Urinary 8-isoprostane levels can indicate the presence, severity and extent of angiographic coronary artery disease

BACKGROUND: Atherosclerotic coronary artery disease is the leading cause of death worldwide. Oxidative stress is one of the key elements in the pathogenesis of atherosclerosis. Isoprostanes are established markers of oxidative stress. The aim of this study was to investigate the association of urinary 8-isoprostane levels with the presence and severity of coronary artery disease (CAD) assessed by a validated scoring system. METHOD: Urinary 8-isoprostane levels were measured in 100 consecutive patients scheduled for coronary angiography. Extent and severity of CAD were assessed by modified Gensini scores. RESULTS: In patients with CAD, 8-isoprostane levels were higher (P < 0.001) than in patients without CAD (68.75 +/- 5.5 vs. 38.27 +/- 3.7 pg/ml). The levels of 8-isoprostane correlated with the number of risk factors (P < 0.001) and significantly increased in relation with the number of diseased vessels (P < 0.001). A significant (P < 0.001) correlation was found between 8-isoprostane levels and Gensini scores (r = 0.496), and a stepwise elevation in 8-isoprostane levels was observed across the increasing tertiles of the Gensini scores (P < 0.001). The multivariate logistic regression analysis revealed that 8-isoprostane was an independent predictor (odds ratio: 7.19 and P = 0.007) associated with angiographic CAD. CONCLUSION: These results confirm the role of oxidative stress in the atherosclerotic process. Urinary 8-isoprostane levels reflect the extent and severity of CAD and they may provide additional information for risk assessment in patients with suspected CAD.     

Association of carotid intima-media thickness with angiographic severity and extent of coronary artery disease

The present study examined the association between carotid intima-media thickness (IMT) and severity and extent of coronary artery disease (CAD). B-mode ultrasound and quantitative coronary angiography were used to assess carotid and coronary artery atherosclerosis in 108 patients with known or suspected CAD who had been referred for cardiac catheterization. Maximum and mean IMT values of carotid arteries were measured and expressed as mean aggregate values. To evaluate anatomic severity and extent of CAD, several quantitative coronary angiographically derived parameters were incorporated into indexes. These quantitative coronary angiographic measurements reflected CAD severity, extent, and overall "atheroma burden" and were calculated for the entire coronary tree and separately for different coronary segments (i.e., left main, proximal, mid, and distal segments). Maximum and mean IMT values were significantly correlated with CAD severity (p = 0.004 and 0.005, respectively), extent (p = 0.022 and 0.016, respectively), and atheroma burden (p = 0.008 for the 2 values). Further, carotid IMT was correlated with quantitative angiographic indexes for mid and distal segments but not with the proximal segments of coronary vessels. In conclusion, our study shows an association between carotid IMT and severity and extent of CAD as assessed by quantitative coronary angiography. Carotid IMT seems to be a weaker predictor of coronary atherosclerosis in the proximal parts of the coronary tree than in the mid and distal parts.     

Associations of plasma 8-isoprostane levels with the presence and extent of coronary stenosis in patients with coronary artery disease

Oxidative stress may play a role in the development of atherosclerosis. The purpose of the present study was to explore the relationship between 8-isoprostaglandin F(2alpha) (8-iso-PGF(2alpha)) levels and the presence of coronary artery disease (CAD) and to also clarify whether 8-iso-PGF(2alpha) might add independently to measures of CAD extent. The study group consisted of 241 consecutive patients who were undergoing coronary angiography for suspected CAD. 8-iso-PGF(2alpha) levels were recorded for all participants. The analysis revealed a significant difference in 8-iso-PGF(2alpha) levels in patients with and without hypertension (P<0.001), in patients with diabetes relative to nondiabetic patients (P<0.05), and in males respect to females (P<0.001). A significant positive correlation was found between age and 8-iso-PGF(2alpha) levels (P<0.001). 8-iso-PGF(2alpha) levels correlated with the number of cardiovascular risk factors (P<0.001). 8-iso-PGF(2alpha) levels were higher in the CAD(+) respect to the CAD(-) groups (337.7+/-80.2 and 263.8+/-74.2 pg/ml and P<0.001). A stepwise elevation in the 8-iso-PGF(2alpha) levels was found depending on the number of affected vessels (P<0.001). The 8-iso-PGF(2alpha) levels showed a significant positive correlation with the numbers of >50 and >25% stenotic segments (P<0.001) and the extent score of coronary stenosis (P<0.001). The multivariate logistic regression analysis indicated 8-iso-PGF(2alpha) as an independent factor associated with CAD (odds ratio, 2.47 and P=0.001). The results suggested that 8-iso-PGF(2alpha) is associated with the presence of CAD in patients undergoing coronary angiography and is also related to the extent of coronary stenosis in Chinese population.     

Relation of C-reactive protein levels to presence,extent, and severity of angiographic coronary artery disease

BACKGROUND: C-reactive protein is a valid marker of cardiovascular risk. It is not known whether C-reactive protein is a marker of atherosclerotic burden or whether it reflects a process (e.g. inflammatory fibrous cap degradation) leading to acute coronary events. This study was performed to determine whetherthe concentration of C-reactive protein is associated with coronary atherosclerosis assessed by coronary angiography. METHODS AND RESULTS: We studied a total of 100 men and women (41 women, 59 men, mean age 63.7 +/- 11.0 years) who were referred for coronary angiography. Baseline data collection comprised clinical characteristics and conventional risk factors for coronary artery disease, levels of serum lipids and fasting total homocysteine levels. The relation between serum C-reactive protein levels and the severity and extension of coronary lesions was studied. The coronary angiograms were evaluated in a blinded manner according to three scores: vessel score (0-3 points for 0-3 vessels with coronary artery disease), stenosis score (0-3 points: number and severity of coronary stenoses or lesions; 0 for no, 1 for coronary lesion with diameter stenosis less than 50%, 2 for 50%-75%, and 3 for more than 75% diameter stenosis), and extent score (0-3 points; segment-extension of all coronary lesions within the total coronary vessel length). According to the total score values obtained, groups for coronary artery disease risk were defined and analyzed forcorrelations with age and levels of total cholesterol. high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, fasting total homocysteine. and C-reactive protein in serum. From the 100 patients, 40 were found to have no or minimal coronary artery disease (group A; score 0-3), 33 had moderate (group B; score 4-8) and 27 had severe (group C: score more than 8) coronary artery disease assessed by coronary angiography. Estimates of the relative risk of coronary heart disease for the third quintile of serum C-reactive protein as compared with the first quintile were 1.79 (95 percent confidence interval 1.23-2.39). Serum C-reactive protein levels were 3.54 (+/- 7.07) mg/L, 11.41 (+/- 13.5) mg/L and 5.66 (+/- 8.32) mg/L in groups A, B and C and represented an independent risk factor for the presence of coronary artery disease assessed by coronary angiography (p<0.01). With step-wise logistic regression analyses, use of C-reactive protein values maintained the ability to predict the probability of coronary artery disease. Moreover, the presence of angiographic coronary artery disease was associated with patient age (p=0.048), male sex (p<0.01), high LDL-cholesterol levels (p=0.02), low HDL-cholesterol levels (p=0.02), high plasma fibrinogen levels (p<0.01) and high fasting total homocysteine levels (p=0.04). CONCLUSIONS: These results suggest that the serum concentration of C-reactive protein is associated with presence, but not severity, of coronary artery disease in patients referred for coronary angiography.     

老年人脂蛋白相关磷脂酶A2与冠心病冠状动脉病变程度及危险因素的关系

目的 观察老年人脂蛋白相关磷脂酶A2(Lp-PLA2)水平与冠心病冠状动脉造影病变程度及冠心病危险因素的关系. 方法 测定90例临床怀疑冠心病行冠状动脉造影老年患者Lp-PLA2、超敏C反应蛋白(hs-CRP),血脂等指标,根据冠状动脉造影结果以病变支数及Gensini积分评价冠状动脉病变程度,分析Lp-PLA2与冠心病的关系. 结果冠心病组Lp-PLA2水平较对照组明显升高[(352.7±129.0)μg/L与(204.0±59.7)μg/L,P<0.01].Lp-PLA2水平随着冠状动脉病变支数和Gensini积分的增加而升高.Lp-PLA2与年龄(r=0.25,P<0.05)、三酰甘油(r=0.33,P<0.01)、低密度脂蛋白胆固醇(r=0.27,P<0.05)、载脂蛋白B(r=0.36,P<0.01)呈正相关.在冠心病组,Lp-PLA2与年龄呈正相关(r=0.29,P<0.05).Stepwise回归分析结果显示Lp-PLA2与冠心病相关. 结论 冠心病患者Lp-PLA2水平升高,其水平的高低可能反映冠状动脉病变的严重程度.为冠心病的危险因素之一.     

Associations of plasma C-reactive protein levels with the presence and extent of coronary stenosis in patients with stable coronary artery disease

Prospective studies showed plasma high sensitivity C-reactive protein (hsCRP) levels to be a powerful predictor of cardiac events. However, the association between hsCRP levels and the extent of coronary stenosis in patients with coronary artery disease (CAD) remains controversial. We investigated the association between hsCRP levels and the extent of coronary stenosis in 273 patients undergoing elective coronary angiography. Plasma hsCRP levels were higher in patients with CAD than in those without CAD (0.70 mg/l versus 0.56 mg/l, P < 0.02), but hsCRP levels did not correlate with the number of >50% stenotic vessels and were not a significant factor for CAD. However, after the exclusion of 76 patients taking statins, a step-wise increase in hsCRP levels was found depending on the number of >50% stenotic vessels: 0.50 in CAD(-), 0.68 in 1-vessel, 0.77 in 2-vessel, and 0.88 mg/l in 3-vessel disease (P < 0.01). The hsCRP levels also correlated with the numbers of >50% and >25% stenotic segments (r = 0.30 and 0.32, P < 0.001). Multivariate analysis revealed the hsCRP levels to be a significant factor for CAD. Thus, after the exclusion of patients with statins, plasma hsCRP levels were found to be associated with the presence and extent of coronary stenosis in patients with stable CAD.     

Plasma osteopontin levels are associated with the presence and extent of coronary artery disease

Recently, osteopontin (OPN) mRNA was reported to be highly expressed in atherosclerotic plaques, most strikingly in calcified plaques. We examined if plasma OPN levels are associated with coronary stenosis and calcification in patients with coronary artery disease (CAD). We measured plasma OPN levels in 178 patients undergoing coronary angiography. Compared with 71 patients without CAD, 107 with CAD had higher OPN levels (616±308 ng/ml versus 443±237 ng/ml, P<0.001). A stepwise increase in OPN levels was found depending on the number of >50% stenotic coronary vessels: 540±293 ng/ml in 1-vessel, 615±230 ng/ml in 2-vessel, and 758±416 ng/ml in 3-vessel disease. OPN levels also correlated with the numbers of >50% and >25% stenotic segments (r=0.35 and 0.43, respectively, P<0.001). In multivariate analysis, OPN levels were significantly associated with CAD (odds ratio=1.21, 95% CI=1.05–1.39 for a 100 ng/ml increase) independent of traditional risk factors. Coronary calcification was found in 86 patients. OPN levels were higher in patients with calcification than in those without calcification (608±328 ng/ml versus 490±246 ng/ml, P<0.01) and correlated with the number of calcified segment (r=0.26, P<0.001). However, OPN levels were not independently associated with coronary calcification. Thus, plasma OPN levels were found to be associated with the presence and extent of CAD.     

空腹血糖与冠状动脉病变程度的相关性

目的探讨空腹血糖（FPG）水平与冠状动脉（下称冠脉）病变程度的相关性。方法回顾分析913例高度怀疑冠心病（CHD）而行冠脉造影的患者的临床资料,冠脉造影病变程度由是否诊断CHD、冠脉病变支数和冠脉病变Gensini总积分三方面表示。对FPG水平与冠脉病变程度进行单因素和多因素分析。结果FPG与冠脉病变程度密切相关：（1）Logistic回归结果显示FPG与冠脉有无病变显著相关（OR值1.462,95%CI为1.178~1.813,P〈0.01）;（2）多元逐步回归结果显示在校正了年龄、性别等因素之后,FPG与冠脉病变支数（r=0.164,P〈0.01）、冠脉病变总积分（r=0.088,P〈0.05）仍然独立相关。随着FPG的升高,冠脉病变支数增加。结论冠心病高危人群的FPG水平与冠脉病变程度密切相关,即使在糖尿病前期,随着FPG升高,冠脉病变程度也更加严重。     

Association of oestrogen receptor alpha gene polymorphism with the angiographic extent of coronary artery disease.

AIMS: To investigate the association between sequence variants in the promoter region of the oestrogen receptor-alpha (ER-alpha) gene and the angiographic severity of coronary artery disease (CAD). METHODS AND RESULTS: We studied 503 subjects undergoing coronary angiography (mean age 63+/-12 years, 72% men, 28% women). Coronary artery disease extent was assessed by the number of: (1) major coronary vessels with >50% narrowing (NMCV); (2) coronary vessels with any narrowing (NCV); (3) narrowed coronary segments (NCS). The number of thymine and adenine dinucleotide repeats [(TA)(n)], 1174 base-pairs upstream exon 1, was determined by PCR. The median number of (TA)(n)(18) was used to categorize subjects into long, short and mixed allele genotypes. Poisson regression was used to analyse the association between genotypes and CAD extent, with age category (age #10877;55 vs >55), sex, risk factors and age at onset of CAD as covariates. In young subjects, (TA)(n)length had a significant effect on NCS (P=0.047) and a borderline significant effect on NCV (P=0.066). Young subjects homozygous for long alleles had higher NCV and NCS compared to those homozygous for short alleles (NCV 3.7+/-2.4 vs 2.4+/-1.8, NCS 4.4+/-2.7 vs 3.1+/-2.3, respectively, P#10877;0.034). CONCLUSION: The (TA)(n)length in the ER-alpha gene promoter region is associated with the angiographic severity of CAD in young patients.     

Plasma homocysteine level and the angiographic extent of coronary artery disease

Recent epidemiologic studies have shown that moderately elevated plasma homocysteine concentrations are associated with an increased risk for the development of atherosclerotic cardiovascular diseases. But, it is not known whether moderate hyperhomocysteinemia is associated with the angiographic extent of atherosclerotic cardiovascular disease in patients with coronary artery disease (CAD). A possible relationship was investigated between admission plasma homocysteine level and the angiographic extent of coronary artery disease in patients with CAD. In this study, 156 consecutive patients presenting with coronary artery disease (group 1) and control group (group 2) of 35 age-matched persons with normal coronary angiography were enrolled. Blood samples for homocysteine were obtained on admission. Plasma homocysteine concentration was measured with high-performance liquid chromatography with fluorescence detection. Radiographs from coronary angiography were viewed and scored using Sullivan's method to assess the atherosclerotic involvement of coronary artery disease. There were significant elevations in homocysteine level in group 1 compared to group 2 (15.59 +/-5.7 micromol/L, 9.24 +/-1.50 micromol/L; respectively, p < 0.001). All scores (demonstrated angiographic extension of CAD) correlated significantly with plasma homocysteine levels; however, the Sullivan's extent score correlated more closely (r = 0.68, p < 0.001) than both the stenosis score (r = 0.44, p < 0.01) and vessel score (r = 0.35, p < 0.05). Elevated homocysteine levels in patients with coronary artery disease correlated with the angiographic extent of atherosclerotic disease.     

Association of paraoxonase-1 activity and concentration with angiographic severity and extent of coronary artery disease.

OBJECTIVES: The goal of this study was to examine the association between paraoxonase-1 (PON1) activity and concentration and the severity and extent of coronary artery disease (CAD). BACKGROUND: Paraoxonase-1, a high-density lipoprotein-associated enzyme, is proposed to have an antiatherogenic effect by protecting low-density lipoproteins against oxidation. METHODS: We studied PON1 activity and concentration in 107 patients with known or suspected CAD referred for cardiac catheterization. Based on visual estimation of coronary angiograms, subjects were classified as having no or mild CAD (<50% stenosis) and significant CAD (> or =50% stenosis). Quantitative coronary angiography (QCA) was used to estimate the indexes of severity, extent, and overall atheroma burden of CAD. RESULTS: We found lower values of PON1 activity and concentration (p = 0.003 and p = 0.016, respectively) in the group with significant CAD as compared with the group with no or mild CAD. The PON1 activity was significantly inversely correlated with CAD severity (r = -0.364, p < 0.001), extent (r = -0.221, p = 0.022), and atheroma burden (r = -0.277, p = 0.004). Similarly, PON1 concentration correlated with CAD severity (r = -0.306, p = 0.001) and atheroma burden (r = -0.229, p = 0.017). In multiple regression analysis, gender and PON1 activity were significant determinants of the severity of CAD independently of age, hypertension, smoking, abnormal glucose regulation, and high-density lipoprotein cholesterol. CONCLUSIONS: Our results indicate that PON1 activity and concentration are lower in subjects with significant CAD, and that there is a significant relationship between PON1 activity and concentration and CAD assessed by QCA.     

Relation of serum uric acid levels with the presence and severity of angiographic coronary artery disease

The aim of this study is to investigate the association between uric acid level and severity of coronary artery disease. Consecutive 495 patients with coronary artery disease and 356 individuals with normal coronary angiograms were included in the study. Severity of coronary artery disease was evaluated using the Gensini score index. For both groups, conventional risk factors, the levels of uric acid, and other biochemical markers were assessed. The mean uric acid levels of the patient group were significantly higher than those of the control group (P = .002). Mean uric acid levels were higher in men than in women (P < .001). In the coronary artery disease group, there was no significant correlation between uric acid levels and Gensini score in both sexes. Thus, it can be concluded that uric acid level is associated with the presence but not with the severity of coronary artery disease.     

Decreased plasma urotensin Ⅱ levels inversely correlate with extent and severity of coronary artery disease

Objective To determine the plasma urolensin Ⅱ(UⅡ) levels in various types of coronary heart disease and to clarify how the plasma UⅡ levels correlate with the clinical presentation, extent and severity of coronary artery atherosclerosis (CAD). Methods: One hundred and three aged patients undergoing elective diagnostic coronary angiography for proven or clinical suspected coronary heart disease were enrolled in this study. The extent and severity of coronary artery disease were evaluated by vessel score and Gensini score, respectively. Plasma UⅡ levels were measured by radioimmunoassay. Results: The plasma UⅡ levels in the patients with modest to severe coronary stenosis (3.03±0.34 pg/ml, 1.83±0.67 pg/ml) were significantly lower than that in subjects with normal coronary artery (4.80±1.11 pg/ml, P＜0.001). The plasma UⅡ levels in patients with coronary heart disease were also significantly lower than that in patients with insignificant coronary stenosis (P ＜ 0.001). Compared to patients with stable angina pectoris, plasma UⅡ levels in patients with acute coronary syndrome were significantly decreased (1.89±0.51 pg/ml vs 2.42±0.77 pg/ml, P＜ 0.001). Plasma UⅡ levels were found to be negatively correlated with the severity of coronary artery stenosis (r = -0.488, P＜0.001), as well as the vessel score (r = -0.408, P＜0.05) in the patients with CAD. Conclusion: Significant inverse correlations exist between the plasma UⅡ levels, and the extent and severity of coronary artery stenosis. These findings suggest that plasma UⅡ contribute to the development and progression of coronary artery stenosis, and may be a novel marker to predict clinical types, as well as the extent and severity of coronary artery disease in the patients.     

血尿酸水平与冠脉狭窄及冠心病的关系

目的探讨血尿酸（SUA）水平与冠脉狭窄和冠心病（CHD）的关系。方法选择647例行冠脉造影患者,根据其冠脉有无狭窄分为冠脉正常组和非正常组,以冠脉至少有1支狭窄≥50%分为CHD组与非CHD组。检测患者的血脂及SUA。结果在冠脉狭窄和CHD两个分组标准下,男性不同年龄组间的SUA水平无统计学差异,女性有统计学差异（P〈0.01）。男性SUA水平与冠脉狭窄或CHD发生均无相关性;女性SUA水平与CHD发生虽无统计学差异,但与冠脉狭窄发生有关（P〈0.05）,对传统风险因素校正后,多因素分析显示女性SUA水平与冠脉狭窄无统计学意义（P〉0.05）。结论 SUA存在性别差异,女性高尿酸血症与CHD发生有一定关系,与冠脉狭窄密切相关,但非发生冠脉狭窄的独立危险因素。男性SUA水平与二者均无关。     

Decreased plasma urotensin Ⅱ levels inversely correlate with extent and severity of coronary artery disease

Objective To determine the plasma urolensin Ⅱ(UII) levels in various types of coronary heart disease and to clarify how the plasma UII levels correlate with the clinical presentation, extent and severity of coronary artery atherosclerosis (CAD). Methods: One hundred and three aged patients undergoing elective diagnostic coronary angiography for proven or clinical suspected coronary heart disease were enrolled in this study. The extent and severity of coronary artery disease were evaluated by vessel score and Gensini score, respectively. Plasma UII levels were measured by radioimmunoassay. Results: The plasma UII levels in the patients with modest to severe coronary stenosis (3.03±0.34 pg/ml, 1.83±0.67 pg/ml) were significantly lower than that in subjects with normal coronary artery (4.80±1.11 pg/ml, P<0.001). The plasma UII levels in patients with coronary heart disease were also significantly lower than that in patients with insignificant coronary stenosis (P < 0. 001). Compared to patients with stable angina pectoris, plasma UII levels in patients with acute coronary syndrome were significantly decreased (1.89±0.51 pg/ml vs 2.42±0.77 pg/ml, P < 0.001). Plasma UII levels were found to be negatively correlated with the severity of coronary artery stenosis (r = -0.488, P<0.001), as well as the vessel score (r = -0.408, P<0.05) in the patients with CAD. Conclusion: Significant inverse correlations exist between the plasma UII levels, and the extent and severity of coronary artery stenosis. These findings suggest that plasma UII contribute to the development and progression of coronary artery stenosis, and may be a novel marker to predict clinical types, as well as the extent and severity of coronary artery disease in the patients.     

Association of ankle-brachial index with severity of angiographic coronary artery disease in patients with peripheral arterial disease and coronary artery disease

The ankle-brachial index (ABI) was correlated with the severity of coronary artery disease (CAD) in 273 patients, mean age 71 years, with peripheral arterial disease and angiographically obstructive CAD (> 50% occlusion). Of 155 patients with an ABI < 0.40, 130 (84%) had 3- or 4-vessel CAD, 17 (11%) had 2-vessel CAD and 8 (5%) had 1-vessel CAD. Of 80 patients with an ABI of 0.40-0.69, 37 (46%) had 3- or 4-vessel CAD, 33 (41%) had 2-vessel CAD and 10 (13%) had 1-vessel CAD. Of 38 patients with an ABI of 0.70-0.89, 10 (26%) had 3- or 4-vessel CAD, 16 (42%) had 2-vessel CAD and 12 (32%) had 1-vessel CAD. The lower the ABI, the higher the prevalence of 3- or 4-vessel CAD and the lower the prevalence of 1-vessel CAD.     

Severity of periodontal disease correlates to inflammatory systemic status and independently predicts the presence and angiographic extent of stable coronary artery disease

Background. Periodontal disease (PD) has been recognized as a risk factor for systemic diseases, but its involvement in the pathogenesis of coronary artery disease (CAD) remains debated. Objectives. We sought to evaluate the potential relations between severity of the PD, inflammatory response and angiographic lesions extent in patients with stable CAD. Design. A total of 131 subjects referred to our centre for coronary angiography were evaluated for presence and extension of CAD, then divided into two groups, one with presence of lesions (cases, n = 85) and other one with absence of lesions (controls, n = 46). Mean periodontal pocket depth (PPkD), high sensitivity C reactive protein (hs‐CRP), serum amyloid A protein (SAA) and fibrinogen levels were measured in all patients. Results. Cases and controls did not differ according to their baseline characteristics and prevalence of traditional cardiovascular risk factors. PPkD was greater in patients with CAD than in controls (2.24 ± 1.28 mm vs 1.50 ± 0.93 mm, P < 0.001 by Student’s t‐test). Systemic inflammatory response was more pronounced in cases than in controls, with higher values of hs‐CRP, SAA and fibrinogen. Furthermore, PPkD values correlated with hs‐CRP (r = 0.80, P < 0.001), SAA (r = 0.71, P < 0.001), fibrinogen levels (r = 0.72, P < 0.001) and the American College of Cardiology/American Heart Association angiographic score (r = 0.68, P < 0.001) in cases. Multivariate analysis indicated a persistent independent correlation between PPkD and angiographic score after adjustment for inflammatory markers levels. Conclusion. In the present study, PD lesions predicted presence of CAD stenosis in patients with cardiovascular risk factors. PD severity was correlated to angiographic extent of coronary lesions, independent of systemic inflammatory status. Those results suggest that these patients might benefit from an intensive periodontal therapy to prevent CAD progression.     

Estrogen receptor alpha gene polymorphisms are associated with the angiographic extent of coronary artery disease

CONTEXT: Sequence variants in the estrogen receptor alpha gene (ESR1) may alter the atheroprotective effects of estrogens, and be associated with the severity of coronary artery disease (CAD). OBJECTIVE: This study seeks to investigate the association between the ESR1 haplotype created by the c.454-397 T>C and c.454-351 A>G polymorphisms, the length of the (TA)n repeats, and the angiographic extent of CAD. DESIGN: Consecutive subjects with age younger than or equal to 55 yr who had undergone coronary angiography between November 2003 and January 2004 were included in the study. SETTING: The study was conducted in a referral center. PATIENTS: One hundred five subjects with age younger than or equal to 55 yr (87 males, 18 females) participated in the study. MAIN OUTCOME MEASURES: The angiographic extent of CAD was graded by number of: 1) major coronary vessels with more than 50% narrowing (NMCV); 2) narrowed major coronary vessels and/or their second-order branch (NCV); and 3) coronary segments with any narrowing (NN). Analysis of covariance was used to test the effect of haplotype and (TA)n length on the angiographic extent of CAD with gender and number of CAD risk factors (hyperlipidemia, diabetes, hypertension, obesity, smoking, and family history of CAD) as covariates. RESULTS: The ESR1 haplotype c.454-397C and c.454-351G was associated with NCV and NN (P = 0.008 and 0.02, respectively). Carriers of two copies of haplotype C-G had a higher number of NCV compared with subjects with one or no copies combined (3.5 +/- 2.2 vs. 2.3 +/- 1.9, P = 0.012, respectively). A longer (TA)n repeat was associated with NCV (P = 0.04). CONCLUSIONS: The ESR1 c.454-397C and c.454-351G haplotype and longer (TA)n repeats are associated with the extent of CAD in young subjects, independent of the known CAD risk factors.