Young Coronary Heart Disease Patients Research Articles

Screening significance of systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) in coronary heart disease of symptomatic youth.

The incidence of coronary heart disease (CHD) in youth is rapidly increasing but difficultly recognized in the early stage. In this retrospective study, 194 CHD patients under the age of 45 who previously experienced chest pain symptoms and 170 non-CHD patients were included and demographic data were collected. Systemic inflammation index (SII) and systemic inflammation response index (SIRI) were increased in young CHD patients (p < 001). Spearman's correlation analysis showed that both SII and SIRI were negatively correlated with HDL and positively correlated with hypertension, Gensini score, and hsTnI. Logistic regression analysis indicated that SII and SIRI were independently associated with the presence of CHD in youth with chest pain symptoms. The area under the ROC curve (AUC) of the SII model for young CHD patients was 0.805 (0.728-0.869), and the sensitivity and specificity were 0.65 and 0.823, respectively. Meanwhile, the AUC for the SIRI model was 0.812 (0.739-0.872), and the sensitivity and specificity were 0.673 and 0.8022. The calibration curves of both SII and SIRI models are in good agreement with the actual curves. And the decision curves of both models indicated their clinical practicality. SII and SIRI are independent risk factors for CHD in young adults, which can quickly and effectively identify CHD patients among young adults who have previously experienced chest pain symptoms.

Levels of toll-like receptors 2 and 4 in serum of men with postinfarction cardiosclerosis and its relationship with antiphospholipid syndrome components

Annotation. There is a tendency for an increase of incidence of coronary heart disease (CHD) among young people, with the development of acute myocardial infarction (MI) in the absence of marked atherosclerosis and obstruction of the coronary arteries. Antiphospholipid syndrome (APS), cellular and humoral mediators of immunoinflammatory activation of endothelium are considered as factors of non-obstructive damage to the coronary vessels. New trigger factors for endothelial dysfunction, cardiac fibrosis, and myocardial hypertrophy include toll-like receptors (TLR2 and TLR4). Antiphospholipid antibodies may act as endogenous activators of toll-like receptors. The study of the association between APS components and expression of toll-like receptors in patients with CHD with postinfarction cardiosclerosis remains relevant. The aim is to study the levels of TLR2 and TLR4 and its relationship with APS components in men with postinfarction cardiosclerosis. 164 patients with stable CHD with postinfarction cardiosclerosis (100% of men, age 53.0±9.14 years) and 48 men of control group (without CHD) were examined. Levels of total antiphospholipid antibodies (aPL), antibodies to β2-glycoprotein 1 (anti-β2-GP 1) IgG and IgM, TLR2, TLR4 in serum were determined by ELISA. The studies were conducted in compliance with bioethical standards. Statistical processing of the results was performed in SPSS Statistics 22.0. Determined that men with postinfarction cardiosclerosis showed higher levels of TLR2 and TLR4 (in 1.8–2.2 times, p&lt;0.001) in serum than control group. Higher (in 1.2–1.4 times) levels of TLR2 and TLR4 were found in patients who underwent Q-MI, recurrent MI and had clinical manifestations of APS (stroke, transient ischemic attacks, livedo reticularis). An increase TLR2 and TLR4 levels was closely associated with an increase of aPL and anti-β2-GP 1 of IgG (r = | 0.31 - 0.51 |, p&lt;0.01). Thus, in men with postinfarction cardiosclerosis who had aPL and anti-β2-GP 1 IgG positivity had an unfavorable immunoinflammatory pattern, that characterized by increased expression of TLR2 and TLR4. The imbalance in TLR2 and TLR4 is more pronounced in young CHD patients and associated with Q-MI and recurrent MI.

Relationship of Interleukin-6 Trans-Signaling and Coronary Heart Disease in Young Adults: a Case-Control Study in Indonesia

Interleukin-6 (IL-6) has been reported to be related to coronary heart disease (CHD). It is proposed that the IL-6 trans-signaling pathway is responsible for the inflammatory effect in diseases, including CHD. In Asian countries, CHD tends to occur in younger age. However, no study has yet been done to assess the relationship between IL-6 trans-signaling pathway and young CHD patients in Indonesia. To assess whether there is a relationship between the levels of some components in the IL-6 trans-signaling pathway, including soluble interleukin-6 receptor (sIL-6R), soluble glycoprotein 130 (sgp130), and intercellular adhesion molecule 1 (ICAM-1) and CHD in young adults. A case-control study was conducted including 33 young CHD patients and 33 non-CHD patients as the control group (age and sex matched with CHD group) at Eka Hospital Pekanbaru, Indonesia, from July to November 2018. CHD was confirmed by coronary angiography, while non-CHD patients were subjects with normal ECG, without history of chest pain and family history of CHD. All participants were checked for sIL-6R, sgp130, and ICAM-1 serum levels using ELISA assays tests. The results were evaluated statistically using Student’s t test. The sIL-6R level tended to be higher in the CHD group compared to the control group (70.19+49.38 ng/ml vs 49.42+38.79 ng/ml) but did not reach statistical significance (p=0.062). The sgp130 level was 428.38+358.79 ng/ml and 474.08+389.43 ng/ml in CHD and control group, respectively (p=0.622). While the ICAM-1 level was 1829.53+1882.37 pg/ml and 2078.16+1595.25 pg/ml in CHD and control group, respectively (p=0.565). The IL-6 trans-signaling pathway, reflected by sIL-6R, sgp130, and ICAM-1 serum levels, was not significantly related with CHD in young adults.

The Association between the C5263T Mutation in the Mitochondrial ND2 Gene and Coronary Heart Disease among Young Chinese Han People

ObjectiveThis study aimed to investigate the genetic background of mitochondrial genes in young patients with Coronary heart disease (CHD) to provide a foundation for the early prevention of young patients with CHD. Methods115 cases of young (≤ 45 years) CHD Chinese Han patients (case group), 100 cases of older (> 45 years) Chinese Han CHD patients (experimental group) hospitalized and 100 cases of healthy people through physical examination (control group) at the General Hospital of PLA between January 2014 and December 2015 were selected. General information, clinical assessment, pedigree analysis, and mitochondrial full sequence scanning were performed. The pedigrees of one patient harbouring the C5263T mutation were recruited. Mitochondrial functional analysis including cellular reactive oxygen species (ROS) levels and mitochondrial membrane potential (MMP) were performed on pedigrees with the C5263T mutation (mutation group) and without the mutation (non-mutation group). ResultsThe differences in biochemical tests (P > 0.05) between the case group and experimental group were not significant. The C5263T single-nucleotide mutation of the mitochondrial ND2 gene was observed in 2 young CHD patients in the case group. The premature CHD of these 2 patients followed a pattern of maternal inheritance. The mutation group (I1, II2) had higher ROS levels (4750.82 ± 1045.55 vs. 3888.58 ± 487.60, P = 0.022) and lower MMP levels (P = 0.045) than the non-mutation group (II1, III1, III2). ConclusionWe speculated that the mitochondrial C5263T mutation might be associated with the occurrence CHD in Chinese Han young people.

Self-reported health status in coronary heart disease patients: A comparison with the general population

The aim of our study was to compare Euroqol-5D (EQ-5D) outcomes in coronary heart disease (CHD) patients with those from the general population. We aimed to identify those dimensions which were mostly impaired. EQ-5D results (both the dimensions and the EQ-5D visual analogue scale (EQ-VAS)) from a European sample (11 countries) of coronary patients were compared with published age- and gender-specific normative data. EQ-5D outcomes differed across countries and gender. Overall, the age-adjusted EQ-VAS scores were significantly lower in coronary patients compared with the general population, both in males (mean difference (MD)= -5.24(-7.59 to -2.88)) and in females (MD= -8.32 (-11.69 to -4.95)). Coronary patients had a significantly higher risk to report moderate or severe problems related to anxiety/depression (odds ratio (OR) male=1.84 (1.14-2.95); OR female=3.20 (2.32-4.40)). Furthermore, female coronary patients reported more problems on the mobility (OR=2.00 (1.38-2.90)), usual activity (OR= 2.54 (1.81-3.57)) and pain/discomfort dimension (OR=1.73 (1.23-2.43)) whereas in males, a borderline significant OR was found on the mobility (OR=1.43 (0.97-2.11)) and usual activity dimension (OR=1.44 (0.94-2.20)). The difference between the general population and the CHD patients attenuated as age increased. CHD has a negative influence on patient's self-reported health status, both the EQ-VAS as well as the EQ-5D dimensions (with the exception of self-care in both genders and pain/discomfort in males) were impaired. The relative impairment was the greatest in female patients and the differences in the proportion of reported problems diminished with increasing age. The EQ-5D instrument is appropriate in capturing problems related to anxiety/depression, pain/discomfort, mobility and usual activities. Within clinical practice, particular attention should be given to females and younger CHD patients.

Coronary Heart Disease in Young Adults

Despite the recent decline in mortality from coronary heart disease (CHD), this disease remains the leading killer of US adults of all ages. CHD in young adults is not as well characterized as CHD in older individuals because it occurs less frequently, but this disease can have devastating consequences for young patients and their families. As in older adults, the majority of coronary events in young adults are related to atherosclerosis, and one or more of the traditional CHD risk factors is typically present. Young patients, however, are more likely than older patients to be smokers, male, obese, and to have a positive family history. Risk factor reduction is thus of major importance in managing young CHD patients. Approximately 20% of CHD in young adults, however, is related to non-atherosclerotic factors, such as coronary abnormalities, connective tissue disorders, and autoimmune diseases. Cocaine and other illicit drug use have been increasingly associated with acute myocardial infarction and accelerated atherosclerosis. The differences in etiologies and risk profiles of younger and older CHD patients result in differences in disease progression, prognosis, and treatment. Limited data suggest that prognosis may be better in the young population, although long-term mortality studies have suggested otherwise. Screening for CHD in the young population may help to improve prognosis in young patients by detecting subclinical disease, although more studies are necessary to establish reference limits for this young population. Additional research must also focus on treatment concerns that are specific to young patients.

The effect of interleukin-10 gene promoter polymorphisms on early-onset coronary artery disease

We assessed the association between interleukin-10 (IL-10) -1082G/A and -592C/A polymorphisms, and coronary heart disease (CHD). A cross-sectional, observational study included 86 patients (mean age 43.36±4.930 years) diagnosed to have CHD and 88 healthy controls (mean age 47.07±8.135 years). IL-10 -1082G/A and -592C/A polymorphisms were analyzed using restriction fragment length polymorphism (RFLP) and agarose gel electrophoresis methods in both patient and control groups. Genotype distributions of the polymorphisms between CHD patients and controls were assessed by Chi-square analysis. The genotype distribution of the -1082 G/A polymorphism was not different in premature CHD patients (GG: 38.3%; GA: 51.1%; AA: 10.6%) and controls (GG: 43.1%; GC: 43.1%; CC: 13.8%) (p=0.57). The prevalence of the A allele at -1082G/A polymorphism was 36.6% in patients and 35.3% in controls. Both allele and genotype frequencies of -592C/A polymorphism did not also differ significantly between patients with CHD and controls. We did not observe relationships between polymorphism-specific haplotypes and adverse angiographic and clinical outcomes. We have observed a significant difference of IL-10 -592C/A allelic frequency (OR=2.00 95% CI=0.9434-4.2579) between the younger CHD patients (<45 years, Group 2) and matched controls. Our study suggests that IL-10-592C/A polymorphism may play a role in susceptibility to CHD in younger patients.

Primena mera sekundarne prevencije kod bolesnika sa koronarnom bolešću - Republika Srbija

Aim The aim of this study was to test the implementation of European recommendations for cardiac rehabilitation and secondary prevention programs and investigate the health-related quality of life (HRQoL).in the population of coronary heart disease (CAD) patients from Serbia. Methods A total of 712 consecutive patients (204 women, aged 60.9 ± 9.3 years) [without revascularization-WR (n=162), percutaneous transluminal coronary angioplasty PTCA (n=218), coronary artery bypass graft CABG (n=332)] admitted for specialized cardiovascular rehabilitation, interviewed and examined in relation to the presence of coronary risk factors and administration of secondary prevention measures, were enrolled in the study. HRQoL was estimated using the SF-36 questionnaire for total QoL and its two dimensions for physical and mental health [physical and mental component summary scores (PCS,MCS)]. Sexual dysfunction was assessed using the ASEX scale. Results Our patients were examined in relation to the European population (EUROSPIRE III) higher percentage of smokers (25 vs. 18%) and fewer have reached the target of cholesterol (40 vs. 53%), but were less obese (21% vs. 38%), have better regulation of the BP (83% vs. 39%) and no significant differences in a number of diabetic patients (29% vs. 28%). In the use of medicaments, there were no significant differences. All the recommended drugs for secondary prevention is receiving 55.2% of patients; beta blockers 91.3%, ACE inhibitors 81%, statins 86.8% and aspirin 94%. The results of the present study have clearly demonstrated significantly better HRQoL in men, younger CAD patients, patients who underwent PCI, and patients with previously not self-reported incident, intermittent or permanent stress. After 24 months of monitoring major cardiovascular events were more common in women and patients without revascularization. These patients had been in a number of smokers and less regulated BP They had a poorer quality of life and were more depressed. Conclusions Inadequate change of lifestyle and poor quality of life after coronary events and have a great prognostic value in our patients with CAD.

The potential of Web-based interventions for heart disease self-management: a mixed methods investigation.

BackgroundExisting initiatives to support patient self-management of heart disease do not appear to be reaching patients most in need. Providing self-management programs over the Internet (web-based interventions) might help reduce health disparities by reaching a greater number of patients. However, it is unclear whether they can achieve this goal and whether their effectiveness might be limited by the digital divide.ObjectiveTo explore the effectiveness of a web-based intervention in decreasing inequalities in access to self-management support in patients with coronary heart disease (CHD).MethodsQuantitative and qualitative methods were used to explore use made of a web-based intervention over a period of 9 months. Patients with CHD, with or without home Internet access or previous experience using the Internet, were recruited from primary care centers in diverse socioeconomic and ethnic areas of North London, UK. Patients without home Internet were supported in using the intervention at public Internet services.ResultsOnly 10.6% of eligible patients chose to participate (N=168). Participants were predominantly Caucasian well-educated men, with greater proportions of male and younger CHD patients among participants than were registered at participating primary care practices. Most had been diagnosed with CHD a number of years prior to the study. Relatively few had been newly diagnosed or had experienced a cardiac event in the previous 5 years. Most had home Internet access and prior experience using the Internet. A greater use of the intervention was observed in older participants (for each 5-year age increase, OR 1.25 for no, low or high intervention use, 95% CI, 1.06-1.47) and in those that had home Internet access and prior Internet experience (OR 3.74, 95% CI, 1.52-9.22). Less use was observed in participants that had not recently experienced a cardiac event or diagnosis (≥ 5 years since cardiac event or diagnosis; OR 0.69, 95% CI, 0.50-0.95). Gender and level of education were not statistically related to level of use of the intervention. Data suggest that a recent cardiac event or diagnosis increased the need for information and advice in participants. However, participants that had been diagnosed several years ago showed little need for information and support. The inconvenience of public Internet access was a barrier for participants without home Internet access. The use of the intervention by participants with little or no Internet experience was limited by a lack of confidence with computers and discomfort with asking for assistance. It was also influenced by the level of participant need for information and by their perception of the intervention.ConclusionsThe availability of a web-based intervention, with support for use at home or through public Internet services, did not result in a large number or all types of patients with CHD using the intervention for self-management support. The effectiveness of web-based interventions for patients with chronic diseases remains a significant challenge.

L-arginine improves post-ischemic vasodilation in coronary heart disease patients taking vasodilating drugs.

The hypothesis that intravenous L-arginine infusion improves the vasodilatory response to ischemia in the resistance vessels of human lower limbs in relatively young coronary heart disease patients taking vasodilating drugs was tested. Twenty patients with onset of symptoms of coronary artery disease before age 50, operated for aortocoronary bypass and taking vasodilating drugs, were compared with 20 control subjects of comparable age and gender; neither group included heavy smokers (>10 cigarettes/day). Blood flow in the lower limbs was measured noninvasively with strain-gauge plethysmography, both at rest and during a reactive hyperemia test. Intravenous infusion of L-arginine was performed in nine coronary heart disease patients and in nine control subjects. Resting blood flow to the lower limbs was 2.3 mL/min/100 mL in control subjects vs 3.4 mL/min/100 mL in patients (difference not statistically significant). Peak blood flow measured after a 3-minute arterial occlusion was 24.0 mL/min/100 mL in control subjects vs 20.3 mL/min/100 mL in coronary heart disease patients (P<0.05). Peripheral minimal vascular resistances were 4.28 and 5.46 peripheral resistances units (p.r.u.) in control subjects and patients, respectively (P<0.05). Intravenous infusion of L-arginine was followed by increased resting blood flow in cases and controls (P=0.009), with a parallel reduction in peripheral resting vascular resistances (P=0.009). Coronary heart disease patients showed increased peak blood flow (P=0.04) and reduced minimal vascular resistances (P=0.02), whereas no statistically significant changes in these parameters were detectable in control subjects. Intravenous glucose infusion, leading to increased serum insulin concentration, did not modify any hemodynamic parameter. Hemodynamic responses in the skeletal muscle are impaired during a reactive hyperemia test in relatively young coronary heart disease patients taking vasodilating drugs. Intravenous L-arginine infusion corrects the impaired vasodilatory response of the lower limbs to an acute increase in flow following a cuff thigh occlusion.

Lipid profile with paternal history of coronary heart disease before age 40.

Serum lipids were measured in children and their parents from 40 families in which the father had a myocardial infarction or coronary heart disease (CHD) before age 40 years. The relationship between physical activity and serum lipid concentrations in the children was also evaluated. Twenty six men had one or more abnormal lipid value (in mmol/l): total venous cholesterol (TVC) > 6.24, triglycerides < 2.55, low density lipoprotein cholesterol (LDL-C) > 4.42, or high density lipoprotein cholesterol (HDL-C) < 0.91. There were 15 spouses with significant hyperlipidaemia (values above). In the 107 children examined, TVC mean (SD) was 4.68 (1.17), triglycerides 1.4 (0.8), LDL-C 3.0 (1.0), and HDL-C 1.18 (0.28). Altogether 42% of the children had significant hyperlipidaemia. No significant correlation was found between the degree of physical activity of the children and their LDL-C and TVC concentrations. However, a significant positive correlation was found between the degree of physical activity and HDL-C and a significant negative one with triglyceride concentrations. It is concluded that screening the progeny of young CHD patients is highly productive in identifying young people at excessive risk for future CHD. The data also suggest that promoting high degrees of activity among these children may have a positive influence on risk factors for adult onset CHD.

Prevalence of familial hypercholesterolemia among young north Karelian patients with coronary heart disease: a study based on diagnosis by polymerase chain reaction.

Two deletions of the low density lipoprotein (LDL) receptor gene account for about 90% of the mutations that cause familial hypercholesterolemia (FH) in eastern Finland. The FH-Helsinki mutation deletes exons 16, 17 and a portion of exon 18, while the FH-North Karelia allele is characterized by a deletion of seven nucleotides from exon 6 of the LDL receptor gene. We developed a DNA assay based on the use of polymerase chain reaction (PCR) which simultaneously detects both of these mutations. We have screened 90 young (< 45 years) eastern Finns with symptomatic coronary heart disease (CHD) for the presence of these FH genes. One or the other of the mutations was present in 4 out of 55 survivors of acute myocardial infarction (AMI) and 4 out of 35 patients with angina pectoris (AP), but in none of 50 healthy controls of similar age. These data show a relatively high prevalence of confirmed FH in young CHD patients (AMI and MI combined: 8/90, or 9%), and also demonstrate the feasibility of PCR techniques in diagnosis of FH among populations with enrichment of specific types of LDL receptor gene mutations.