Serum tumour necrosis factor-alpha,interleukin-2 and interleukin-10 activation in stable angina and acute coronary syndromes

BACKGROUND: Dynamic instability of coronary atherosclerotic plaque results in the development of both unstable angina and myocardial infarction. The aim of the study was to investigate the dynamics of serum concentrations of tumour necrosis factor (TNF)alpha, interleukin (IL)-10, and IL-2 in patients with myocardial infarction (MI) and unstable angina (UA) as compared to stable angina (SA) patients and healthy volunteers. METHODS: A total of 189 patients with coronary artery disease (CAD) were studied: 100 patients with SA (class II/III according to CCS), 57 patients with UA (Braunwald class IIIB; determinations at 6, 24, and 48 h after chest pain), and 32 patients with MI (determinations at admission, on the 7th and 30th days after MI). Twenty healthy volunteers acted as controls. RESULTS: Serum TNFalpha levels were elevated in all CAD groups (SA: 17.3+/-4; UA: 18.7+/-4; MI: 22.0+/-3 pg/ml; p<0.001) in comparison to the controls (8.3+/-1.4 pg/ml). However, the highest values were characteristic of MI patients, especially values obtained at admission (p<0.01 versus SA and UA). Mean serum concentrations of IL-2 were significantly higher in patients with MI and UA (89.6+/-40; 87.0+/-24 pg/ml, respectively; p<0.01) when compared to SA and the control group (58.3+/-49; and 51.5+/-39, respectively). Serum IL-10 levels were also higher in MI and UA patients. Levels of IL-2 and IL-10 measured following chest pain in unstable patients, as well as their consecutive determinations in MI patients did not show any change dynamics, that is, they were persistently elevated. CONCLUSIONS: When compared to stable CAD and healthy subjects, acute coronary syndromes are associated with long-term increase of serum concentrations of pro- and anti-inflammatory cytokines. It seems likely that sudden CAD progression leading to acute coronary syndromes is triggered/accompanied by prolonged immune activation.     

An immunoenzyme method of determining apoprotein B and its diagnostic value in ischemic heart disease

Enzyme immunoassays were used to measure blood apoprotein B (apo-B), a major protein component of low-density lipoproteins, in 96 patients with coronary disease due to coronary atherosclerosis, 21 patients with angiographically intact coronary arteries, and 130 apparently normal individuals (donors). The results of serum apo-B measurements were correlated to the presence or absence of atherosclerotic coronary arterial lesions, the spread of coronary atherosclerosis, as evidenced by selective coronarography, and patients' sex and age. The measurement of serum apo-B may be helpful in early diagnosis of coronary disease, being particularly valuable in males below 50 years of age.     

可溶性糖蛋白130与稳定型冠心病患者冠状动脉粥样硬化严重程度之间关系

目的: 评估稳定型冠状动脉疾病（stable coronary artery disease, CAD）患者血清白细胞介素-6（IL-6）、可溶性IL-6受体（sIL-6R）和可溶性糖蛋白130（sgp130）浓度及与冠状动脉粥样硬化严重程度间的关系。方法：纳入2017年1月到2019年1月间于惠州市第六人民医院心内科具有动脉造影适应症疑似冠心病患者89例,根据冠状动脉造影结果将患者分成两组：存在冠状动脉粥样斑块CAD组,即粥样斑块组,共64例;不存在冠状动脉粥样斑块CAD组,即非粥样斑块组,共25例。采用ELISA法检测两组患者血清IL-6、sIL-6R和sgp130浓度,Spearman相关分析sgp130浓度与受累冠脉数目及Gensini评分的相关性,多因素logistic回归分析冠状动脉粥样硬化斑块病变的预测因子。结果： 粥样斑块组与非粥样斑块组在年龄、BMI、高血压、糖尿病、血脂参数上无统计学差异（P>0.05）, 粥样斑块组患者男性吸烟者居多（P<0.05）。粥样斑块组血清sgp130浓度显著低于非粥样斑块组（314.97±84.39 VS 399.08±79.99 ng/ml, P<0.001）,粥样斑块组血清IL-6浓度显著高于非粥样斑块组（P<0.05）, 粥样斑块组血清sIL-6R浓度和C-反应蛋白浓度(CRP)与非粥样斑块组比较差异无统计学意义。多因素logistic回归分析示血清sgp130浓度是冠状动脉粥样硬化斑块病变存在的预测因子（P=0.018）。血清sgp130浓度与受累冠状动脉数目间呈负相关（r=-0.310,P=0.007）,Gensini评分指数与血清sgp130浓度呈负相关（r=-0.410, P=0.001）,稳定型CAD患者sgp130浓度是Gensini评分指数独立危险因素。结论：稳定型CAD患者血清sgp130浓度与冠状动脉损伤严重程度呈负相关,血清sgp130水平是冠状动脉粥样硬化严重程度血清标志物。     

Associations Between Plasma Kinin B1 Receptor Levels and the Presence and Severity of Coronary Artery Disease

Aim: Kinin B1 receptor (KB1R) was shown to be up-regulated in human carotid atherosclerotic lesions. Serum KB1R levels were also reported to be high in patients with stroke. However, KB1R deficiency increased atherosclerotic lesions. Therefore, the role of KB1R in atherosclerosis remains unclear. Moreover, no study has reported blood KB1R levels in patients with coronary artery disease (CAD). Methods: We measured plasma KB1R levels in 375 patients undergoing coronary angiography. The severity of CAD was represented as the numbers of ＞50% stenotic vessels and segments and the severity score. Results: CAD was found in 197 patients, of whom 89 had 1-vessel disease (1-VD), 62 had 2-VD, and 46 had 3-VD. Plasma KB1R levels were higher in 197 patients with CAD than in 178 without CAD (median 83.3 vs. 73.7 pg/mL, p ＜0.01). A stepwise increase in KB1R levels was found depending on the number of stenotic vessels: 77.1 in 1-VD, 87.8 in 2-VD, and 88.5 pg/mL in 3-VD ( p ＜0.025). A high KB1R level (＞90.0 pg/mL) was present in 30% of patients with CAD(-), 39% of 1-VD, 50% of 2-VD, and 48% of 3-VD ( p ＜0.025). KB1R levels correlated with the number of stenotic segments and the severity score (r=0.14 and r=0.17, p ＜0.01). In multivariate analysis, KB1R levels were an independent factor associated with CAD. Odds ratio for CAD was 1.62 (95%CI=1.02-2.58) for high KB1R level ＞90.0 pg/mL. Conclusion: Plasma KB1R levels in patients with CAD were high and were associated with the presence and severity of CAD independent of atherosclerotic risk factors.     

Enhanced expression of TLR4 in smooth muscle cells in human atherosclerotic coronary arteries

Toll-like receptors (TLRs) play an essential role in innate immunity as components of the primary defense system against microbial infections. It has become evident that TLRs are also involved in the pathogenesis of various cardiovascular diseases. However, the expression patterns of TLRs in the human coronary arteries of coronary artery disease (CAD) patients and the regulatory mechanisms of their expression remain unknown. The TLR4 expression patterns were invstigated by immunohistochemical analysis of coronary specimens obtained from autopsy cases or CAD patients by using directional coronary atherectomy. In atherosclerotic coronary arteries (n = 8), TLR4 immunoreactivity was colocalized with infiltrating inflammatory cells. Interestingly, vascular smooth muscle cells of atherosclerotic coronary arteries intensely expressed TLR4 even in the regions that had few inflammatory cells. In contrast, TLR4 expression was barely detected in the vascular smooth muscle cells of nonatherosclerotic coronary arteries (n = 4). Furthermore, intense expression of smooth muscle TLR4 was observed in the coronary arteries of CAD patients (n = 52). Stimulation with tumor necrosis factor α and angiotensin II increased the expression of TLR4 mRNA in cultured human vascular smooth muscle cells. Candesartan, an antagonist of the angiotensin II type 1 receptor (AT1), and N-acetylcystine inhibited angiotensin II-induced TLR4 mRNA expression in these cells. These findings suggest that the vascular smooth muscle cells of atherosclerotic coronary arteries may be activated to express TLR4. Furthermore, proinflammatory cytokines and oxidative stress in the inflammatory lesions might contribute to the enhanced expression of TLR4 in vascular smooth muscle cells of atherosclerotic arteries.     

Effect of isoptin on myocardial hemodynamics and contractility during an anginal attack induced by the atrial stimulation test

The effect of 10 mg intravenous isoptin on myocardial hemodynamics, contractility and metabolism during an anginal attack provoked by the atrial stimulation test was examined in 15 coronary patients with angina of effort. Isoptin administration increased anginal threshold, reduced the values indicative of cardiac activity and myocardial oxygen requirement and had no basic effect on coronary flow, while metabolic manifestations of ischemia were neutralized. Isoptin is recommended as an effective means of treatment for angina of effort in patients with atherosclerotic lesions of coronary arteries.     

冠心病患者血清胱抑素C水平与冠状动脉病变的相关性

目的:观察冠心病患者血清胱抑素C(cystatin C)水平,探讨其与冠状动脉病变的相关性。方法:88例疑似冠心病的患者均行冠状动脉造影,其中确诊为冠心病的患者62例(冠心病组),根据冠状动脉病变支数分为单支病变亚组(28例)、双支病变亚组(14例)和多支病变亚组(20例);26例冠状动脉造影正常者为对照组。采用双抗夹心酶联免疫吸附(ELISA)法测定入选患者血清cystatin C和基质金属蛋白酶-9(MMP-9)水平。结果:①与对照组比较,冠心病组血清cystatin C水平明显降低,MMP-9水平明显升高,差异有统计学意义(P<0.05)。②各亚组间比较,血清cystatin C水平随冠状动脉病变支数的增加而降低,差异有统计学意义(P<0.05)。③冠心病组血清cystatin C水平与体质指数、TG、MMP-9和冠状动脉病变支数呈明显负相关(P<0.05),与HDL-C呈明显正相关(P<0.05)。结论:冠心病患者血清cystatin C水平明显降低,与冠状动脉病变程度呈负相关。     

The Relationship of Serum Soluble Fas Ligand (sFasL) Level with the Extent of Coronary Artery Disease

Fas/Fas ligand system contributes to the programmed cell death induced by myocardial ischemia. We investigated whether serum soluble Fas ligand (sFasL) level is independently related with the severity and extent of angiographically assessed coronary artery disease (CAD). We included 169 patients in this study. Two groups were formed based on the existence of a lesion on coronary angiography. First group included patients with normal coronary arteries (NCA; n = 53). Patients with atherosclerotic lesions were included in the second group (n = 116). We used the coronary vessel score (the number of the coronary arteries with a lesion leading to ≥ 50% luminal obstruction) and the Azar score to determine the extent and the severity of CAD. Standard enzyme-linked immunosorbent assay kits were used to measure serum sFasL levels. The serum sFasL level was higher in patients with CAD than in patients with NCA (0.52 ± 0.23 mU/mL vs. 0.45 ± 0.18 mU/mL, p = 0.023). The sFasL level correlated with Azar score (r = 0.231, p = 0.003) and with coronary vessel score (r = 0.269, p < 0.001). In the multivariate analysis, we found that age (beta: 0.188, p = 0.008), gender (beta: 0.317, p < 0.001), diabetes mellitus (DM; beta: 0.195, p = 0.008), and sFasL level (beta: 0.209, p = 0.003) were independently related with Azar score. When we used coronary vessel score as the dependent variable, we found that age (p = 0.020), gender (p < 0.001), DM (p = 0.006), and sFasL level (p = 0.001) were independent predictors. Serum sFasL level is associated with angiographically more severe CAD. Our findings suggest that sFasL level may be a biochemical surrogate of severe coronary atherosclerosis.     

Serum gamma-glutamyl transferase activity increased in patients with coronary artery ectasia

BACKGROUND: Serum gamma-glutamyl transferase (GGT) activity, an enzyme responsible for the extracellular catabolism of antioxidant glutathione, may directly take part in atherogenesis and evolve as a potential biochemical risk indicator of cardiovascular morbidity and mortality. An important characteristic of coronary artery ectasia (CAE) is the fact that in 85% of the cases, atherosclerotic coronary disease accompanies it. The relation between CAE and serum GGT activity has not been studied so far. Hence, we decided to investigate the serum GGT level in patients with CAE. METHODS: We measured serum GGT activity in 88 consecutive patients (48 males) with isolated CAE and 86 patients with coronary artery disease (CAD) and 84 controls. CAE was defined as being without any stenotic lesions with a visual assessment of the coronary arteries showing a luminal dilatation 1.5-fold or more of the adjacent normal coronary segments. Four subgroups were created in accordance with the CAE extension in coronary arteries. RESULTS: There were no statistically significant differences in serum GGT activity among CAE and CAD groups. Serum GGT activity was found significantly increased in patients in both CAE and CAD groups, compared with those in control group (P<0.001, P<0.001, respectively). According to the CAE severity, there were no statistically significant differences in CAE among these subgroups. CONCLUSION: We have shown for the first time that patients with CAE have higher serum GGT activity compared with controls with normal coronary angiograms. Hence, serum GGT activity can be used as a follow-up marker in patients with CAE.     

Increased serum glycated albumin level is associated with the presence and severity of coronary artery disease in type 2 diabetic patients.

BACKGROUND: Glycated albumin is the predominant circulating Amadori-type glycated protein in vivo and plays a major role in the development of diabetic vascular complications. The aim of this study was to assess the relationship between increased serum glycated albumin level and the presence and severity of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). METHODS AND RESULTS: In a total of 320 consecutive patients with T2DM, coronary angiography revealed normal coronary arteries in 83 patients (control group) and significant coronary stenosis (> or = 70% luminal diameter narrowing) in 237, of whom 51 patients had 1-vessel disease (Group I), 80 had 2-vessel disease (Group II), and 106 had 3-vessel disease (Group III). Serum glycated albumin, hemoglobin A(1c) (HbA(1c)) and tumor necrosis factor (TNF)-alpha levels, lipid profile, and renal function were measured. Logistic regression analysis was performed to determine the relative risk of serum glycated albumin level for the presence and severity of CAD. Multivariate stepwise linear regression analysis was done to identify independent determinants of the glycated albumin level. Serum glycated albumin (21.2+/-5.3% vs 19.4+/-4.3%, p=0.005) and TNF-alpha levels (123 +/-115 pg/ml vs 65+/-59 pg/ml, p<0.001) were significantly higher in patients with CAD than in controls, but serum HbAlc level did not significantly differ between them (7.6+/-1.3% vs 7.4+/-1.2%, p=0.19). There was a significant difference in serum glycated albumin level between Groups I and III (19.5+/-3.3% vs 21.8+/-5.7%, p<0.001). The serum glycated albumin level correlated with the number of diseased arteries (Spearman r=0.205, p<0.001), and was closely related to serum levels on admission of glucose (r=0.495, p<0.001), TNF-alpha (r=0.123, p=0.028), blood urea nitrogen (r=0.167, p=0.004), triglycerides (r=0.129, p=0.021), and HbA(1c) (r=0.795, p<0.001). Multivariate analysis indicated that serum levels of glucose (p<0.0001), TNF-alpha (p=0.001), blood urea nitrogen (p=0.004) and triglycerides (p=0.035) were independent determinants for glycated albumin. Logistic regression analysis revealed that glycated albumin > or = 19% (odds ratio (OR) 2.9, p<0.001) was an independent predictor for CAD and glycated albumin > or = 21% (OR 2.3, p=0.032) for 3-vessel disease prediction. The area under the receiver-operating characteristic curve for glycated albumin (0.620, 95% confidence interval (CI) 0.548 to 0.691, p=0.001) was superior to that for HbA(1c) (0.543, 95% CI 0.473 to 0.613, p=0.243). CONCLUSIONS: An increased serum level of glycated albumin is associated with the presence and severity of CAD, and may be useful in screening patients with T2DM.     

Status of the coronary vessels and functional state of autovenous shunts in patients with ischemic heart disease at remote periods after aortocoronary bypass

Repeated coronarography in 89 coronary patients at late dates after aortocoronary shunting, including 74 (83%) patients with residual or recurrent angina and only 15 (17%) angina-free patients, demonstrated that the progress of atherosclerosis continued in both the shunted and intact coronary arteries after the operation. Thrombosis of autovenous shunts had a pronounced effect on clinical condition of the patients. Only 50% of the shunts were open in patients with residual or recurrent angina, while bypass patency was 81% in the absence of anginal attacks.     

Progression of atherosclerosis in coronary arteries and bypass grafts: Ten years later

Progression of atherosclerosis in aortocoronary saphenous vein grafts is frequent and is the predominant cause of late graft closure after CABG. Only approximately 60% of grafts remain patent between 10 and 12 years after surgery. Of patent grafts, 45% show angiographie evidence of atherosclerosis between 10 and 12 years after surgery and 70% of the atherosclerotic lesions reduce the graft lumen diameter by 50% or more. Atherosclerosis of saphenous vein grafts does not appear to be related to age, sex or cigarette smoking, but is associated with abnormalities of cholesterol lipoprotein fractions. Progression of atherosclerosis in the native coronary arteries is also very significant after CABG. Progression of CAD between 10 and 12 years after surgery occurs in approximately 50% of nongrafted arteries. Between 10 and 12 years after surgery, the rate of progression of disease in nongrafted arteries is not different from that of grafted arteries with patent grafts; however, progression is more frequent in grafted arteries with occluded grafts. The rate of progression is not related to age, sex, risk factors or extent of disease at baseline coronary arteriography. Progression of preexisting stenoses is more frequent than appearance of new stenosis. Progression is related to the severity of the preexisting stenosis only in nongrafted arteries. Finally, progression is related to alterations of left ventricular function during follow-up.

Because of these progressive late changes, CABG should probably remain limited to patients with incapacitating anginal symptoms or to those with severe lesions for whom surgery might enhance long-term survival, such as patients with severe left main CAD and 3-vessel CAD.     

Troponin levels in patients with stable CAD

IntroductionCardiac troponins are known as specific markers of myocardial damage. Their elevation in the serum is not always related to acute myocardial ischaemia. The increased sensitivity of diagnostic kits has resulted in an increase in the number of positive results in patients without acute coronary syndrome (ACS).Study objectivesTo determine the level of highly sensitive troponin T (hs TnT) in stable patients (without ACS) before selective coronarography (SCG) and to determine the correlation between hs TnT values and the extent of atherosclerotic damage to the coronary arteries.MethodologyWe studied a group of 251 consecutive patients with indications for SCG diagnosis. Indication criteria were stable angina pectoris, shortness of breath, newly diagnosed heart failure, syncope, and ventricular arrhythmia. Exclusion criteria were acute coronary syndrome, including unstable angina pectoris, prior cardiopulmonary resuscitation, cerebrovascular accident (CVA) within the last 6 months, and ongoing sepsis. The hs TnT value was determined before SCG (normal range, 0–0.013 μg/l). Monitored parameters included coronary angiography (70% stenosis of coronary artery diameter was considered significant coronary disease), age, gender, heart rate, and serum creatinine levels. The study included 182 patients with normal renal function and 69 patients with renal insufficiency. The results were processed using STATISTICA (version 12), StatSoft©, Inc. (2013).ResultsThe average age of the studied population was 69.6 ± 10.3 years (median, 70 years); 33% of patients were women. The serum level of hs TnT for the entire population was 0.031 ± 0.091 μg/l (0.014). A positive hs TnT was noted in 133 patients. The population study group consisted of 121 patients with normal coronary arteries or with insignificant atherosclerotic disease. Significant damage involving one or more arteries was present in 130 patients. In the subgroup with significant coronary disease, we found a significantly higher hs TnT level than in the group of patients without significant coronary disease: 0.043 ± 0.125 μg/l (0.018) vs. 0.019 ± 0.018 μg/l (0.013) (p = 0.008) (Mann–Whitney test).Significantly higher troponin levels were found in the group of patients with renal insufficiency than in the subgroup with normal creatinine levels: 0.057 ± 0.150 μg/l (0.023) vs. 0.022 ± 0.053 μg/l (0.012), respectively (p < 0.05) (Mann–Whitney test).ConclusionSlightly elevated serum troponin T levels are common in patients with stable coronary artery disease (CAD). We observed a significant correlation between the level of troponin and the presence of atherosclerotic damage to the coronary arteries. A significant correlation between the value of troponin and the extent of atherosclerotic damage (in terms of the number of damaged arteries) could not be demonstrated. On the basis of our findings, the absolute level of troponin T in patients with stable CAD must be interpreted with caution, especially in patients who also have renal insufficiency. Determination of basal troponin T levels in patients with stable CAD is reasonable as they may be used for comparison in case of change in a patient's clinical condition.     

Predictive value of mitral annular calcification for the diagnosis of coronary artery disease in patients with dilated cardiomyopathy

Mitral annulus calcification (MAC) is an independent predictor of coronary artery disease (CAD). The present study was designed to determine whether an association exists between MAC and CAD in patients with dilated cardiomyopathy. Among the 286 patients with MAC on echocardiographic examination who underwent coronary angiography, 55 patients with echocardiographic findings of dilated cardiomyopathy (group I) were compared to 60 age-matched controls without MAC and an echocardiographic diagnosis of dilated cardiomyopathy (group II) who underwent coronary angiography during the same time. There were no differences in echocardiographic findings between two groups. The prevalence of CAD was higher in group I when compared to group II (74% vs 28%, p<0.001). With regard to severity of CAD, two-vessel, three-vessel, and left main coronary artery disease were found to be significantly frequent in group I (p<0.001). Multivariate analysis revealed that MAC (p=0.001), diabetes mellitus (p=0.048), and history of anginal chest pain (p=0.009) are the independent predictors for the presence of CAD in patients with dilated cardiomyopathy. In conclusion, MAC may be a marker for the presence of coronary artery disease in patients with dilated cardiomyopathy.     

Atherosclerotic burden in coronary and peripheral arteries in patients with first clinical manifestation of coronary artery disease

The aim of our study was to assess the atherosclerotic burden in patients with the first symptoms of coronary artery disease (CAD). The study population consisted of 100 consecutive patients (new-onset severe angina or myocardial infarction) and 70 age- and sex-matched volunteers without symptoms of CAD. Functional and morphologic atherosclerotic markers were sought in carotid, brachial, and femoral arteries of all subjects by means of high-resolution ultrasonography while coronary arteriography was performed in the CAD patients only. A total of 347 coronary lesions, 230 (66%) of them obstructive, were discovered in the CAD patients as well as 105 peripheral plaques, of which 26 (25%) were obstructive. The mean percent diameter stenosis of the culprit coronary lesion was 83.8% ± 15.8%, the mean vessel score 1.7 ± 0.8 (range 0–3), the mean stenosis score 19.8 (range 1.5–89.0), and the mean extent score 49.1% (range 10%–65%). Endothelium-dependent vasodilation, as assessed by the brachial flow-mediated response (FMR), was reduced by 50% in the CAD patients (P < 0.001 vs controls); it was also observed in carotid and femoral arteries by the cold pressor test. Furthermore, endothelium-independent vasodilation was significantly impaired in all investigated peripheral arteries of the CAD patients (P < 0.05–0.001 vs controls). Intima-media thickness (IMT) was increased in the carotid arteries of the CAD patients by 43%, in brachial arteries by 20%, and in femoral arteries by 57% (P < 0.01–0.001 vs controls). Decreased FMR or increased carotid IMT were found to be independent risk factors for the CAD, and they correlated with the coronary vessel and extent scores. Peripheral atherosclerosis was more developed in older patients but was similar in patients with different clinical presentation. Hyperlipidemia, a positive family history, and smoking were associated with premature CAD. In conclusion, the atherosclerotic process was quite advanced in coronary as well as peripheral arteries of our patients with the first clinical presentation of CAD. Received: February 1, 2002 / Accepted: May 24, 2002 Correspondence to A. Cerne     

Cigarette smoking and inflammatory indices in coronary artery disease

BACKGROUND: Smoking-induced endothelial dysfunction may lead to inflammatory activation within a vascular wall mediated by cytokines and adhesion molecules. The aim of the study was to assess the relationship between the smoking status and serum levels of tumor necrosis factor (TNF) alpha, sTNFR 1 and 2 (soluble forms of TNF receptor), Interleukin (IL)-2, IL-10 and some selected adhesion molecules (AM): sE-selectin, sP-selectin, Vascular Cell AM-1 (sVCAM-1) and Intercellular AM-1 (sICAM-1) in patients with coronary artery disease (CAD). METHODS AND RESULTS: The study group consisted of 122 consecutive admissions with stable CAD (class II/III CCS): 31 current smokers (group I; mean age+/-S.E.M.: 53.8+/-1.6 years), 38 ex-smokers (group II; mean age+/-S.E.M.: 57.8+/-1.4 years) and 53 patients who have never smoked (group III; mean age+/-S.E.M.: 62.4+/-1.1 years). Serum concentration of IL-2 was higher in the group of active smokers (77.5+/-12.7 pg/ml) than in ex-smokers (40.0+/-10.6 pg/ml; P=0.017). AM determination also revealed differences between groups I and II-elevated serum sP-selectin levels in active smokers (174.7+/-17.1 ng/ml) than in ex-smokers (123.5+/-10.3 ng/ml; P=0.024). Serum sTNFR 2 level was higher in group III (2457.3+/-120.5 pg/ml) in comparison to group II (2018.4+/-121.5 pg/ml; P=0.006). There were no differences between TNF alpha, sTNFR 1, IL-10, sE-selectin, sICAM-1, sVCAM-1 levels in the groups examined. CONCLUSIONS: Cigarette smoking is associated with the elevation of IL-2 and sP-selectin serum levels in patients with stable CAD. CAD patients who have never smoked are characterized by delayed onset of angina and increased sTNFR 2 concentrations.     

Prevalence of coronary artery disease in patients undergoing valvular operation due to rheumatic involvement.

OBJECTIVE: Rheumatic heart disease is still a major health problem in developing countries. The impact of coronary artery disease (CAD) on or its relation to rheumatic fever is not well established. We aimed to evaluate the prevalence of CAD and atherosclerotic risk factors in patients who underwent valvular surgery due to rheumatic heart disease. METHODS: The records of 346 patients who had undergone rheumatic valvular surgery in a university hospital between 1996 and 2002 were evaluated. RESULTS: Coronary angiography was performed in 218 (63%) patients, of whom 41 (18.8%) had CAD. The mean age of the patients having CAD and normal coronary arteries were 57.3 and 50.5 years respectively (p<0.001). In the study population patients with CAD had significantly increased prevalence of diabetes mellitus (14.6% vs. 4.5%; p=0.02), hypertension (36.6% vs. 16.4%; p=0.003), smoking (51.2% vs. 23.2%; p=0.001) and family history of CAD (39.5% vs. 20.0%; p=0.01) compared to patients with normal coronary arteries. However, the prevalence of dyslipidemia was similar in both groups (45.9% vs. 36.4%; p=0.1). CONCLUSION: These findings suggest that coronary artery disease prevalence in rheumatic valvular disease patients is similar to the normal population of same age. In cases where invasive assessment of valvular lesions is not indicated we suggest coronary angiography to be performed only in patients having clinical suspicion of CAD or multiple risk factors.     

Increased urinary albumin excretion rates can be a marker of coexisting coronary artery disease in patients with peripheral arterial disease

Coexisting coronary artery disease (CAD) is an important cause of morbidity and mortality in patients with peripheral arterial disease (PAD). Clinical evaluation and noninvasive tests have some important limitations for the detection of CAD in patients with PAD. The purpose of this study was to investigate whether urinary albumin excretion (UAE) was a sign of atherosclerotic involvement of coronary arteries in patients with PAD. Our study consisted of 65 consecutive patients (56 men, 9 women, mean age; 59.7+/-7.9 years) with PAD who underwent coronary angiography. Urinary albumin excretion was measured in 24-hour urine samples by immunoprecipitation technique. PAD was defined as the presence of > or =50% stenotic lesions in at least 1 of the iliac, femoral, popliteal, tibialis anterior, tibialis posterior, or peroneal arteries. CAD was defined as > or =25% diameter stenosis in at least 1 coronary artery. Patients without any coronary lesions were accepted as having normal coronaries. Age, sex, distributions of coronary risk factors, and UAE rates were compared between patients with and without CAD. Mean UAE was 17.9+/-15.6 mg/day in the total population. Thirty-seven percent of patients had CAD, and 63% had no coronary lesion. UAE rates were 22.33+/-18.74 and 15.32+/-13.01 mg/day in patients with CAD and those with normal coronary arteries, respectively (p = 0.021). Microalbuminuria was detected in 25% in patients with CAD and 12% in those without coronary artery lesions (p = 0.184). The difference was not statistically significant. The distributions of other risk factors and sex were not different between the 2 groups. These data suggest that in patients with PAD, urinary albumin excretion rates may be used to determine those with a high probability of CAD. Further studies are required to decide whether this noninvasive testing is appropriate in detecting high-risk patients.     

Rheumatoid arthritis patients have higher prevalence and burden of asymptomatic coronary artery disease assessed by coronary computed tomography: A systematic literature review and meta-analysis

BackgroundRheumatoid arthritis (RA) is associated with increased risk of coronary artery disease (CAD) and studies with coronary computed tomography have suggested increased rates of asymptomatic CAD determined by the coronary calcium score (CCS) in these patients. To synthesize the evidence on this topic, we conducted a systematic review and meta-analysis of the literature.MethodsA systematic review was performed of data comparing the prevalence and burden of asymptomatic CAD in RA and controls using CCS with or without coronary computed tomographic angiography (CCTA). For the meta-analysis, pooled data provided the estimated risk ratio (RR) of CAD and weighted mean differences of CCS in patients with RA compared to controls.ResultsThe search revealed 1841 results of which 1083 were screened and 26 full text papers were evaluated. Eight studies were included with data on 788 patients with RA and 1641 controls. Patients with RA had significantly increased risk of CAD (RR = 1.26 [95% CI 1.04–1.52]; p = .021) and increased weighted mean differences for CCS (48.25 [95% CI 26.97–69.53]; p < .001) compared to controls. Limited evidence suggested that patients with RA had a higher prevalence of moderate-severe (CCS > 100) CAD and more multivessel CAD, and RA duration and disease activity were associated with higher CCS, RA disease activity was linked with presence of high risk (non-calcified or mixed) coronary plaques, and treatment with methotrexate was tied to absence of CAD, respectively.ConclusionsIn patients with RA, asymptomatic CAD is more prevalent, with higher mean CCS, more multivessel disease, and more high-risk plaques compared to controls.