Type Of Ischemic Heart Disease Research Articles

Spectrum of Ischemic Heart Disease Throughout a Woman's Life Cycle.

Ischemic heart disease (IHD) is the leading cause of morbidity and mortality in both genders; however, young women fare the worst, likely reflecting the more complex spectrum of IHD in women when compared to men. Substantial sex-based differences exist in the underlying risk factors, risk enhancers, presentation, diagnosis, and pathophysiology of IHD that are mainly attributed to the influence of female sex hormones. This article reviews the spectrum of IHD including obstructive epicardial coronary artery disease (CAD), myocardial infarction with no obstructive coronary artery disease, ischemia with no obstructive coronary artery disease, spontaneous coronary artery dissection, coronary microvascular dysfunction, vasospastic angina, and coronary thrombosis/embolism that occur in women throughout various stages of their life cycle. We aim to update clinicians on the diagnosis and management of these various types of IHD and highlight where further randomized controlled studies are needed to determine optimal treatment and inform guideline-directed medical therapy.

Chitosan-sodium alginate-polyethylene glycol-Ally isothiocyante nanocomposites ameliorates isoproterenol-induced myocardial infarction in rats.

Myocardial infarction (MI) is a common type of ischemic heart disease that affects millions of people worldwide. In recent times, nanotechnology has become a very promising field with immense applications. The current exploration was conducted to synthesize the chitosan-sodium alginate-polyethylene glycol-Ally isothiocyanate nanocomposites (CSP-AIso-NCs) and evaluate their beneficial roles against the isoproterenol (ISO)-induced MI in rats. The CSP-AIso-NCs were prepared and characterized by several characterization techniques. The MI was initiated in the rats by the administration of 85 mg/kg of ISO for 2 days and treated with 10 and 20 mg/kg of CSP-AIso-NCs for 1 month. The changes in heart weight and bodyweight were measured. The cardiac function markers were assessed with echocardiography. The lipid profiles, Na+, K+, and Ca2+ ions, cardiac biomarkers, antioxidant parameters, and inflammatory cytokines were assessed using corresponding assay kits. The histopathological study was done on the heart tissues. The UV spectral analysis revealed the maximum peak at 208 nm, which confirms the formation of CSP-AIso-NCs. The FT-IR analysis revealed the occurrence of different functional groups, and the crystallinity of the CSP-AIso-NCs was proved by the XRD analysis. DLS analysis indicated the size of the CSP-AIso-NCs at 146.50 nm. The CSP-AIso-NCs treatment increased the bodyweight and decreased the HW/BW ratio in the MI rats. The status of lipids was reduced, and HDL was elevated in the CSP-AIso-NCs administered to MI rats. CSP-AIso-NCs decreased the LVEDs, LVEDd, and NT-proBNP and increased the LVEF level. The oxidative stress markers were decreased, and the antioxidants were increased by the CSP-AIso-NCs treatment in the MI rats. The Na+ and Ca+ ions were reduced, and the K+ ions were increased by the CSP-AIso-NCs. The interleukin-1β and tumor necrosis factor-α were also depleted, and Nrf-2 was improved in the CSP-AIso-NCs administered to MI rats. The histological study revealed the ameliorative effects of CSP-AIso-NCs. Overall, our outcomes revealed that the CSP-AIso-NCs are effective against the ISO-induced MI rats. Hence, it could be a hopeful therapeutic nanomedicine for MI treatment.

Abstract P3122: Rap1gap2 Fine-mapping For Causal Variants Of Prevalent Ischemic Heart Disease Among Diverse Postmenopausal Women From The Women’s Health Initiative

Background: RAP1GAP2 is a GTP-ase activating protein that regulates secretion of dense granules from platelets at sites of endothelial damage, eliciting maximal platelet aggregation, a hallmark of ischemic events. Our published sex-stratified GWAS significantly associated RAP1GAP2 (Chr 17p13.3) variants with ischemic heart disease (IHD) case status and increased mortality risk among women but not men. We hypothesize that RAP1GAP2 genetic variation may demonstrate causal effects for the increased risk of IHD case status among postmenopausal women. Purpose: To fine-map RAP1GAP2 to identify causal markers for risk of IHD case status among racially and ethnically diverse postmenopausal women. Methods: We performed secondary analysis of 8,699 postmenopausal women from the Women’s Health Initiative (Observational cohort) who have publicly available genome-wide and densely imputed genotype data via NIH/dbGap (Affymetrix Affy 6.0). IHD case status was defined as prevalence of myocardial infarction, stroke, angina, congestive heart failure, peripheral arterial disease, or atherosclerotic interventional procedures at or prior to baseline; non-IHD controls were absent of all IHD criteria. PCA and Efficient Local Ancestry Inference (ELAI) were used to infer global and SNP-wise local ancestries. For each SNP, we performed SNP-wise logistic regression modeling, calibrating for the confounding effects of local and global ancestries and controlling for major cardiac risk factors, hormone replacement and cardiac medication exposure, IHD type (obstructive, nonobstructive), eGFR, education, income, and occupation. Results: Mean age 64.08 (±7.74) for a sample of 3,125 (36%) non-Hispanic Whites, 3,841 (44%) African Americans and 1,733 (20%) Hispanic Americans. We observed 1,932 IHD cases and 6,767 non-IHD controls. Novel PCA and ELAI uncovered strong spatial global population structure, varying ancestries, and ancestry-genotype correlations across genomic regions. Fine mapping analyses are underway and results will be available at time of presentation. Conclusions: Identifying sex- and ancestry-related causal genetic factors can serve as future targets for precision prevention of IHD among postmenopausal women.

Melatonin Engineered Adipose-Derived Biomimetic Nanovesicles Regulate Mitochondrial Functions and Promote Myocardial Repair in Myocardial Infarction.

Myocardial infarction (MI), one type of ischemic heart disease, is a major cause of disability and mortality worldwide. Currently, extracellular vesicles (EVs) derived from adipose-derived stem cells (ADSC) have been proven to be a potentially promising therapeutic treatment for MI. However, the inconvenience of isolation, the low productivity, and the high cost of EVs greatly limits their application in clinic. In this study, we constructed novel biomimetic ADSC-derived nanovesicles (ADSC NVs) to achieve cell-free therapy for MI. Here, we firstly developed a novel Mel@NVs delivery system consisting of engineered ADSC NVs with melatonin (Mel). Then, the characterization and properties of Mel@NVs were performed. The effect of Mel@NVs on cellular oxidative stress and myocardial infarction repair was conducted. The results showed that Mel@NVs treatment under ischemia mimic condition reduced cell apoptosis from 42.59 ± 2.69% to 13.88 ± 1.77%. Moreover, this novel engineered Mel@NVs could ameliorate excessive ROS generation, promote microvessel formation, and attenuate cardiac fibrosis, which further alleviates mitochondrial dysfunction and finally enhance myocardial repair. Hence, the engineered NVs show a potential strategy for MI therapy.

Brownian movement analyzed from psychophysiological measures associated with ischemic heart disease and Alzheimer’s disease

There are several coronary diseases that human beings can suffer from, which in themselves generate health deterioration and can lead to the development of other diseases that diminish the quality of life. Ischemic diseases are unique in that they are evidenced by blockages generated by the accumulation of fat that impedes circulation, triggering heart and brain-related problems. By means of fractional Brownian motion in relation to Hurst’s parameter, an analysis of a data of 137 patients aged between 30 and 71 years, who present some type of ischemic disease such as mixed, restricted, effort angina and angina pectoris, is performed. The data used was European, which is found in the PhysioNet open-access medical research data repository, managed by the Massachusetts Institute of Technology Computational Physiology Laboratory. This data shows the Hurst coefficient calculations associated with each type of ischemic heart disease.

Evaluation of left ventricular systolic function in patients with different types of ischemic heart disease by two-dimensional speckle tracking imaging

BackgroundThe purpose of this study was to evaluate left ventricular systolic function in patients with different types of ischemic heart disease using two-dimensional speckle tracking imaging (2D-STI).MethodsWe retrospectively studied patients who were admitted to Peking University Third Hospital from January 2011 to December 2017 due to chest tightness and chest pain. Two hundred forty-two patients were divided into control group, CMD group and obstructive CAD group. The main coronary artery stenosis was confirmed by coronary angiography or coronary computed tomography and coronary flow reserve (CFR) in patients was measured by transthoracic Doppler echocardiography. Left ventricular strain and strain rate (SR) measured by 2D-STI. Cardiac structure and function were measured by conventional echocardiography.ResultsConventional echocardiography showed that there was no significant difference in cardiac structure and function among the three groups (P > 0.05). Moreover, the longitudinal strain (LS) of each ventricular wall in CMD group was notably lower than that in control group (P < 0.01). In addition, global longitudinal SR and longitudinal SR in CMD group and obstructive CAD group were obviously lower than those in control group (P < 0.01). GLS, endocardial LS and epicardial LS were negatively correlated with CFR (P < 0.01).ConclusionsEarly left ventricular systolic dysfunction was found in patients with CMD and patients with obstructive CAD, with similar degree. CFR is an independent influencing factor of GLS. GLS and stratified LS have certain diagnostic value for CMD.

Cancer comorbidity in patients with non-obstructive coronary artery disease: Depressive symptoms related to C-reactive protein

BackgroundBased on guidelines for cardiovascular risk assessment among non-cancer populations, depression and anxiety can be seen as risk factors for CVD, on top of cardiotoxic cancer treatment and traditional CVD risk factors among cancer survivors. Increased inflammation can be a shared potential pathophysiological mechanism, as higher levels of inflammation (like C-reactive protein, CRP) are known associates of depression and anxiety. In turn, increased inflammation is involved in the pathogenesis of CVDs. Furthermore, both cancer and cancer treatment including chemotherapy and radiation can lead to elevated levels of inflammation. We will therefore examine whether the relation between depression and anxiety with inflammatory markers among patients with either CVD or cancer is different from those with both conditions. MethodThe TweeSteden Mild Stenosis (TWIST) study among patients with non-obstructive coronary artery disease (NOCAD, luminal narrowing <60%), a type of ischemic heart disease, previously reported a significant association between depressive symptoms and increased inflammation (measured by high-sensitive (hs)CRP). Of the included NOCAD-patients, 6% had a history of cancer. The TWIST patient sample was therefore used to explore whether the association between depression and elevated inflammation (hsCRP) was similar for NOCAD-patients with and without a history of cancer. ResultsThe association between depressive symptoms and increased hsCRP levels is stronger among NOCAD-patients with a history of cancer than among NOCAD-patients without a history of cancer. Furthermore, whereas this relation is mediated by lifestyle factors among NOCAD-patients without cancer, the association remained significant after adjusting for BMI, smoking, and physical activity among NOCAD-patients with a history of cancer. ConclusionThe stronger association between depression and hsCRP among NOCAD-patients with a history of cancer indicates that there may be an additive or synergistic effect of having NOCAD and cancer for general inflammation and possibly depression.

Is Chemotherapy‐Induced Cardiomyopathy Caused by Myocardial Ischemia?

Over the last 50 years progress has been made in treating childhood and adult solid and hematological tumors. One commonly used chemotherapeutic agent is doxorubicin (DOX), an anthracycline antitumor antibiotic, which was discovered in early 1960s. Anthracycline (ANT) chemotherapy alone or in combination with other chemotherapeutic agents markedly improves the survival rate of cancer patients, particularly among children, where survival rates have more than doubled over 5 decades. However, the use of ANT chemotherapy is a double‐edged sword in that it can produce chemotherapy induced cardiac dysfunction (CRCD), which can cause death in 50% of the patients with who present with the cardiomyopathy. We hypothesized, that one of the causes for CRGD is a reduction in myocardial blood flow (MBF) that leads to cardiac myocyte hypoxia, producing small areas of ischemia and myocyte damage. We also hypothesize that increasing MBF by the coronary vasodilator chromonar prevents cardiomyocytes from hypoxic damage.To test these hypotheses, we treated mice genetically engineered to show cardiac myocyte fluorescence if the cells are hypoxic (hypoxia fate mapping [HFM]) with DOX for 6 weeks (group 1, N=8) and Dox + Chromonar for 6 weeks (group 2 N=8). Five weeks after treatment we started tamoxifen for 5 days to activate the HFM protocol. Tamoxifen induces Cre in cardiac myocytes and hypoxia activates a program that results in the expression of td‐tomato only in hypoxic cardiac myocytes. In tissue sections, hypoxic cardiac myocytes are visualized by fluorescence microscopy. Cardiac function was measured by ultrasound and MBF was measured with contrast echocardiography.Six weeks after DOX treatment many hypoxic myocytes were observed in the myocardium. Cardiac function was significantly decreased at the end of DOX treatment (% ejection fraction EF=39±3) compared to baseline (62±5.8%). Simultaneous administration of chromonar prevents the cardiomyocytes from hypoxic damage and prevents cardiac dysfunction development. %EF was 58±6 at the end of the chemotherapy. Chromonar also significantly increased MBF in group 2 mice compared to group 1 (P&lt;0.05).Based on these data CRCD may be a type of ischemic heart disease where the treatment reduces MBF, which leads cardiomyocyte hypoxia, and causes progressive, accumulative cardiac injury. Moreover, increasing myocardial blood flow by chromonar prevents the cardiomyocytes from hypoxic damage and development of CRCD.Support or Funding InformationNIH, NHLBIPanel A shows the relationship between myocardial blood flow and cardiac work 6 weeks after DOX and DOX + Chromonar treatment. Panel B shows ejection fraction changes in DOX +Chromonar (Group 2 mice)Figure 1

Effect of traditional Chinese medicine in attenuating coronary heart disease and main risk factors by regulating gut micro-biota

Ischemic heart disease has became the world's most common deadly disease, and coronary heart disease(CHD) is the most common type of ischemic heart disease. The pathological mechanism of CHD has not been fully elucidated. In recent years, scientific studies have found that gut micro-biota are closely related to the occurrence and development of CHD, and CHD could be intervened by regulating gut micro-biota because of the correlation between CHD and intermediate metabolite of gut micro-biota. Current intervention strategies mainly include probiotics supplementation, reduction of TMAO and increase of SCFAs, which can achieve the effect of stabilizing plaques, and controlling blood pressure, blood lipids, blood glucose and obesity. Traditional Chinese medicine(TCM) has the multi-component and multi-target effects, which is correlated to its role in the prevention and treatment of CHD. This paper summarizes the domestic and foreign researches on the effect of TCM in attenuating CHD and its main risk factors by regulating gut micro-biota. The article aims to explore the correlation between gut micro-biota and CHD, and propose three main intervention strategies. Furthermore, the research progress of TCM on CHD, hypertension, dyslipidemia, hyperglycemia and obesity is reviewed by the categories of Chinese medicine monomer and compound, in the hope to provide more theoretical basis for TCM therapy on CHD and guidance for further studies in this field.

Study of Stability and Reproducibility of Cardiac Troponin I Based on FET Sensor

In recent years, our research team has successfully detected a variety of protein biomarkers for cardiovascular diseases (CVD). The most common type of ischemic heart disease is mainly caused by acute myocardial infarction (AMI, also known as heart attack) usually presented in an acute manner and requires immediate emergency treatment. One of the most important protein biomarkers for AMI in the blood is cardiac troponin I (cTnI). However, in order to develop a cTnI FET sensor that allows patients to track CVD for a long term and often, the instrument must have better sensitivity, stability and reproducibility. In this study, the purpose is understanding the mechanisms contributing to reduce the disturbance in the system. Firstly, the better stability are obtained by adjusting the drain voltage and the gate voltage of the metal oxide semiconductor field effect transistor (MOSFET). It can also be a bias condition for future cTnI FET sensor operation. Although our research team has developed a handheld biomedical sensor, it can not monitor the electrical signal by setting different gate voltages simultaneously. Therefore, Agilent B1530/B1500A is used for measurement. In addition, the Protein detection of different anti-cTnI concentrations also have an great influence on the sensitivity and stability of biomedical sensors. The results of this study can be used as an important basis for optimizing hand-held biomedical sensors in the future. Keyword: Troponin I、Bias condition、Sensitivity、Stability、Reproducibility

Association between tamoxifen use and acute myocardial infarction in women with breast cancer.

The relationship between tamoxifen use and acute myocardial infarction in women with breast cancer remains uncertain. The goal of the study was to assess whether tamoxifen use could be associated with acute myocardial infarction in women with breast cancer in Taiwan.A population-based case–control study was conducted to analyze the database of the Taiwan National Health Insurance Program. Totally, 489 women with breast cancer aged 20 to 84 years having the first episode of acute myocardial infarction from 2000 to 2011 were found as the cases. In addition, 1718 women with breast cancer aged 20 to 84 years without any type of ischemic heart disease were selected as the matched controls. Ever use of tamoxifen was classified as the studied women who had at least a prescription for tamoxifen before the index date. Never use of tamoxifen was classified as the studied women who never had a prescription for tamoxifen before the index date. We used the multivariable logistic regression model to estimate the odds ratio (OR) and 95% confidence interval (CI) for acute myocardial infarction associated with tamoxifen use.In a multivariable-adjusted analysis, women with acute myocardial infarction were 1.71 times more likely to be exposed to tamoxifen than those women without acute myocardial infarction (adjusted OR 1.71, 95% CI 1.38–2.13).The odds of tamoxifen use are 1.71 times higher in women with acute myocardial infarction versus those women without acute myocardial infarction in Taiwan.

GW29-e1815 The evaluation of left ventricular systolic function in different types of ischemic heart disease by two-dimensional speckle-tracking echocardiography

Coronary microvascular dysfunction (CMD) induced by abnormalities of coronary microcirculation and obstructive coronary artery disease (CAD) with epicardial coronary stenosis are two types of ischemic heart disease. Both CMD and obstructive CAD can induce ventricular remodeling, eventually

Inhibition of miR-182-5p protects cardiomyocytes from hypoxia-induced apoptosis by targeting CIAPIN1.

Myocardial infarction (MI), a type of ischemic heart disease, is generally accompanied by apoptosis of cardiomyocytes. MicroRNAs play the vital roles in the development and physiology of MI. Here, we established a downregulation model of miR-182-5p in H9c2 cells under hypoxic conditions to investigate the potential molecular mechanisms for miR-182-5p in hypoxia-induced cardiomyocyte apoptosis (HICA). RT-qPCR indicated that miR-182-5p levels exhibit a time-dependent increase in the rate of apoptosis induced by hypoxia. The results from the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) and LDH (lactate dehydrogenase) assays indicated that cardiomyocyte injury noticeably increased after exposure to hypoxia. Meanwhile, hypoxia dramatically increased the apoptosis rate [which was reflected in the results from the annexin V - propidium iodide (PI) assay], enhanced caspase-3 activity, and reduced the expression of Bcl-2. Downregulation of miR-182-5p can significantly reverse hypoxia-induced cardiomyocyte injury or apoptosis. Importantly, bioinformatic analysis and dual-luciferase reporter assay revealed that CIAPIN1 (cytokine-induced apoptosis inhibitor 1) was a direct functional target of miR-182-5p, and that inhibition of miR-182-5p can lead to an increase in CIAPIN1 expression at both the mRNA and protein levels. Furthermore, the knockdown of CIAPIN1 with small interfering RNAs (siRNAs) efficiently abolished the protective effects of miR-182-5p inhibitor on HICA, demonstrating that miR-182-5p plays a pro-apoptotic role in cardiomyocytes under hypoxic conditions by downregulating CIAPIN1. Collectively, our results demonstrate that miR-182-5p may serve an underlying target to prevent cardiomyocytes from hypoxia-induced injury or apoptosis.

FUNCTIONAL CLASSES AND CLINICAL CHARACTERISTICS OF CHRONIC HEART FAILURE IN PATIENTS WITH ATRIAL FIBRILLATION AND/OR FLUTTER AFTER RADIOFREQUENCY ABLATION

The combination of atrial fibrillation and/or flutter and chronic heart failure is a frequent problem for many patients. Radiofrequency ablation is effective in the strategy for controlling the rhythm of patients with atrial fibrillation and/or flutter, but always requires concomitant therapeutic support. The study involved 70 patients with atrial fibrillation and/or flutter after radiofrequency ablation which were divided into groups according to the functional class of chronic heart failure. Gender and age of patients; types of ischemic heart disease; stages of chronic heart failure; degrees of arterial hypertension; the form of atrial fibrillation and flutter; class EHRA; the presence of diabetes mellitus type 1 or 2 we evaluated. The female sex prevailed in the group of II functional class of chronic heart failure than in I functional class or III functional class. Ischemic heart disease, first of all angina of effort, in patients with III functional class of chronic heart failure was significantly more frequent. In group of III functional class of chronic heart failure there were significantly more patients with 3 degrees of arterial hypertension. Male patients, regardless of functional class of chronic heart failure, more often than females are conducted invasive methods of treatment for atrial fibrillation/flutter. With increasing of functional class of angina the functional class of chronic heart failure is increasing. Among patients II and III functional class of chronic heart failure prevails the arterial hypertension III degree, which may be a predictor of adverse prognosis.

DYSLIPIDEMIA AS A FACTOR FOR PROGRESSION OF RENAL OSTEODYSTROPHY AND CORONARY HEART DISEASE IN PATIENTS WITH CHRONIC KIDNEY DISEASE ON PERITONEAL DIALYSIS

Numerous studies of the last years focused on various links of pathogenesis and factors for progression of coronary heart disease (CHD) and chronic kidney disease (CKD) allowed to find intersection, such as progression of atherosclerosis or phosphorus and calcium and lipid imbalance, which lead to vascular calcareous infiltration, development of renal osteodystrophy and rising of cardiac risks.&#x0D; Purpose of the research: To define indicators of lipid exchange in patients on peritoneal dialysis which can be factors for progression of renal osteodystrophy and ischemic heart disease.&#x0D; Materials and methods. Indicators of lipid exchange, various types of renal osteodystrophy and clinical types of ischemic heart disease in 114 patients receiving peritoneal dialysis therapy in the Regional Clinical Center of Urology and Nephrology of V.I.Shapoval were analysed.&#x0D; Results. Having analysed changes in blood lipid profile of patients on peritoneal dialysis (PD), we found out a reliable growth of high-density lipoproteins (HDL) in a group of patients without signs of ischemic heart disease and in a group of patients having stable angina, whose primary types of renal osteodystrophy were osteoporosis and fibrous ostitis. Reliable differences had also very-low-density lipoproteins (VLDL) which also were the highest in a group of patients having stable angina without signs of cardiac decompensation. The average duration of PD treatment of patients of this group was 12,3 months.&#x0D; Conclusion. The results of the research confirmed that calcareous infiltration of vessels and heart valves on early stages of PD therapy is mainly caused by dyslipidemia and atherosclerotic changes and less by phosphorus and calcium imbalance which importance increases with duration of PD treatment.

Frequency of Risk Factors in Patients with Acute Myocardial Infarction

Introduction: Various risk factors contribute to the occurrence of acute myocardial infarction as the most serious type of ischemic heart disease and the leading cause of sudden death worldwide. Aim of the Study: The aim of this study was to assess the frequency of changeable and unchangeable risk factors in patients with acute myocardial infarction in the Republic of Srpska. Patients and Methods: This cross-sectional study included patients treated for acute myocardial infarction at the University Clinical Center of Banja Luka, in the period from January 1st to December 31st, 2011. The patients were from the municipalities of Banja Luka and Laktaši. We analyzed the following risk factors: hypertension, total cholesterol values, diabetes, increased body weight and obesity, smoking, family history and physical inactivity. Results: Out of 273 patients, the majority were male (64%), and there was a statistically significant difference between age and sex (p <0.01) of the respondents. The most common risk factor for both genders was hypertension (70.1%), while the least frequent risk factor was diabetes mellitus (25.6%). Smokers and ex-smokers accounted for 58.1%, with a statistical significance between men and women (p <0.01). The average BMI in both genders was in the overweight category (27.69 kg / m2). A positive family history was found in almost half of the respondents (49.4%), with a statistically significant difference between age groups and family history (p = 0.036). Conclusion: Acute myocardial infarction mainly affects men in their sixties, while women are averagely affected nine years later than men. The number one risk factor for both genders is hypertension. Given the large impact of risk factors on the occurrence of acute myocardial infarction, priority must be given to the prevention and control of the aforementioned, especially in the primary health care.

TIMELINE FOR THE DOUBLE ANTIPLATELET THERAPY. FACTS AND SUGGESTIONS

The review article provides with recent data on the crucial cardiology problems — duration of double antiplatelet therapy (DAPT) in patients with different types of ischemic heart disease. The analysis is provided of actual clinical guidelines on this issue, the results of recent clinical trials are highlighted, as of metaanalyses. Based on the results of international trials, the necessity postulated of thorough assessment of risk and safety for either prolongation or shortening of DAPT, and some possible indications provided for these changes in 12-month DAPT.

ROLE OF THE ANTIPLATELET DRUGS IN TREATMENT OF STABLE ANGINA: COMMON SENSE AND NON-RESOLVED ISSUES

Stable angina pectoris is the most prevalent type of ischemic heart disease. In its treatment, the main role play drugs that block adhesion and aggreagation of platelets — antiaggregants. Their role in prevention of cardiovascular complications in this kind of patients was confirmed by multiple large clinical trials. However, there is a plenty of antiaggregants with various mechanisms of effect, only two of them: acetylsalicylic acid and clopidogrel currently are recommended for continuous use for patients with stable IHD. Acetylsalicylic acid is in priority, and clopidogrel as an alternative in its intolerance. At the same time, lower prevalence of side effects, common for clopidogrel, makes the use of the drug more attractive. Many generics of the both drugs, invented recently, actualizes the comparative studies of these forms with the originals.

LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 IN CARDIOVASCULAR RISK STRATIFICATION AFTER CORONARY ANGIOPLASTY IN PATIENTS WITH TYPE 2 DIABETES: WHICH DECISION RULE THRESHOLD TO CHOOSE?

The research objective is to determine the posterior probability of adverse cardiovascular events after elective coronary intervention in patients with ischemic heart disease (IHD) associated with type 2 diabetes, at high level of lipoprotein-associated phospholipase A2 (Lp-PLA2) in blood serum, as well as to find out the optimal separation point value for this predictor, which increase allows to identify high risk with accuracy.Material and methods. The 12-month cohort observational study included 60 patients (78% of men and 22% of women) with IHD associated with type 2 diabetes, aged 48–78. At the beginning of the study, along with conventional diagnostic techniques typical of a specialized cardiology clinic, the state of carbohydrate and lipid metabolism was analyzed and the proinflammatory status was evaluated (including assessment of Lp-PLA2 concentration by ELISA). At the end of the study distant results of treatment were assessed. The following events were taken into account: death of cardiovascular events, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization (surgical, endovascular) due to restricture formation of a primary implanted stent or stricture formation of native coronary arteries, angina pectoris relapses.Results and discussion. The link between adverse cardiovascular events after elective percutaneous coronary intervention in patients with IHD type 2 diabetes-associated and high concentration of Lp-PLA2 in blood serum has been identified. Variation of the decision rule threshold on the performance curve has allowed to take Lp-PLA2 concentration of 983 ng/ml as a separation point. Accuracy of twoclass classification (determination of the posterior probability of adverse cardiovascular events) after identifying such separation point was characterized by 80% sensitivity and 100% specificity.Conclusion. The increase in the Lp-PLA2 concentration in blood serum (&gt;983 ng/ml) may be considered as a predictor of adverse cardiovascular events after elective percutaneous coronary intervention in patients with IHD associated with type 2 diabetes.

New Insights into the Role of Metformin Effects on Serum Omentin-1 Levels in Acute Myocardial Infarction: Cross-Sectional Study.

Background. Serum omentin-1 level was low in the most types of ischemic heart disease compared to normal subjects; it also dependently correlated with coronary heart disease; thus, omentin-1 is regarded as a novel biomarker in IHD. Objective. The aim of the present study was to establish the links between omentin-1 and acute myocardial infarction in metformin patients. Subjects and Methods. A cross-sectional study was performed on eighty-five patients with type II DM and acute MI. They are divided as follows: Group I, 62 patients with type II DM who received metformin prior to onset of acute MI; Group II, 23 patients with type II DM who did not receive metformin prior to onset of acute MI; and Group III, 30 normal healthy controls. Venous blood was drawn from each participant for determination of lipid profile, plasma omentin-1, cardiac troponin-I (cTn-I) and other routine tests. Results. Patients that presented with acute MI that received metformin show a significant difference in all biochemical parameters (p < 0.001); metformin increases serum omentin-1 level and decreases serum cardiac troponin-I level compared with control subjects and nonmetformin treated patients. Conclusion. Metformin pharmacotherapy increases omentin-1 serum levels and may be regarded as a potential agent in the prevention of the occurrences of acute MI in diabetic patients.