Abnormal blood glucose and coronary heart disease: the Puerto Rico Heart Health Program

The presence of abnormal blood glucose (ABG) was determined for participants in the Puerto Rico Heart Health Program, a prospective epidemiological study of cardiovascular disease. Subjects were considered to have ABG at baseline if they were receiving treatment for diabetes (diet, oral hypoglycemics, or insulin), or if the blood glucose level was 140 mg/dl or more. Urban-rural comparisons of the prevalence of ABG were made in this cohort of 2585 rural and 6208 urban men aged 45-64 yr. The prevalence of ABG in the urban population was more than double that in the rural. This population has been followed up for coronary heart disease (CHD) over an 8 1/4-yr period. ABG at baseline is significantly associated with CHD death in urban men. When the relationship is controlled for smoking, systolic blood pressure, cholesterol, and relative weight, the relationship remains significant. The association with total CHD is similar. Either by adjusting for diabetes (i.e., when treated diabetes was excluded from analysis) or by entering both blood glucose and diabetes under treatment into the model, blood glucose was no longer statistically significant. This suggests that ABG, rather than blood glucose alone, is the important variable associated with CHD.     

The significant effect of diabetes duration on coronary heart disease mortality: the Framingham Heart Study

OBJECTIVE: The risk of coronary heart disease (CHD) in type 2 diabetes is two- to threefold higher than in the general population, but the effect of diabetes duration on CHD risk has not been well characterized. We hypothesized that duration of diabetes is an important predictor of incident CHD among people with diabetes. RESEARCH DESIGN AND METHODS: The duration of diabetes (fasting glucose > or =126 mg/dl, random glucose > or =200 mg/dl, or use of an oral hypoglycemic agent or insulin) was assessed in participants with diabetes in the original and offspring cohorts of the Framingham Heart Study. Only subjects with diabetes diagnosed between the ages of 30 and 74 years, without a history of ketoacidosis, and free of cardiovascular disease at the baseline evaluation were included. Cox proportional hazards models were used to estimate the hazard ratio of incident CHD events and mortality over a 12-year follow-up period; models were adjusted for known CHD risk factors. RESULTS: Among 588 person-exams with diabetes (mean age 58 +/- 9 years, 56% men), there were 86 CHD events, including 36 deaths. After adjustment for age, sex, and CHD risk factors, the risk of CHD was 1.38 times higher for each 10-year increase in duration of diabetes (95% CI 0.99-1.92), and the risk for CHD death was 1.86 times higher (1.17-2.93) for the same increase in duration of diabetes. CONCLUSIONS: Duration of diabetes increases the risk of CHD death independent of coexisting risk factors. Further research is necessary to understand the pathophysiology of this increased risk.     

Exercise cardiac power and the risk of coronary heart disease and cardiovascular mortality in men

Purpose: The aim of this study was to examine the relationship of exercise cardiac power (ECP), defined as a ratio of directly measured maximal oxygen uptake with peak systolic blood pressure during exercise, with the risk of mortality from coronary heart diseases (CHD) and cardiovascular diseases (CVD).

Design: Population-based cohort study with an average follow-up of 25 years from eastern Finland. About 2358 men at baseline participated in exercise stress test and 182 CHD and 302 CVD deaths occurred.

Results: Men with low ECP (16.4?mL/mmHg, highest quartile) after adjusting for age and examination year. Low ECP was associated with a 2.8-fold risk of CHD and 2.4-fold for CVD mortality after additional adjustment for conventional risk factors. After further adjustment for leisure time physical activity, the results hardly changed (HR 2.5, 95% CI 1.71–3.67, p?Conclusion: ECP provides non-invasive and easily available measure for the prediction of CHD and CVD mortality. One of the most potential explanation for the association between ECP and the risk of CHD and CVD mortality is an elevated afterload and peripheral resistance indicated by hypertension.

• Key messages

• Index of exercise cardiac power defined as the ratio of directly measured maximal oxygen uptake (VO_2max) with peak systolic blood pressure gives prognostic information in coronary heart disease (CHD) and CVD mortality risk stratification.

• ECP provides non-invasive and easily available measure for the prediction of CHD and CVD mortality.

• One of the most potential explanation for the association between ECP and the risk of CHD and CVD mortality is an elevated afterload and peripheral resistance indicated by hypertension.

     

Asessing coronary heart disease risk and managing lipids.

Elevated low-density lipoprotein (LDL) and below normal high-density lipoprotein (HDL) cholesterol are risk factors for coronary heart disease (CHD). According to clinical guidelines, LDL cholesterol is the primary target for lipid-altering therapy. Many patients who develop CHD have LDL and HDL cholesterol levels that fall within the desirable or low-risk category; consequently, conventional measurements of plasma lipids may not accurately detect high-risk patients. This article discusses the clinical significance of lipoprotein subclasses and methods of measurement. Assessing lipoprotein subclasses provides a more comprehensive and efficacious therapeutic approach compared with the standard lipid profile.     

Prevention of mortality from coronary heart disease with pravastatin.

Cardiovascular disease extracts a heavy burden on society. Until recently, the role of cholesterol lowering in coronary heart disease (CHD) patients has been debated, largely because there was no clear evidence that mortality could be reduced, particularly in patients with relatively normal cholesterol levels. Large-scale, placebo-controlled trials of pravastatin have now demonstrated however, a clear benefit and the safety of this HMG CoA reductase inhibitor. In typical patients with coronary heart disease and average cholesterol levels, pravastatin reduces cardiovascular events, coronary heart disease-related deaths and total mortality when compared to placebo (secondary prevention). Myocardial infarction and mortality from coronary heart disease is also reduced in patients with elevated cholesterol levels without preexisting coronary heart disease (primary prevention). The magnitude of this benefit depends on the particular cohort and absolute risk, which has implications for health strategy. Potential mechanisms of action of pravastatin in addition to lipid lowering are also discussed.     

Five-year mortality and coronary heart disease development after normal coronary angiogram

BACKGROUND:

Previous studies depict low cardiac event and mortality rates in patients with angiographically normal coronary arteries. These studies, however, are limited by small sample sizes, short follow-up intervals, and selection biases. This study was undertaken to determine the natural five-year course of a diverse cohort of subjects with documented normal coronary arteries with respect to coronary heart disease development, revascularization need, and all-cause mortality.

METHODS:

Consecutive adult patients with angiographically normal coronary arteries were followed up for 5 years through medical record review. Patients with any degree of angiographic abnormality, including minimal luminal irregularity or non-critical stenosis, were excluded. Patients were not excluded based on age, co-morbidities (except cardiac transplant and structural heart disease), indication for angiogram, or initial hospitalization status.

RESULTS:

Normal coronary arteries were found in 182 (31.3%) of 582 patients; 129 met all inclusion criteria. The mean age was (49.1±12.5) years; 47 (36.7%) were male and 75 (58.1%) were caucasian. The most common indication for angiography was cumulative risk factors (60.5%). Within 5 years of a normal angiogram, 13 of 129 patients died (10.1%; 95 CI 5.7%-16.9%). Six (40%; 95 CI 19.8% to 64.3%) of 15 patients undergoing repeat angiogram within five years developed new coronary heart disease, with one requiring revascularization. Of traditional risk factors of coronary heart disease, only diabetes was associated with a higher risk of death.

CONCLUSION:

The natural five-year course of a diverse cohort of patients with documented normal coronary arteries suggests that there is significant risk for death and development of coronary heart disease.KEY WORDS: Angiography, Coronary disease, Mortality, Prognosis     

总胆固醇/高密度脂蛋白胆固醇比值预测冠心病危险程度的评价

目的 评价总胆固醇/高密度脂蛋白胆固醇(TC/HDL-C)比值预测冠心病危险程度的价值.方法回顾性分析250例冠心病患者的临床资料分为:稳定型心绞痛组(SA组),不稳定型心绞痛组(UA组),并另选125例健康者为对照组,测定两组的TC/HDL-C、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)和HDL-C并比较其差异性和异常率.结果SA组及UA组TC、TG、LDL-C及TC/HDL-C均高于对照组(P<0.01),HDL-C低于对照组(P<0.01),HDL-C分别为(1.08±0.36)mmol/L、(1.03±0.29)mmol/L vs(1.66±0.67)mmol/L,SA组、UA组HDL-C、LDL-C及TC/HDL-C异常率与对照组比较差异有统计学意义(P<0.05),分别为36.9%、39.1%Vs 20.0%,32.0%、32.8%Vs 16.0%,65.6%、72.7%vs 38.6%.结论TC/HDL-C作为冠心病危险因素的预测价值和灵敏度高于单项血脂指标.     

Migraine and coronary heart disease mortality: a prospective cohort study

A recent population-based prospective study reported that in women, migraine with aura (MA), but not migraine without aura (MoA), was associated with increased risk of coronary heart disease events (CHD). We sought to confirm this association in an Australian population-based cohort of older men and women (n = 2331, aged 49-97 years). We defined MA and MoA from face-to-face interview using International Headache Society criteria. Over a mean 6-year follow-up, 30 women (2.8%) and 30 men (4.4%) without any prior CHD history died from CHD-related causes. In women, a history of MA was associated with a non-significant twofold higher risk of CHD death (age-adjusted relative risk 2.2, 95% confidence interval 0.8, 5.8, P = 0.11), which remained similar after adjustment for cardiovascular risk factors. There were no CHD deaths in men with a history of migraine. Our findings support reports that in women, MA, but not MoA, may be associated with increased risk of CHD.     

Efficacy of 3-year prophylaxis of coronary heart disease risk factors in an organized population

An organized community numbering 1563 men aged 20 to 59 years engaged in scientific activity were entered into an experimental and prophylactic study. The intervention measures were exercised in a high risk group with dyslipoproteinemia, borderline hypertension and coronary heart disease (CHD), mainly at the expense of alterations in nutrition. The three-year prophylaxis resulted in a 7-percent decrease in blood plasma cholesterol and a 13-percent fall in triglycerides. The prevalence of arterial hypertension declined by 3 and the excess body weight by 3.7 percent, which led to a 33-percent decrease in CHD risk development calculated with the aid of the R. P. Prochorskas risk logistic function. Advantages of the individual strategy of CHD prevention are discussed.     

Direct,indirect and total bilirubin and risk of incident coronary heart disease in the Dongfeng-Tongji cohort

Background: Total bilirubin (TBIL) is known to be inversely associated with coronary heart disease (CHD) risk, however, whether this association is dose-response remains inconsistent and it is unclear which subtype of bilirubin is responsible for the potential protective effect.

Methods: We included 12,097 participants who were free of CHD, stroke, cancer and potential liver, biliary and renal diseases at baseline from September 2008 to June 2010 and were followed-up until October 2013. Cox proportional hazards models were used to assess the hazard ratios (HR) and 95% confidence interval (95% CI) of bilirubin with incident CHD risk.

Results: The adjusted HRs for incident CHD increased with increasing direct bilirubin (DBIL) (p for trend?=?.013). Participants within the highest quintile of DBIL had 30% higher risk of incident CHD compared to those in the lowest quintile (95% CI: 1.07, 1.58). In contrast, compared with subjects in the lowest quintile of TBIL, those in the third quintile had the lowest of 24% risk for CHD incidence (95% CI: 0.63, 0.92), which showed a U-shaped association (p for quadratic trend?=?.040).

Conclusions: DBIL was associated with a dose-response increased risk for CHD incidence. However, a U-shaped association existed between TBIL, indirect bilirubin and incident CHD risk.

• Key messages

• Direct bilirubin is independently associated with incident coronary heart disease (CHD) in a dose-response manner.

• A similarly consistent U-shaped association was found between total bilirubin, indirect bilirubin and incident CHD.

• The potential protective effect of total bilirubin within the normal range on incident CHD should be mainly attributed to mild-to moderate elevated levels of indirect bilirubin.

     

High-sensitivity C-reactive protein and coronary heart disease mortality in patients with type 2 diabetes: a 7-year follow-up study

OBJECTIVE: To investigate in a follow-up study whether high-sensitivity C-reactive protein (hs-CRP) predicts coronary heart disease (CHD) events in subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS: The original study population consisted of 1,059 patients with type 2 diabetes (age 45-64 years). Mean duration of diabetes was 8 years. CRP values were available from 1,045 subjects, of whom 878 were free of myocardial infarction (MI) at baseline. CHD mortality and the incidence of nonfatal MI were assessed in a 7-year follow-up. RESULTS: Altogether, 157 patients died from CHD and 254 had a nonfatal or fatal CHD event. Patients with hs-CRP >3 mg/l had a higher risk for CHD death than patients with hs-CRP < or =3 mg/l (19.8 and 12.9%, respectively, P = 0.004). In Cox regression analysis, patients with high hs-CRP had a relative risk of 1.72 for CHD death even after the adjustment for confounding factors (P = 0.002). Among subjects who were free from MI at baseline, those with a high hs-CRP level had relative risks of 1.83 (P = 0.003) and 1.84 (P = 0.004) for CHD death in univariate and multivariate analyses, respectively. CONCLUSIONS: In this large cohort of type 2 diabetic patients, hs-CRP was an independent risk factor for CHD deaths.     

冠心病危险生物学标志物的探索

目的对冠状动脉粥样硬化性心脏病(简称冠心病)的危险因素进行再评估,寻找更全面的冠心病预警指标。方法收集2018年8月至2019年12月四川大学华西医院经冠脉造影确诊为冠心病,且确认入院前未服用过他汀类等降脂药的298例患者作为冠心病组,收集无冠心病的健康人群290例作为对照组,分析两组患者病史和实验室指标的差异。结果冠心病组三酰甘油(TG)、非高密度脂蛋白胆固醇(Non-HDL-C)、残余胆固醇(RC)、单核细胞显著高于对照组,差异有统计学意义(P<0.05);冠心病组总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A(apoA)和同型半胱氨酸(Hcy)显著低于对照组,差异有统计学意义(P<0.05),多因素logistic回归分析提示TG、RC和Non-HDL-C升高是冠心病的独立危险因素,而apoA是冠心病的保护因素。结论临床在关注传统血脂四项的基础上,也应注意监测RC、Non-HDL-C、apoA水平。     

三酰甘油与冠心病危险性的相关性

目的:探讨血浆三酰甘油(triglyceride,TG)升高与冠心病危险性的关系及影响因素。方法:研究对象均为年龄大于40岁的男性,血浆胆固醇≤5.2mmol/L,近3个月未使用利尿剂、调脂药,无严重的肝肾和甲状腺疾病。然后比较健康对照者和冠心病患者空腹及普通饮食后血脂组分的变化。结果:冠心病组空腹非高密度脂蛋白-载脂蛋白CⅢ(non-HDL-ApoCⅢ)水平显著高于健康对照组(360±20)和(670±50)g/L;冠心病组高密度脂蛋白2-胆固醇明显下降,高密度脂蛋白和低密度脂蛋白颗粒中的TG/胆固醇轻度升高;餐后两组TG浓度均显著增加,但冠心病组增加的幅度更大;冠心病组餐后血浆non-HDL-ApoCⅢ、胰岛素/血糖比值显著高于健康对照组(t=2.8,5.9;P<0.05);TG与血浆non-HDL-ApoCⅢ、血浆胰岛素水平呈显著正相关(r=0.72,0.62;P<0.05)。结论:高TG血症是冠心病的重要危险因子,冠心病患者血浆存在non-HDL-ApoCⅢ浓度升高和胰岛素抵抗现象可能是重要的发病原因。     

Glucose intolerance as contributor to noncommunicable disease morbidity and mortality. WHO integrated program for community health in noncommunicable diseases

The World Health Organization (WHO) has considerable evidence that several interrelated factors (e.g., smoking, hypertension, cholesterol, and obesity) contribute to total mortality. Data are presented documenting that glucose intolerance is also a risk factor for total mortality, as well as for cancer and cardiovascular morality. The Kaunas-Rotterdam Intervention Study, which documented glucose tolerance and mortality in a cohort of men, shows a linear increase in total mortality with increasing blood glucose levels. By use of multiple logistic regressions, glucose was shown to be a significant risk factor (c = .2534, t = 4.0) for total mortality. A paradigm is presented in which diabetes is placed as a disease and glucose intolerance as a risk factor within the total scheme for the development of noncommunicable diseases. The WHO action plan for integrated programs in noncommunicable diseases is discussed. The program expands on the experience gained by WHO investigators in community programs and proposes a cooperative effort globally in community-based programming.     

Barriers to coronary heart disease risk modification in women without prior history of coronary heart disease

PURPOSE: To explore the extent to which women perceive barriers to coronary heart disease (CHD) risk modification and to determine if access to a nurse practitioner (NP) decreases perceived barriers to CHD risk modification. DATA SOURCES: Surveys completed by 120 women between the ages of 35 and 60 years, with no known history of CHD. The barriers scale was used to examine women's perceived barriers to CHD risk modification. CONCLUSIONS: Women with access to an NP had less perceived barriers to CHD risk modification. IMPLICATIONS FOR PRACTICE: NPs are ideally suited to decrease the mortality and morbidity associated with CHD through education strategies and attention to individual barriers women face when attempting to incorporate CHD risk factor modification into their lifestyles.     

Asymmetric and symmetric dimethylarginine and risk of secondary cardiovascular disease events and mortality in patients with stable coronary heart disease: the KAROLA follow-up study

Background

Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide synthase inhibitor, which has been associated with total and cardiovascular mortality in various clinical settings. Studies on its structural isomer, symmetric dimethylarginine (SDMA), are scarce. This study aimed to determine the associations of both ADMA and SDMA levels with secondary cardiovascular disease events and all-cause mortality in patients with stable coronary heart disease (CHD).

Methods

In the observational prospective cohort study KAROLA, 1,148 CHD patients were followed for a median of 8.1 years. ADMA and SDMA were determined by liquid chromatography–tandem mass spectrometry. Baseline ADMA and SDMA levels were categorized in quartiles or standardized by their respective standard deviation, and appropriate hazard ratios and 95 % confidence intervals (HR [95 % CI]) were estimated in Cox proportional hazards models.

Results

150 patients experienced secondary cardiovascular disease events (CVD) and 121 patients died. After adjustment for confounders, ADMA was not associated with the risk of secondary CVD events (HR per standard deviation increase: 1.02 [95 %CI: 0.86–1.21]), whereas an association was suggested for SDMA (HR 1.17 [1.00–1.37]). Higher hazard ratios were observed in all-cause mortality models (ADMA: HR 1.15 [0.95–1.37]; SDMA: HR 1.29 [1.09–1.52]).

Conclusions

Our results suggest that especially SDMA might possibly have potential as a risk marker for all-cause mortality and to a lesser extent for secondary cardiovascular events. Future studies are needed to quantify these associations more precisely and should, in particular, further address the possibility of residual confounding by impaired kidney function.