Stable Coronary Heart Disease Patients Research Articles

High Perceived Stress Predicts Worse Clinical Outcomes in Patients with Stable Coronary Heart Disease

Background. High stress is associated with coronary heart disease (CHD), but the impact of perceived stress on prognosis with stable CHD remains unclear. This study investigated the impact of high perceived stress (HPS) on cardiovascular events in stable CHD patients. Methods. From March 2015 and December 2020, 2215 stable CHD patients were recruited. The Chinese version of the Perceived Stress Scale-14 (CPSS) was used, with follow-up conducted every 6 months until the occurrence of a cardiovascular event or March 31, 2022. Cardiovascular-related events were used as outcomes, including myocardial infarction, unplanned revascularization, stroke, death, or rehospitalization from angina. Patients were divided into HPS (CPSS≥31) and nonhigh perceived stress (NHPS) groups. The Kaplan-Meier survival curves were plotted, and the log-rank test compared the incidence of adverse events after adjusting for sociodemographic, lifestyle, and clinical information. Results. The recruited CHD population was 59.6 years old on average, 79.6% male, 27.2 points average CPSS, and median follow-up of 47 months. There were 523 HPS patients, with 98 (18.7%) cardiovascular events, and 1692 NHPS patients with 239 (14.1%) cardiovascular events. The log-rank analysis showed that risk of cardiovascular events with HPS was higher than NHPS (P=0.012). After adjusting for demographic, lifestyle, and clinical information, the HPS group had significantly increased risk of events within 24 months (HR 1.369, 95% CI 1.037-1.807, P=0.027), but less impact after 24 months. Conclusions. HPS predicts subsequent cardiovascular events in patients with stable CHD within 24 months. Therefore, more attention should be given to CHD patients with HPS, which may improve clinical prognosis.

THE EFFECT OF PLATELET-RICH PLASMA ADMINISTRATION ON PROLIFERATION AND DIFFERENTIATION OF ENDOTHELIAL PROGENITOR CELLS IN PATIENTS WITH STABLE CORONARY HEART DISEASE

Endothelial Progenitor Cells (EPCs) are crucial precursors to endothelial cells, playing a key role in regulating blood vessel structure and maintaining homeostasis to protect against inflammation and thrombosis, contributing to stable coronary heart disease (CHD). Growth factors stimulate signal transduction during EPC proliferation and differentiation. Platelet-Rich Plasma (PRP) contains widely recognized growth factors in angiogenesis. Our research aimed to analyze PRP's effects on EPC proliferation and differentiation in stable CHD patients. Using an experimental post-test control group design, mononuclear cells (MNCs) from peripheral blood were cultured with M-199 medium, divided into PRP, Platelet Poor Plasma (PPP), and control groups, and incubated for 14 days. EPC proliferation was quantified with CD34 markers using ANOVA. After 7 days, differentiated cells were counted with von Willebrand Factor (vWF) markers using the Mann-Whitney U test.EPC proliferation significantly increased in the PRP group (1.052 ± 0.16) compared to PPP (0.762 ± 0.19) and the control (0.068 ± 0.05, p=0.000). However, EPC differentiation showed no significant increase in the PRP group compared to PPP (0.00-0.30 vs. 0.00-0.20, p = 0.565) or the control (0.00-0.30 vs. 0.00-0.00, p = 0.064). Additionally, no significant increase in EPC differentiation was observed in the PPP group compared to the control (0.00-0.20 vs. 0.00-0.00, p = 0.144). PRP significantly enhanced EPC proliferation but did not significantly enhance differentiation in the peripheral blood of stable CHD patients compared to PPP and control groups.

Correlation between Mean Platelet Volume and Gensini Score in Patients with Coronary Heart Disease in Different Diabetic States.

To investigate the correlation between mean platelet volume (MPV) levels and Gensini scores in stable coronary heart disease (CHD) patients with or without diabetes. A retrospective analysis was conducted on 2525 patients with stable CHD in Zhongshan Hospital, Fudan University. There were 1274 in the low MPV group and 1251 in the high MPV group, divided by a median MPV level of 10.9 fL. In the total population, 1605 patients were non-diabetic and 920 were diabetic. The severity of coronary artery disease was quantified using the Gensini score. The Gensini score was significantly higher in the high MPV group than in the low MPV group (p < 0.001). MPV levels increased significantly with the number of stenotic (>50%) coronary vessels (p < 0.001). The Spearman analysis showed a positive correlation between MPV and Gensini score (r = 0.189, p < 0.001), which was more significant in the diabetic subgroup (r = 0.232, p < 0.001). Receiver operating characteristic (ROC) curves were employed to assess the predictive value of MPV for high Gensini scores, using the median value of 32 points as the cutoff. MPV levels in the diabetes cohort exhibited a higher predictive value for high Gensini scores (area under the curve: 0.635 [0.614-0.657], p < 0.001). Multivariate linear regression analysis showed that diabetes and MPV were independently associated with Gensini scores. MPV levels in stable CHD patients can predict the severity of coronary artery stenosis. This correlation is more significant in the presence of diabetes.

MARKERS OF ENDOTHELIAL DYSFUNCTION IN CORONARY HEART DISEASE PATIENTS DEPENDING ON ARTERIAL HYPERTENSION PRESENCE

Objective: To evaluate the role of arterial hypertension (AH) on endothelial functional state in the coronary heart disease (CHD) patients. Design and method: 173 CHD patients were examined (the average age was 57.24±5.12 years): 92 patients with stable angina (45 with II functional class (FC) (23 without and 22 with AH) and 47 with III FC (26 without and 21 with AH) and 81 patients with acute coronary syndromes (ACS)(43–with unstable angina (UA) (22 without and 21 with AH) and 38–with acute myocardial infarction (MI) (20 without and 18 with AH)). Endothelial dysfunction was assessed by the levels of vasoconstrictor endothelin-1 (ET-1) and the concentration of soluble vascular adhesion molecule (sVCAM), which were determined by ELISA. Results: Both markers of endothelial dysfunction increased with an increase in disease severity. The most severe changes were in patients with ACS, although differences between patients with UA and MI were not significant (p&gt;0.05). Levels of ET-1 were significantly higher (p&lt;0.05) in all clinical variants of CHD in patients with AH regarding patients without it. The same tendance (difference with p&lt;0.01 ) was observed with sVCAM levels, but only in stable CHD patients. sVCAM levels raised significantly in ACS patients not only according to the control group, but also patients with stable CHD (p&lt;0.05), but without difference depending on AH presence in both groups with UA and MI (p&gt;0.05). There were no significant associations between levels of endothelial dysfunction markers and troponin I and T (p&gt;0.05). The significant relationships between levels of sVCAM and ET-1 on one hand and C-reactive protein on other were noted in both groups with stable CHD and with ACS, regardless of the presence of hypertension. Conclusions: Elevated levels of ET-1 and sVCAM in blood of CHD patients are the indicator of atherosclerotic plaque instability and the possibility of ACS development, especially with AH comorbidity.

Feasibility of a smartphone app for prescribed exercise tutoring in patients with stable coronary heart disease.

Digital health technologies have potential to address the challenges associated with traditional cardiac rehabilitation (CR). However, it is not complete enough for prescribed exercise guidance and remote monitoring. We aimed to evaluate the feasibility of a smartphone app for prescribed exercise tutoring by exercise videos combined with wearable devices to monitor heart rate in patients with stable coronary heart disease (CHD). The study is a quasi-experimental design study with a single group. A total of 31 patients were included with an average age of 56.2 years (SD 13.4). They participated in a 12-week remote digital CR program. We employed a wearable heart rate monitoring device connected with an app to monitor the patients' exercise intensity. The app can display the videos corresponding to an exercise prescription to guide the exercise. Cardiorespiratory endurance, blood pressure, blood glucose, cholesterol, blood uric acid, left ventricular ejection fraction and quality of life (QoL) were assessed at the beginning and end of the intervention. Compliance and safety events were recorded as well. Completion rate reached 90.3%. Average daily effective exercise time was 39.4 min (SD 17.8), and 92.9% of the patients could exercise in the prescribed intensity for at least 20 min per day. Average effective exercise days per week were 4.6 days (SD 2.2), and 67.9% of the patients could exercise in the prescribed intensity for at least 3 days per week. Patients' peak VO2 (P = 0.041) and peak metabolic equivalents (P = 0.018) were significantly increased, low-density lipoprotein (P = 0.036) and diastolic blood pressure at rest (P = 0.044) were significantly decreased, and depression (GAD-7, P = 0.014) and anxiety (PHQ-9, P = 0.013) were significantly improved. It is feasible, safe, and helpful for stable CHD patients to use the app for prescribed exercise tutoring with videos combined with wearable devices to monitor heart rate. ChiCTR1800019144.

Relationship between Vitamin D Levels and Platelet Function in the Elderly Patients with Coronary Heart Disease

Introduction: Coronary Heart Disease (CHD) is a degenerative disease caused by fat accumulation and chronic inflammation. The elderly have a significant CHD risk due to the prevalence of vitamin D insufficiency and decreased platelet function, influencing the inflammatory response in this population. Therefore, this study aims to assess the relationship between vitamin D levels and platelet function measured by the mean platelet volume (MPV) and P-Selectin serum levels of CHD patients. Method: The cross-sectional design was carried out on stable CHD patients aged 60-75. Meanwhile, vitamin D, MPV, and P-Selectin were taken through venous blood, and an ELISA examination was performed to determine their levels in serum. A correlation test using the Pearson product-moment was also conducted between vitamin D and platelet function. Result: The subjects involved were 45 male and 16 female at 73.8% and 23.2%, respectively. The highest risk factor was dyslipidemia found in 45 (73.8%) and all subjects (100%) received statins. This study showed no correlation between vitamin D levels and MPV levels (p= 0.094) and P-Selectin (p=0.362). Conclusion: Vitamin D levels are not associated with platelet function levels (MPV and P-Selectin) in elderly patients with CHD.

Wrist pulse diagnosis of stable coronary heart disease based on acoustics waveforms

Background and objectiveAs a common pathological pulse, unsmooth pulse has important diagnostic value in traditional Chinese medicine (TCM). In modern pulse diagnosis, unsmooth pulse plays an important role in the diagnosis of disease location and nature, but there are few studies on it. In this paper, a pulse diagnosis approach based on acoustic waveforms was proposed, the wrist pulse was divided into five layers vertically for the first time. Five layers acoustic waves of the radial artery in stable coronary heart disease (CHD) patients and relatively healthy people were compared to explore whether there are abnormal changes in acoustic pulse in stable CHD patients. MethodsThe acoustic features of unsmooth pulse in patients with stable CHD were analyzed in time domain, frequency domain and empirical mode decomposition, combined with shannon entropy and multi-scale entropy. Sixteen pulse characteristics were discovered, and one-way analysis of variance were performed. The characteristics of the two groups were tested by T test. 13 features were used to identify patients with stable CHD by support vector machine (SVM). ResultsCompared to healthy people, all parameters of the third layer of the stable CHD left Cun pulse were significantly different from those of the healthy people. The identification rates of the fourth and third layer of the left Cun pulse were the first (90.79%) and the second (88.16%), respectively. ConclusionAbnormal acoustic pulse appeared in the radial artery in patients with stable CHD. According to these changes, patients with stable CHD can be effectively identified from the perspective of pulse.

Abstract 8902: The High Circulating Leptin is Associated With Increased Mortality Risk in Stable Coronary Heart Disease Patients

Introduction: Leptin is an adipocyte-derived peptide, involved in energy homeostasis and regulation of body weight. The position of leptin in cardiovascular pathophysiology remained controversial, some studies suggest a detrimental effect of hyperleptinemia on the cardiovascular (CV) system, while others assume the role of leptin as protective. Hypothesis: We explore whether high leptin status affects the mortality/ morbidity risk in stable patients with coronary heart disease. Methods: 975 patients, ≥6 months after myocardial infarction (EUROASPIRE cohort) were followed in a prospective study. All-cause or CV death, non-fatal events (myocardial infarction, stroke or any revascularization) and hospitalizations for heart failure (HF) were registered as outcomes Results: High serum leptin concentrations (≥18.9 ng/mL, i.e. 4 th quartile) indicate inferior survival, as well as a higher incidence of fatal vascular event or hospitalizations for HF ( see Figure). Even after full adjustment for potential covariates, high leptin was associated with significantly increased 5-years risk of all-cause death [HRR 2.10 (95%CIs:1.29-3.42), p&lt;0.003], CV death [HRR 2.65 (95%CIs:1.48-4.74), p&lt;0.001] and HF hospitalization [HRR 1.95 (95%CIs:1.11-3.44), p&lt;0.020]. In contrast, the incidence risk of non-fatal CV events was only marginally and non-significantly influenced [HRR 1.27 (95%CIs:0.76-2.13), p=0.359] Conclusions: High leptin concentration entails an increased risk of mortality (apparently driven by fatal CV events) and future worsening of HF, on top of conventional CV risk factors and the baseline status of left ventricular function.

Impact of aerobic training periodisation on global and regional right ventricular strain in coronary heart disease.

Linear aerobic training periodisation (LP) is recommended for patients with coronary heart disease (CHD). However, the effects of training periodisation on the right heart mechanics in patients with CHD have never been examined. This study aimed to explore the effects of LP and non-linear periodisation (NLP) on right heart mechanics. We prospectively randomised CHD patients to 12 weeks of aerobic training with LP or NLP. While there was a weekly increase in energy expenditure with LP, there was a steeper increase during the first 3 weeks, followed by a decrease in the fourth week with NLP. Echocardiography was performed at baseline and after the training period to assess the right ventricular free wall (RVFW) and right atrial strain. Thirty patients with CHD were included (NLP, n = 16; LP, n = 14). The traditional right and left heart parameters showed no significant time effects. There was a decrease of RVFW strain with time in both groups (+1.3 ± 0.9% with NLP, and +1.5 ± 0.8% with LP; p = 0.033). Mid-ventricular RVFW strain changed significantly with time (+2.0 ± 1.3% with NLP, and from +2.3 ± 1.2% with LP; p = 0.025). There was no time effect on the right atrial strain. In stable CHD patients, LP and NLP resulted in right ventricular strain decrements with a segment-specific pattern. This study was registered at ClinicalTrials.gov (identifier number: NCT03414996). Novelty: In stable coronary heart disease patients, both linear and non-linear aerobic training periodisation programs result in right ventricular strain decrements with time, particularly in the mid-ventricular segment. Traditional right and left heart parameters and right atrial strain showed no significant time effect in both 12 weeks aerobic training periodisation programs.

Two RECK Splice Variants (Long and Short) Are Differentially Expressed in Patients with Stable and Unstable Coronary Artery Disease: A Pilot Study.

Primary prevention is crucial for coronary heart disease (CAD) and the identification of new reliable biomarkers might help risk stratification or predict adverse coronary events. Alternative splicing (AS) is a less investigated genetic factors implicated in CAD etiology. We performed an RNA-seq study on PBMCs from CAD patients and control subjects (CTR) and observed 113 differentially regulated AS events (24 up and 89 downregulated) in 86 genes. The RECK (Reversion-inducing-cysteine-rich protein with Kazal motifs) gene was further analyzed in a larger case study (24 CTR subjects, 72 CAD and 32 AMI patients) for its Splicing-Index FC (FC = −2.64; p = 0.0217), the AS event involving an exon (exon 18), and its role in vascular inflammation and remodeling. We observed a significant downregulation of Long RECK splice variant (containing exon 18) in PBMCs of AMI compared to CTR subjects (FC = −3.3; p < 0.005). Interestingly, the Short RECK splice variant (lacking exon 18) was under-expressed in AMI compared to both CTR (FC = −4.5; p < 0.0001) and CAD patients (FC = −4.2; p < 0.0001). A ROC curve, constructed combining Long and Short RECK expression data, shows an AUC = 0.81 (p < 0.001) to distinguish AMI from stable CAD patients. A significant negative correlation between Long RECK and triglycerides in CTR group and a positive correlation in the AMI group was found. The combined evaluation of Long and Short RECK expression levels is a potential genomic biomarker for the discrimination of AMI from CAD patients. Our results underline the relevance of deeper studies on the expression of these two splice variants to elucidate their functional role in CAD development and progression.

10-YEAR DYNAMIC OF FREQUENCY, USED DOSES AND ORIGINAL AND GENERIC FORMS OF MAIN DRUG GROUPS IN CORONARY HEART DISEASE REGISTRY

Abstract Objective: To assess dynamics of reception frequency, used doses and use of original and generic forms of antiplatelet drugs, statins, beta-blockers, ACE-inhibitors/ARBs in stable coronary heart disease (CHD) patients in 2004–2014 within the CHD registry. Design and method: Patients with angiographically confirmed in 2004–2007 CHD, who came for a follow-up visit in 2010 (n = 303) and in 2014 (n = 125) were included. Results: Statins were taken by 7.6% of patients prior to hospitalization and by 86.5% of patients at discharge, antiplatelet drugs by 68% and 96%, beta-blockers by 24,8% and 94%, and ACE-inhibitors by 19% and 83% of patients, respectively (p &lt; 0.001). Statins were taken by 67% and 70% of patients 4 and 7 years after discharge, respectively, antiplatelet drugs by 80% and 90%, beta-blockers by 80% and 75%, ACE-inhibitors by 66% and 65% of patients, respectively. The main 4 groups of drugs for secondary prevention of CHD were taken by 15% of patients prior to hospitalization, by 69% of patients at discharge (p &lt; 0.001), by 41% 4 years, and by 35% 7 years after discharge (p &lt; 0.01). From 2004 to 2014 all groups of drugs with an exception of antiplatelets were used in low and medium doses with an increase in the use of generic forms, especially for statins (76%). Conclusions: Frequency of assignment of beta-blockers, ACE-inhibitors/ARBs and statins in patients with stable CHD was low prior to hospitalization, increased during their hospital stay and decreased 4 and 7 years after discharge. Throughout these 10 years all drugs were used in medium and low doses, with an increase in the use of generic forms.

Effects of salvianolate on microcirculatory disturbance in patients with stable coronary heart disease: study protocol for a randomized controlled trial

BackgroundObstruction of coronary microcirculation can lead to myocardial ischemia and poor prognosis. Salvianolate exerts cardiovascular protection at cellular levels. However, no studies have confirmed the effect of salvianolate on stable coronary heart disease (CHD) with high fractional flow reserve (FFR) and myocardial microcirculatory disturbances.Methods/designThis study will enroll 78 patients who have stable coronary disease with 50 to 70% stenosis in major coronary arteries and whose FFR > 0.80 and index of microcirculatory resistance (IMR) > 25. Patients will be randomly divided into the salvianolate group or the placebo group. After above evaluations, salvianolate 200 mg will be intravenously dripped immediately for the next 30 min and subsequent 7 days in the salvianolate group, and matching 0.9% normal saline will be arranged in the placebo group. IMR will be reevaluated in immediate phase after first 30 min of salvianolate or placebo treatment. The primary end point will be the IMR change in this phase, and the secondary end points will be the total ischemic burden assessed by the Seattle angina scale, quality of life scale, Holter electrocardiography, and 6-min walk test after 7 days before discharge.DiscussionThis study will firstly clarify the improvement effect of salvianolate on coronary microcirculation and provide an effective treatment method for stable CHD patients with high FFR and myocardial microcirculatory disturbance.Trial registrationChinese Clinical Trial Registry ChiCTR1800018772. Registered on 9 October 2018 and updated on 2 March 2020

Dysregulation of serum miR-361-5p serves as a biomarker to predict disease onset and short-term prognosis in acute coronary syndrome patients

BackgroundSerum microRNAs (miRNAs) have been used as novel biomarkers for various diseases, including acute coronary syndrome (ACS). This study aimed to investigate the expression and clinical significance of microRNA-361-5p (miR-361-5p) in patients with ACS.MethodsThis study included 118 ACS patients, 78 patients with stable coronary heart disease (SCHD) and 66 healthy controls. MiR-361-5p expression was measured by qRT-PCR. The diagnostic value of miR-361-5p was evaluated by the ROC analysis. A 30-day follow-up was performed for the patients from hospitalization, and Kaplan–Meier curves and logistics analysis were used to evaluate the ability of miR-361-5p to predict the occurrence of major adverse cardiac events (MACE). ELISA kits were used to detect the levels of endothelial dysfunction (ED) markers, including vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1) and E-selectin.ResultsThe expression of miR-361-5p was significantly increased in patients with SCHD and ACS, and positively correlated with Gensini scores. Serum miR-361-5p expression had a high diagnostic accuracy for distinguishing ACS from health controls and SCHD patients. ACS patients with high expression of miR-361-5p had a higher probability of developing MACE. MiR-361-5p expression was an independent risk factor for the occurrence of MACE in ACS patients, and was positively correlated with the levels of VCAM-1, ICAM-1 and E-selectin.ConclusionAll data indicated that miR-361-5p expression was significantly increased in ACS patients. Aberrant miR-361-5p expression in ACS might be a candidate biomarker for ACS diagnosis and the the prediction of MACE onset.

Study on Inflammation and Rehabilitation of Patients with Coronary Heart Disease after Percutaneous Coronary Intervention

In order to prevent the inflammatory reaction caused by vascular wall injury after percutaneous coronary intervention treatment, affecting the therapeutic effect and rehabilitation, this study will select 54 patients with coronary heart disease and then randomly divided them into two groups to observe and compare inflammatory factors and their connection with postoperative thrombolysis in myocardial infarction frame count, the factors include interleukin-6, interleukin-9, interleukin-17A. It has been found that part of factors was elevated after surgery of elective percutaneous coronary intervention for stable coronary heart disease patients, suggesting that percutaneous coronary intervention may induce inflammatory reactions. High level of local inflammatory factors interleukin-6, helper T cells 17 may affect the forward arterial blood flow after interventional intervention. Thrombus aspiration can reduce the occurrence of slow or no reflow in patients with thrombotic load, increase coronary perfusion, improve postoperative cardiac function, and is expected to reduce heart attacks. In patients with coronary heart disease, the expression of inflammatory factors increases with the severity of coronary heart disease and the severity of coronary atherosclerosis. The level of inflammatory factors is correlated with the degree of coronary artery disease, which may promote the progression of coronary lesions. Rehabilitation therapy of traditional Chinese and Western medicine is necessary for patients with coronary heart disease after percutaneous coronary intervention. Active rehabilitation therapy is of great significance in improving the patient’s exercise tolerance, reducing the incidence of cardiovascular adverse events, reducing complications and improving patient’s quality of life.

Исследование ISCHEMIA. Взаимоотношение консервативного и интервенционного подходов к лечению стабильной ишемической болезни сердца. Ишемия миокарда при необструктивном поражении коронарных артерий (INOCA)

Introduction. Approaches to the stable coronary heart disease (CHD) treatment have been the subject to debate a long time. One of the fi rst and fundamental studies in the treatment of stable coronary heart disease patients is the COURAGE trial, which showed the advantage of rational drug therapy in comparison with percutaneous intervention in such patients. However, the CHD high prevalence with medical and social signifi cance necessitate the future consideration of the relationship between medical, that is conservative, and invasive approaches in treatment of this disease. It was particularly the focus of the recently completed multicentre ISCHEMIA trial. Another urgent problem of modern cardiology is myocardial ischemia in non-obstructive (&lt;50% luminal occlusion) coronary arteries (INOCA) identifi ed in approximately 70% of patients who underwent coronary angiography. Aim of the research. Analysis of the available data on the management of stable CHD patients based on the ISCHEMIA trial data and review of publications on the INOCA problem. Results. In the ISCHEMIA trial, the occurrence rate of the primary outcome (cardiovascular death, myocardial infarction (MI), resuscitated cardiac arrest, hospitalization for chronic heart failure) was 13.3% in the routine invasive strategy group and 15.5% in the conservative strategy group (p = 0.34). The occurrence rate of the main secondary outcomes also did not differ between the groups signifi cantly. Quality of life in the invasive group was higher only in patients who had angina at baseline. The study subanalysis demonstrated that borderline left coronary artery stenosis is associated with a poor prognosis, and an invasive strategy relieves the angina symptoms. Women who participated in the ISCHEMIA trial had a higher incidence of angina attacks, despite less extensive coronary arteries (CA) lesions and less severe ischemia manifestations than men. Among patients with stable CHD accompanied with moderate to severe ischemia and severe chronic kidney disease patients, no evidence for the benefi t of the initial invasive strategy in reducing the risk of death or nonfatal myocardial infarction compared to the conservative strategy was found. As for ischemia in non-obstructive coronary arteries (INOCA), it is diagnosed in at least one in five patients who have undergone coronary angiography. This requires the search for new diagnostic methods, verifi cation of risk factors, causes, and optimal treatment approaches. Conclusion. The ISCHEMIA trial data demonstrated the necessity for a more careful selection of patients with stable CHD for invasive treatment, taking into account the angina pectoris severity and modern antianginal therapy possibilities. Management of patients with myocardial ischemia accompanied by non-obstructive CA lesions should be carried out on the basis of the EAPCI Expert Consensus Document on Ischaemia with INOCA (2020) which discusses the genesis of angina, as well as the diagnosis and treatment of this condition.

The coincidence of low vitamin K status and high expression of growth differentiation factor 15 may indicate increased mortality risk in stable coronary heart disease patients

Background and aimsMatrix Gla protein (MGP) is a natural inhibitor of vascular calcification critically dependent on circulating vitamin K status. Growth differentiation factor 15 (GDF-15) is a regulatory cytokine mainly of the inflammatory and angiogenesis pathways, but potentially also involved in bone mineralization. We sought to determine whether these two circulating biomarkers jointly influenced morbidity and mortality risk in patients with chronic coronary heart disease (CHD). Methods and results894 patients ≥6 months after myocardial infarction and/or coronary revascularization at baseline were followed in a prospective study. All-cause and cardiovascular mortality, non-fatal cardiovascular events (myocardial infarction, stroke, any revascularization), and hospitalization for heart failure (HF) were followed as outcomes. Desphospho-uncarboxylated MGP (dp-ucMGP) was used as a biomarker of vitamin K status.Both, increased concentrations of dp-ucMGP (≥884 pmol/L) and GDF-15 (≥1339 pg/mL) were identified as independent predictors of 5-year all-cause or cardiovascular mortality. However, their coincidence further increased mortality risk. The highest risk was observed in patients with high dp-ucMGP plus high GDF-15, not only when compared with those with “normal” concentrations of both biomarkers [HR 5.51 (95% CI 2.91–10.44), p < 0.0001 and 6.79 (95% CI 3.06–15.08), p < 0.0001 for all-cause and cardiovascular mortality, respectively], but even when compared with patients with only one factor increased. This pattern was less convincing with non-fatal cardiovascular events or hospitalization for HF. ConclusionsThe individual coincidence of low vitamin K status (high dp-ucMGP) and high GDF-15 expression predicts poor survival of stable CHD patients.

Matrix Metalloproteinases as Biomarkers of Atherosclerotic Plaque Instability.

Matrix metalloproteinases (MMPs) are a family of zinc-dependent endopeptidases responsible for tissue remodeling and degradation of extracellular matrix (ECM) proteins. MMPs may modulate various cellular and signaling pathways in atherosclerosis responsible for progression and rupture of atherosclerotic plaques. The effect of MMPs polymorphisms and the expression of MMPs in both the atherosclerotic plaque and plasma was shown. They are independent predictors of atherosclerotic plaque instability in stable coronary heart disease (CHD) patients. Increased levels of MMPs in patients with advanced cardiovascular disease (CAD) and acute coronary syndrome (ACS) was associated with future risk of cardiovascular events. These data confirm that MMPs may be biomarkers in plaque instability as they target in potential drug therapies for atherosclerosis. They provide important prognostic information, independent of traditional risk factors, and may turn out to be useful in improving risk stratification.

An Attempt to Accord the Quality of Therapy of Stable Coronary Heart Disease Patients with Current Clinical Guidelines (ALIGN study): Design and the First Results

Aim. To assess the quality of therapy in stable coronary heart disease (CHD) patients, who first sought consultation in the specialized cardiology department of the research center, and try to adjust the therapy in accordance with current clinical guidelines, paying special attention to achieving the target levels of blood pressure, low-density lipoprotein cholesterol (LDL), and glycosylated hemoglobin (in patients with diabetes mellitus), increasing exercise tolerance and improving the quality of life (QL).Material and methods. The ALIGN study is an integral part of the PROFILE outpatient registry. ALIGN study included all patients with verified coronary heart disease who came for consultation to the specialized institution for the first time or for the first time in more than the last 3 years. Patients have been recruited from December 01, 2017 to December 31, 2019. The study consisted of 4 visits: the first-time visit – inclusion in the study (V0), when drug therapy, QL, and adherence were evaluated, and therapy correction was made in accordance with clinical guidelines. In 3 months (V1) the target values of clinical and laboratory parameters were estimated. The third visit (V2) was planned to take place 1 year after the first visit with reevaluation of QL and patients' adherence to treatment, and effectiveness of the therapy. The fourth visit (V3)/telephone contact was planned in 2 years after the first visit to assess life status, get information about complications and therapy.Results. 389 people were included in the PROFILE registry for the specified period of time, 79 had a verified diagnosis of CHD, and 71 patients were included in the ALIGN study: 55 men (aged of 68.7±8.96 years) and 16 women (aged of 67.5±8.08 years). Arterial hypertension was registered in 90.1% of patients, stable angina class I-III – in 62%, 47.9% of patients had a history of acute myocardial infarction (AMI), 52.1% had percutaneous coronary intervention, 15.5% of patients had coronary artery bypass graft, chronic heart failure was detected in 40.8%, diabetes mellitus – in 21.1%, atrial fibrillation – in 15.5% of patients. Lipid-lowering drugs were taken by 53 (74.6%) patients, but only 21 (29.6%) achieved the target values of LDL cholesterol. Angiotensin-converting enzyme inhibitors were taken by 34 patients (47.9%), and angiotensin receptor blockers by 15 (21%) of patients, 47 (66.2%) patients took beta-blockers, antiplatelet agents were taken by 61 people, and anticoagulants by 10 patients. Patients who had a history of AMI had been prescribed BB in 88%, statins – in 90%, and renin-angiotensin-aldosterone system (RAAS) blockers – in 80% of cases.Conclusions. Initial quality of therapy for patients with stable CHD did not fully match the clinical guidelines: a quarter of patients did not receive lipidlowering therapy, and target levels of LDL cholesterol were achieved only in one third of patients. Among patients who had a history of AMI, every fifth patient did not receive RAAS blockers.

Immature Platelet Level in Stable Coronary Heart Disease (CHD) Patients with Diabetes Mellitus compared to Stable CHD Patients without Diabetes Mellitus

Coronary heart disease (CHD) causes high mortality and morbidity in many countries. Immature platelet reactivity is one of the major causes of CHD thrombus formation due to its larger size and stronger aggregation properties than normal platelets. Though still controversial, diabetes mellitus (DM), which is one of the CHD risk factors, is mentioned to have a strong association with a high immature platelet level. Since studies on immature platelet in stable CHD are limited, the authors intended to search for the difference between immature platelet level in DM and non-DM patients with stable CHD. This research was an observational analytic study with a cross-sectional design; 31 samples of CHD patients who underwent coronary catheterization were obtained. The characteristics of the data was collected by completing a pre-operation form and the immature platelets were counted using an automated cytometry tool, SYSMEX XE 2100. They were analyzed using Pearson’s statistical analysis. There was no significant correlation between the immature platelet levels of DM and non-DM patients with stable CHD (p>0.05). There was a significant positive correlation between HbA1C and the immature platelet level (Immature Platelet Fraction, p <0.05; Immature Platelet Count, p <0.01) in stable CHD patients.

The efficacy of secondary prevention programs with remote support in coronary heart disease patients with abdominal obesity

To assess the impact of 2 preventive counselling programs with subsequent remote support in CHD patients with concomitant obesity. A prospective randomized parallel-group study in 120 stable CHD patients hospitalized for elective coronary revascularization who were from 40 to 65 years old and had concomitant obesity. Patients were randomized (1:1:1) into 3 groups (n=40 each). Before discharge, Groups 1 and 2 received a single-session comprehensive counselling with focus on diet followed by remote counselling by phone (Group 1) or via text messages (Group 2). Remote counselling was delivered weekly (Months 1-3) and then monthly (Months 4-6). Group 3 received only standard advice from their attending physicians. The patients were followed for 12 months with assessment of adiposity measures, self-reported dietary patterns, physical activity (IPAQ questionnaire), smoking status, blood pressure (BP), fasting blood glucose, lipids and C-reactive protein (CRP) levels, as well as of clinical events. At 1 year of follow-up, the patients from both intervention groups showed a marked improvement of several risk factors including obesity: the body mass index was reduced by 1.48±0.13 kg/m² in Group 1 and by 1.53±0.18 kg/m² in Group 2; the waist circumference went down by 7.62±0.49 and by 7.41±0.74 cm, respectively; the height-normalized fat mass decreased by 4.66±0.40 kg and 5.98±0.63 kg, respectively (all P values are &lt;0.01 vs corresponding changes in the control group). These changes were coupled with more healthy dietary patterns and less sedentary lifestyles in both intervention groups: the proportion of patients with low activity level fell from 87.5% to 2.5% in Group 1 and from 80% to 10% in Group 2 (both p values &lt;0.01 vs control). In Group 1, BP decreased by 18.08±2.20 mmHg (systolic) and 8.56±1.61 mmHg (diastolic); both р values &lt;0.01 vs Group 3. In Group 2 systolic BP dropped by only 11.95±2.50 mmHg (non-significant) and diastolic BP by 6.33±1.52 mmHg (р&lt;0.05 vs control). The proportion of smokers went down from 30% to 5% in Group 1 and from 22.5% to 0% in Group 2 (both p values &lt;0.01 vs control). The fasting glucose levels decreased by 0.21±0.20 mmol/L in Group 1 and by 0.48±0.25 mmol/L in Group 2 (&lt;0.01 vs control, both), but there were no meaningful improvements in blood lipids or CRP. Long-term (6 months) secondary prevention programs incorporating remote support technologies result into sustained improvement of key secondary prevention indicators in obese CHD patients, irrespective of the support modality (by phone or via electronic messaging).