Common genetic variants on chromosome 9p21 are associated with myocardial infarction and type 2 diabetes in an Italian population

Background  

A genomic region on chromosome 9p21 has been identified as closely associated with increased susceptibility to coronary artery disease (CAD) and to type 2 diabetes (T2D) although the evidence suggests that the genetic variants within chromosome 9p21 that contribute to CAD are different from those that contribute to T2D.     

The influence of statin treatment on the inflammatory biomarkers YKL-40 and HsCRP in patients with stable coronary artery disease

Objective  

The inflammatory biomarker YKL-40 is elevated and associated with mortality in patients with stable coronary artery disease (CAD). The aim was to investigate the influence of statin treatment and lipid status on serum YKL-40 and Hs-CRP in patients with stable CAD.     

T null and M null genotypes of the glutathione S-transferase gene are risk factor for CAD independent of smoking

Background  

The association of the deletion in GSTT1 and GSTM1 genes with coronary artery disease (CAD) among smokers is controversial. In addition, no such investigation has previously been conducted among Arabs.     

Daily Stress and Social Support among Women with CAD: Results from a 1-year Randomized Controlled Stress Management Intervention Study

Background  

Psychosocial stress may play a causative role in development and progression of coronary artery disease (CAD).     

The interactive role of type 2 diabetes mellitus and E-selectin S128R mutation on susceptibility to coronary heart disease

Background  

The role of gene-environment interactions as risk factors for coronary heart disease (CAD) remains largely undefined. Such interactions may involve gene mutations and disease conditions such as type 2 diabetes mellitus (DM2) predisposing individuals to acquiring the disease.     

Peripheral monocytes from diabetic patients with coronary artery disease display increased bFGF and VEGF mRNA expression

Background  

Macrophages can produce vascular endothelial growth factor (VEGF) in response to hypoxia, transforming growth factor β1 (TGF-β1), angiotensin II, basic fibroblast growth factor (bFGF), and interleukin-1. These factors have been found in the serum of coronary artery disease (CAD) patients as well as in atherosclerotic lesions. The aim of the present study was to test the hypothesis that the expression of VEGF, TGF-β1 and bFGF in peripheral monocytes and lymphocytes is related to CAD.     

Genetic polymorphisms of TP53 and FAS promoter modulate the progression of coronary artery disease after coronary artery bypass grafting: a gender-specific view

Introduction  

Progression of coronary artery disease (CAD) after primary coronary artery bypass grafting (CABG) is frequent and may lead to recurrent symptoms. Various data indicate that apoptosis is the main event occurring during development and progression of atherosclerotic plaque. Plaque vascular smooth muscle cells (VSMCs) are more sensitive than regular VSMCs to TP53-mediated apoptosis.     

Aging syndrome genes and premature coronary artery disease

Background  

Vascular disease is a feature of aging, and coronary vascular events are a major source of morbidity and mortality in rare premature aging syndromes. One such syndrome is caused by mutations in the lamin A/C (LMNA) gene, which also has been implicated in familial insulin resistance. A second gene related to premature aging in man and in murine models is the KLOTHO gene, a hypomorphic variant of which (KL-VS) is significantly more common in the first-degree relatives of patients with premature coronary artery disease (CAD). We evaluated whether common variants at the LMNA or KLOTHO genes are associated with rigorously defined premature CAD.     

Risk factor reduction in progression of angiographic coronary artery disease

Introduction

To investigate differences between outpatients with progressive and nonprogressive coronary artery disease (CAD) measured by coronary angiography.

Material and methods

Chart reviews were performed in patients in an outpatient cardiology practice having ≥ 2 coronary angiographies ≥ 1 year apart. Progressive CAD was defined as 1) new non-obstructive or obstructive CAD in a previously disease-free vessel; or 2) new obstruction in a previously non-obstructive vessel. Coronary risk factors, comorbidities, cardiovascular events, medication use, serum low-density lipoprotein cholesterol (LDL-C), and blood pressure were used for analysis.

Results

The study included 183 patients, mean age 71 years. Mean follow-up duration was 11 years. Mean follow-up between coronary angiographies was 58 months. Of 183 patients, 108 (59%) had progressive CAD, and 75 (41%) had nonprogressive CAD. The use of statins, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and aspirin was not significantly different in patient with progressive CAD or nonprogressive CAD Mean arterial pressure was higher in patients with progressive CAD than in patients with nonprogressive CAD (97±13 mm Hg vs. 92±12 mm Hg) (p<0.05). Serum LDL-C was insignificantly higher in patients with progressive CAD (94±40 mg/dl) than in patients with nonprogressive CAD (81±34 mg/dl) (p=0.09).

Conclusions

Our data suggest that in addition to using appropriate medical therapy, control of blood pressure and serum LDL-C level may reduce progression of CAD.     

Computer-aided assessment of diagnostic images for epidemiological research

Background  

Diagnostic images are often assessed for clinical outcomes using subjective methods, which are limited by the skill of the reviewer. Computer-aided diagnosis (CAD) algorithms that assist reviewers in their decisions concerning outcomes have been developed to increase sensitivity and specificity in the clinical setting. However, these systems have not been well utilized in research settings to improve the measurement of clinical endpoints. Reductions in bias through their use could have important implications for etiologic research.     

Carotid intima media thickness and low high-density lipoprotein (HDL) in South Asian immigrants: could dysfunctional HDL be the missing link?

Introduction

South Asian immigrants (SAIs) in the US exhibit higher prevalence of coronary artery disease (CAD) and its risk factors compared with other ethnic populations. Conventional CAD risk factors do not explain the excess CAD risk; therefore there is a need to identify other markers that can predict future risk of CAD in high-risk SAIs. The objective of the current study is to assess the presence of sub-clinical CAD using common carotid artery intima-media thickness (CCA-IMT), and its association with metabolic syndrome (MS) and pro-inflammatory/dysfunctional HDL (Dys-HDL).

Material and methods

A community-based study was conducted on 130 first generation SAIs aged 35–65 years. Dys-HDL was determined using the HDL inflammatory index. Analysis was completed using logistic regression and Fisher''s exact test.

Results

Sub-clinical CAD using CCA-IMT ≥ 0.8 mm (as a surrogate marker) was seen in 31.46%. Age and gender adjusted CCA-IMT was significantly associated with type 2 diabetes (p = 0.008), hypertension (p = 0.012), high-sensitivity C-reactive protein (p < 0.001) and homocysteine (p = 0.051). Both the presence of MS and Dys-HDL was significantly correlated with CCA-IMT, even after age and gender adjustment. The odds of having Dys-HDL with CCA-IMT were 5 times (95% CI: 1.68, 10.78).

Conclusions

There is a need to explore and understand non-traditional CAD risk factors with a special focus on Dys-HDL, knowing that SAIs have low HDL levels. This information will not only help to stratify high-risk asymptomatic SAI groups, but will also be useful from a disease management point of view.     

Association between serum inhibin-B levels and coronary artery disease in aging males

Introduction

Atherosclerosis is a systemic disorder. It is a frequent leading cause of coronary artery disease (CAD). Similarly, atherosclerotic vascular alterations could lead to testicular arterial blood flow reduction and impairment of testicular function with age. Inhibin-B has been validated as a valuable serum marker of testicular functions and its correlation with testicular volume was shown in some studies done before. The purpose of this study is to investigate the association between serum inhibin-B levels and CAD in elderly men.

Material and methods

Between March 2009 and March 2010, fifty-two 50-80-year-old consecutive patients with Gensini score over 20 and ejection fraction (EF) > 50% were included in the study as the CAD group. Fifty healthy men without any cardiac disease history were recruited as the control group. All patients in the CAD group who had indications for coronary artery angiography underwent selective coronary artery angiography.

Results

Inhibin-B, total testosterone and testicular volume levels were found to be significantly lower in the CAD group in comparison with the control group (p = 0.004, p < 0.0001, and p = 0.001 respectively).

Conclusions

In this study, although no correlation was found in CAD patients between Gensini score and inhibin-B or testicular volume, inhibin-B levels and testicular volume were significantly lower in patients with CAD than in healthy men. In order to fully assess the relationship between serum inhibin-B levels and CAD, multi-centered prospective and longitudinal studies must be done in elderly male patients.     

Combined ECG,Echocardiographic, and Biomarker Criteria for Diagnosing Acute Myocardial Infarction in Out-of-Hospital Cardiac Arrest Patients

Purpose

Acute coronary lesions commonly trigger out-of-hospital cardiac arrest (OHCA). However, the prevalence of coronary artery disease (CAD) in Asian patients with OHCA and whether electrocardiogram (ECG) and other findings might predict acute myocardial infarction (AMI) have not been fully elucidated.

Materials and Methods

Of 284 consecutive resuscitated OHCA patients seen between January 2006 and July 2013, we enrolled 135 patients who had undergone coronary evaluation. ECGs, echocardiography, and biomarkers were compared between patients with or without CAD.

Results

We included 135 consecutive patients aged 54 years (interquartile range 45-65) with sustained return of spontaneous circulation after OHCA between 2006 and 2012. Sixty six (45%) patients had CAD. The initial rhythm was shockable and non-shockable in 110 (81%) and 25 (19%) patients, respectively. ST-segment elevation predicted CAD with 42% sensitivity, 87% specificity, and 65% accuracy. ST elevation and/or regional wall motion abnormality (RWMA) showed 68% sensitivity, 52% specificity, and 70% accuracy in the prediction of CAD. Finally, a combination of ST elevation and/or RWMA and/or troponin T elevation predicted CAD with 94% sensitivity, 17% specificity, and 55% accuracy.

Conclusion

In patients with OHCA without obvious non-cardiac causes, selection for coronary angiogram based on the combined criterion could detect 94% of CADs. However, compared with ECG only criteria, the combined criterion failed to improve diagnostic accuracy with a lower specificity.     

NLRP3 and downstream cytokine expression elevated in the monocytes of patients with coronary artery disease

Introduction

Pattern recognition receptor (PRR)-mediated signaling pathways have recently been elucidated to bridge the innate immune system and atherosclerosis. NLRP3 is among the family members of NOD-like receptors (NLRs), a type of PRRs. At present, most studies about the NLRP3 inflammasome focus on animal models and immune cells. Limited information is available regarding the role of NLRP3 in patients with coronary artery disease (CAD).

Material and methods

In this study, we observed the expression of NLRP3 and downstream cytokines in patients with CAD by ELISA, real-time qPCR and Western blot.

Results

We found that NLRP3 and downstream cytokines were coupled with increasing severity of CAD and a dynamic variation exists in patients with acute myocardial infarction. We also found that NLRP3 was correlated with Gensini score, indicating that NLRP3 might be relevant not only for the severity of CAD but also for the severity of coronary atherosclerosis.

Conclusions

This study provides a new theoretical basis for innate immune participation in atherosclerosis development and highlights the potential of the NLRP3 inflammasome as a target for prevention and treatment of CAD.     

Genetic study of common variants at the Apo E,Apo AI,Apo CIII,Apo B,lipoprotein lipase (LPL) and hepatic lipase (LIPC) genes and coronary artery disease (CAD): variation in LIPC gene associates with clinical outcomes in patients with established CAD

Background  

Current evidence demonstrates that positive family history and several alterations in lipid metabolism are all important risk factors for coronary artery disease (CAD). All lipid abnormalities themselves have genetic determinants. Thus, objective of this study was to determine whether 6 genetic variants potentially related to altered lipid metabolism were associated with CAD and with lipid abnormalities in an Italian population. These genetic variables were: apolipoprotein E (Apo E), Apo AI, Apo CIII, Apo B, lipoprotein lipase (LPL) and the hepatic lipase (LIPC) genes. Furthermore, an 8 years prospective analysis of clinical cardiovascular events was related to the various genetic markers.     

Comparison of prevalence of obstructive sleep apnea,restless legs syndrome,and poor sleep quality in patients with coronary artery disease and depression

Background

This study was designed to compare the prevalence of restless leg syndrome (RLS), obstructive sleep apnea (OSA), and poor sleep quality between patients with coronary artery disease (CAD) and those with major depressive disorder (MDD)/somatic symptom disorder (SSD).

Methods

In this study, subjects with CAD were included. The comparison group consisted of subjects with MDD or SSD. After screening for exclusion criteria, a total of 100 subjects from each group were screened for OSA, RLS, and sleep quality. Hindi versions of the Berlin questionnaire, the Cambridge–Hopkins RLS diagnostic questionnaire, and the Pittsburgh Sleep Quality Index (PSQI) were used for screening, respectively. The groups were compared using statistical tests.

Results

Due to missing data, 33 subjects were excluded from final analysis. Final analysis was performed on 167 subjects—82 with CAD and 85 with MDD/SSD. Males outnumbered females in this sample (79?% men and 21?% women) and patients with CAD were older (56.1 ± 10.4 years in CAD vs. 35.5 ± 10.9 years in MDD/SSD). Prevalence of “high risk for OSA” was higher among CAD (34?%) as compared to MDD/SSD subjects (12.9?%), even after controlling for age and gender. The prevalence of RLS was comparable (13.4?% in CAD vs. 9.4?% in MDD/SSD). Daytime dysfunction, sleep quality, use of medication to induce sleep, and sleep latency were worse in the MDD/SSD group as compared to the CAD group.

Conclusion

In conclusion, this study shows that CAD patients are at a higher risk of OSA, while sleep-related parameters are worse in MDD/SSD patients. RLS was comparable between groups. On the whole, the prevalence of OSA, RLS, and poor sleep quality in both groups was higher as compared to the general population.

     

Immunoglobulin G (IgG) anticardiolipin antibodies and recurrent cardiovascular events. A systematic review and Bayesian meta-regression analysis

Background

Anticardiolipin antibodies of the immunoglobulin G isotype (IgG aCL) have been suggested as risk factor for arterial and venous thrombosis. No conclusive data in patients with coronary artery disease (CAD) do exist. We investigate the risk of recurrent CAD according to the presence of IgG aCL.

Lateralization of cognitive functions in aphasia after right brain damage

Purpose

The lateralization of cognitive functions in crossed aphasia in dextrals (CAD) has been explored and compared mainly with cases of aphasia with left hemisphere damage. However, comparing the neuropsychological aspects of CAD and aphasia after right brain damage in left-handers (ARL) could potentially provide more insights into the effect of a shift in the laterality of handedness or language on other cognitive organization. Thus, this case study compared two cases of CAD and one case of ARL.

Materials and Methods

The following neuropsychological measures were obtained from three aphasic patients with right brain damage (two cases of CAD and one case of ARL); language, oral and limb praxis, and nonverbal cognitive functions (visuospatial neglect and visuospatial construction).

Results

All three patients showed impaired visuoconstructional abilities, whereas each patient showed a different level of performances for oral and limb praxis, and visuospatial neglect.

Conclusion

Based on the analysis of these three aphasic patients'' performances, we highlighted the lateralization of language, handedness, oral and limb praxis, visuospatial neglect and visuospatial constructive ability in aphasic patients with right brain damage.     

The Association of Type D personality with Heart Rate Variability and Lipid Profiles Among Patients with Coronary Artery Disease

Purpose

Characteristics of the distressed (Type D) personality include negative affectivity (NA) and social inhibition (SI), which are associated with an increased risk of major adverse cardiac events and mortality among patients with coronary artery disease (CAD). The aims of this study were to examine: (1) the correlation of NA and SI with psychological characteristics, heart rate variability (HRV) indices, and lipids profiles and (2) the differences in psychological characteristics, HRV indices, and lipid profiles between patients with CAD with Type D personality and those with non-Type D personality.

Method

A cross-sectional study was conducted on 168 patients with CAD. The Taiwanese 14-item Type D Scale, Chinese Hostility Inventory-Short Form, Beck Depression Inventory-II, Beck Anxiety Inventory, and Anger Rumination Scale were administered to all of the participants. The raw signals of electrocardiograms were recorded over a 5-min baseline resting period and then transformed to HRV indices representing short-term cardiac autonomic activations. Lipid profiles were acquired from patients’ medical records.

Results

NA was positively correlated with hostility, depression, anxiety, and anger rumination. With respect to pathophysiological mechanisms for CAD with Type D personality, NA was negatively correlated with standard deviation of all normal-to-normal intervals (SDNN) and total power of HRV and positively correlated with total cholesterol. SI was positively correlated with suppressive hostility behavior and anger rumination; however, SI was not significantly correlated with expressive hostility behavior, or HRV indices and lipid profiles.

Conclusion

Pathophysiological mechanisms leading to higher rates of adverse outcomes in CAD in individuals with Type D personalities may involve cardiac autonomic imbalance and lipid dysregulation.