptomatic chest pain. The readouts of the CTCA include presence or absence of obstructive CAD (epicardial artery stenosis ≥50% on CTCA) and the CACS. In the asymptomatic cohort, we derived the formula for the median predicted CACS using latent class analysis and quantile regression with age and gender. The symptomatic cohort was divided into derivation and validation groups. Multivariate logistic regression was used to select significant risk factors for CAD and develop the prediction model. The presence of a ≥10-point difference between the patient's actual CACS and predicted median CACS was established as a predictive parameter. Performance of the model was assessed and compared with the CAD I consortium score using area under the curve (AUC), net classification index and integrated discriminative index in the validation group. In the asymptomatic cohort of 1911 persons, gender and age were significant factors used to calculate median predicted CACS. In the derivation cohort of 2345 patients, a CACS of 10-point difference between patient's CACS and predicted medium calcium score had a negative predictive value of 96.8%. Performance AUC (Figure 1) of the various models were: new model with chest pain history 0.887 (95% CI 0.858–0.916); without chest pain history 0.884 (95% CI 0.854–0.913); CAD I Consortium score 0.746 (95% CI 0.707–0.784). Both models performed significantly better than calcium score alone, p-value = 0.011. Coronary calcium score is an objective measure of coronary atherosclerosis and appears to be a reliable surrogate for chest pain history. A new risk marker of positive 10-points difference between patient's calcium score and predicted median calcium score can potentially better risk stratify patients presenting with chest pain in the outpatient setting. Funding Acknowledgement Type of funding source: None

Evaluation of Routine Coronary Angiography Before Pulmonary Thromboendarterectomy

At the University of California, San Diego, routine coronary angiography has generally been performed in men 40 years of age and older and women 45 years of age and older before pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension (CTEPH). The prevalence of significant coronary artery disease (CAD) in this population has not been evaluated, however, and the optimal screening strategy has not been established. This study sought to evaluate whether the current approach may be better optimized on the basis of cardiac risk factors. This study included 462 consecutive patients with CTEPH who were undergoing preoperative coronary angiography for pulmonary thromboendarterectomy. Baseline demographic and medical information was recorded. Major cardiac risk factors included: diabetes, hypertension, hyperlipidemia, body mass index 25 kg/m2 or greater, tobacco use, and family history of CAD. Charts were then reviewed for presence of significant CAD and revascularization. Significant CAD was found in 13.4% of patients who underwent routine preoperative coronary angiography; it was present in only 5% of patients younger than 50 years of age, compared with 16% of patients 50 years old and older. No patient younger than 50 years of age without cardiac risk factors was found to have significant CAD. Furthermore, in patients younger than 50 years of age, significant CAD was found only among those with 3 or more major risk factors. In patients younger than 50 years of age with CTEPH, the prevalence of significant CAD was low. Omitting preoperative coronary angiography in this subset of patients is reasonable when no coronary risk factors are present. Preoperative coronary angiography is warranted in individuals 50 years of age and older, as well as in those younger than 50 years who have significant risk factors for CAD.

Serological evidence of association between &lt;i&gt;Helicobacter pylori&lt;/i&gt; infection and coronary artery disease

Background: Studies have reported relationship between chronic Helicobacter pylori infection and coronary artery disease (CAD). The cytotoxin-associated gene A product (CagA) is an immunodominant protein which indicates infection with virulent H. pylori strains. Significant associations of CagA-positive H. pylori strains with coronary artery disorders have been widely reported. H. pylori is also known to produce different heat shock proteins (HSPs) which can stimulate the production of specific antibody against microbial proteins and capable of eliciting autoimmune reaction against human tissue expressing HSPs such as vascular endothelial cells. The objectives of this study are to investigate the association between H. pylori and CagA with coronary atherosclerosis and CAD, and to determine the possible role of H. pylori HSP60 protein in increasing the risk of CAD development. Methods: This study included 70 patients with stable angina and 70 age and gender-matched controls. Each group was evaluated by clinical history, physical examination, cardiac echocardiography (ECHO) and electrocardiography (ECG) with and without exercise. Fasting blood glucose, total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides (TG) were estimated by automated enzymatic methods. H. pylori IgG, CagA IgG and HSP60 IgG were measured by enzyme-linked immunosorbent assay (ELISA) for both groups. Results: The seroprevalence of H. pylori infection was high in both groups; 75.7% in case and 68.6% in control (p=0.346). Serum IgG levels were significantly higher for CagA (p=0.028) and HSP60 (p&lt;0.001) in cases than in controls. There was significant association between H. pylori and CagA IgGs in cases (p=0.007) but no association in controls (p=0.700). Higher HSP60 IgG level was significantly associated with both positive H. pylori IgG (p&lt;0.001) and CagA IgG (p&lt;0.001) in cases but no significant association was found with H. pylori (p=0.815) or CagA (p=0.332) IgG levels in the control group. Serum values were significantly higher for TC (p&lt;0.001), TG (p&lt;0.001) and LDL (p=0.004) while value for HDL was significantly lower (p&lt;0.001) in H. pylori IgG-positive subjects (case and control). Conclusion: There is serological evidence that H. pylori infection may pose a significant risk factor for CAD. Since H. pylori can be eliminated by specific treatment, this may be a good preventive approach for CAD.Key words: H. pylori, coronary artery disease, CagA, HSP60, serology.

Assessing cardiovascular risk in the prerenal transplant population: Comparison of myocardial perfusion imaging and coronary angiography with risk factor stratification.

Patients with end-stage renal disease (ESRD) have a higher incidence of coronary artery disease (CAD). Hence, it is crucial to evaluate CAD before renal transplantation. This study compares the utility of pharmacologic single-photon emission computed-tomography (SPECT) imaging directly to coronary angiography for diagnosis of CAD with correlation to cardiovascular risk factors. Retrospective review of asymptomatic renal failure patients who underwent both SPECT and coronary angiography to identify obstructive CAD between the years 2008-2016. Ninety-four ESRD subjects were evaluated. Myocardial perfusion SPECT study found, when compared to coronary angiography demonstrated for CAD, the sensitivity of 93.3% with a specificity of 73.4%. Importantly, the negative predictive value for coronary artery disease was 96%. With seven or more cardiac risk factors, 66.7% of patients had obstructive coronary artery disease. Among all the risk factors examined, patients with a previous history of coronary artery disease had a 68% risk of obstructive coronary artery disease. Comparing myocardial perfusion imaging SPECT findings with coronary angiography in patients with ESRD, a sensitivity of 93.3% and a specificity of 73% were observed. Of all the risk factors examined, patient with the previous history of CAD was the single most significant risk factor for CAD in 68% of cases.

The Effect of Reproductive Factors on Coronary Artery Disease in Women

Abstract Introduction: There is a sex discrepancy in cardiovascular physiology. In this study, we aimed to investigate the effect of female reproductive factors on coronary artery disease (CAD) beyond the known CAD risk factors. Methods: In a case-control study, women referred to Tehran Heart Center for coronary artery angiography from 2012 to 2014 were enrolled. Of these, 80 premenopausal and 100 postmenopausal females with CAD in angiography were randomly selected as cases and 80 premenopausal and 100 postmenopausal females without CAD in angiography were selected as controls. A questionnaire including reproductive history and known CAD risk factors was filled for every subject. Analysis was performed separately for pre and postmenopausal women and a final adjustment for coronary artery disease risk factors was done. Results: Among reproductive factors, oligomenorrhea (OR= 6.72) was a significant risk factor for CAD in premenopausal women and history of oral contraceptive (OCP) use had a protective effect on CAD in pre and postmenopausal woman (OR= 0.24 and 0.20, respectively). Conclusions: Since oligomenorrhea has a strong association with insulin resistance and diabetes, a conventional risk factor of CAD, women with oligomenorrhea should be treated not only for cyclic irregularity but also for prevention of CAD.

Coronary artery disease with type 2 diabetes and other risk factors: A tertiary care hospital in Bangladesh

Background: The aim of this study was to determine the prevalence of coronary artery disease (CAD) and to identify the various risk factors related to this complication in subject with diabetes.&#x0D; Methods: The study was cross-sectional and conducted in out-patients department of BIRDEM, from July 2016 to December 2017. Subjects were considered at age 30 to 70 years and duration of diabetes was 5-10 years. Investigations included socio-demographic (age, sex, education etc.), anthropometry (height, weight) and blood pressure. Blood samples were collected for HbA1c, fasting blood glucose (FBG), 2 hour after breakfast (2HABF), lipid profile and CAD were taken from the record books which was diagnosed by respective physician.&#x0D; Results: A total of 221 type 2 diabetes mellitus (T2DM) patients data were taken from the record books. There were 38 patients who had developed CAD and the prevalence of CAD was 17.2%. The study found that it had no significant difference between gender and CAD. The study also found that advanced age (OR=2.16;p=&lt;0.025), lack of physical exercise (OR=3.46; p=0.001), rural patients (OR=2.09; p=0.043), no schooling (OR=4.06; p=0.001), long duration of diabetes (OR=2.87;p=0.018), SBP(OR=2.99; p=0.003), DBP(OR=2.33; p=0.025) and increasing 2HABF (OR=2.6; p=0.026) were independent significant risk factors for CAD.&#x0D; Conclusions: The study concluded that the prevalence of CAD in Type 2 diabetes was more common and comparable to other developed countries. The study also proved that older age, rural community, lack of education, lack of physical exercise, long duration of diabetes, high blood pressure and high blood glucose were significantly independent risk factors for development of CAD. Therefore, the study concluded that lifestyle modification and tight blood pressure control with diabetes is key part to reduce CAD.&#x0D; Bangladesh Crit Care J March 2019; 7(1): 20-25

Significant association of anti-platelet factor 4/heparin antibody with cardiovascular disease in hemodialysis patients: a longitudinal 7-year study.

Hemodialysis patients have a high incidence of anti-platelet factor 4/heparin antibody (PF4-H Ab) and are at a high risk of cardiovascular disease. This study determines the association between PF4-H Ab and cardiovascular events including coronary artery disease (CAD), ischemic stroke (IS), and native arteriovenous fistula thrombosis (AVFT), in a longitudinal 7-year follow-up. 84 hemodialysis patients were enrolled. Data collection included chart reviews and assessments of laboratory records. PF4-H Ab was evaluated by ELISA and a titer ≥ 0.4 was defined to have PF4-H Ab. 30 patients were PF4-H Ab positive, 30 patients had CAD, 29 patients had IS, and 43 patients had AVFT. In Cox proportional hazard regression analysis, PF4-H Ab (HR 2.72, p = 0.01) was a significant risk factor for CAD. Age (HR 1.06, p = 0.003), PF4-H Ab (HR 4.53, p < 0.001), 7-year averaged serum phosphate levels (HR 0.53, p = 0.012), and 7-year averaged blood platelet count (HR 1.01, p = 0.029) were risk factors for IS. Age (HR 1.03, p = 0.047), PF4-H Ab (HR 3.57, p < 0.001), and 7-year averaged serum triglyceride levels (HR 1.01, p = 0.005) were risk factors for AVFT. In PF4-H Ab-positive groups, thrombocytopenia was not associated with CAD, IS, and AVFT by Fisher's test analysis. This study reveals that PF4-H Ab is a risk factor for developing CAD, IS, and AVFT among hemodialysis patients.

Coronary Angiography Profile at the Time of Hemodialysis Initiation in End-Stage Renal Disease Population: A Retrospective Analysis.

Cardiovascular disease is associated with increased mortality in dialysis population. However, there are very few studies that assessed the prevalence of coronary artery disease (CAD) at the time of initiation of hemodialysis (HD). The present study was aimed to assess the prevalence of CAD in end-stage renal disease (ESRD) patients at the time of initiation of HD and the risk factors for CAD in this population. This was a single-center retrospective study and included ESRD patients who underwent coronary angiography (CAG) at the time of initiation of HD. Inclusion criteria were age >18 years and those who were subjected to CAG within 2 weeks of initiation of HD. According to the findings on CAG, patients were divided into no CAD and CAD groups. CAD was diagnosed if there was >50% stenosis of vessel. Clinical and laboratory parameters between these two groups were analyzed. Ninety-seven patients were included in the study based on the inclusion criteria. Forty-four (45%) patients were diagnosed with CAD. Patients who had CAD were younger compared to no CAD group (50.7 + 10 vs. 55.8 + 9.3 years; P = 0.01). Majority of them were males. Diabetic nephropathy (DN) was associated with increased risk of CAD (60% vs. 40%, P = 0.007). History of smoking, high high-sensitivity C-reactive protein (hs-CRP), low total cholesterol, and low high-density lipoprotein (HDL) were associated with significantly increased risk of CAD. Gender, symptoms of CAD, serum low-density lipoprotein (LDL), very LDL, and triglycerides were not associated with increased risk of CAD. Neither calcium (Ca), phosphorus (PO4), nor Ca × PO4products were associated with an increased risk of CAD. Resting electrocardiogram abnormalities had no significance in predicting CAD (32% in CAD and 19% in no CAD group). Echocardiography showed regional wall motion abnormalities/global hypokinesia in 18% patients of CAD group and 3.8% patients of no CAD group (P = 0.03). Single-, double-, and triple-vessel disease was documented in 17 (38%), 13 (29.5%), and 14 (32.5%) patients, respectively, and the most common vessel involved was the left anterior descending artery. At the initiation of HD in ESRD patients, CAD was seen in almost half of the patients. DN was a significant risk factor for CAD. Other risk factors for CAD include smoking, low cholesterol, low HDL, and high hs-CRP levels.

Risk factors for coronary artery disease in patients undergoing elective coronary angiography in Jordan

BackgroundUnhealthy lifestyle factors such as smoking, obesity, inactivity and type 2 diabetes are endemic in the Middle East. The public health consequences might be detrimental; however, local studies on risk factors for coronary artery disease (CAD) are scarce.MethodsPatients referred for coronary angiography at a tertiary hospital in Amman, Jordan, between January and December 2015, were included in this study. Risk factors for CAD were assessed in a multivariate logistic regression model, and presented as odds ratio (OR) with 95% confidence interval (CI).ResultsAmong 557 participants, 356 (63.9%) had CAD and 201 (36.1%) had a normal cardiogram. The majority (n = 395, 70.9%) were male, and median age was 55 years (interquartile range 47–64). Two-hundred-and-fifteen (38.6%) individuals reported previous diabetes, and 287 (51.5%) were current or previous smokers. In multivariate analysis, male gender (OR 3.7, 95% CI 2.3–6.0), age (45–54 years: OR 4.8, 95% CI 2.7–8.5; 55–64 years: OR 6.0, 95% CI 3.2–11.4; ≥65 years: OR 15.7, 95% CI 7.8–31.3), previous diabetes (OR 2.6, 95% CI 1.7–4.1) and current/previous smoking (OR 2.1, 95% CI 1.3–3.4) were significant predictors of CAD.ConclusionsAge, gender, diabetes and smoking were strong and significant risk factors for CAD in Jordan. Public health interventions to reduce the prevalence of smoking and diabetes are urgently needed.