H型高血压患者血清中ADMA、CRP水平与患者动脉粥样硬化及心血管事件的关系

目的探讨H型高血压患者血清中不对称二甲基精氨酸(ADMA)、C反应蛋白(CRP)水平与患者动脉粥样硬化及其心血管事件的关系。方法选择2012年8月至2015年8月在该院诊断为H型高血压患者80例为研究对象,并以同期80例非H型的原发性高血压患者为对照组,采用酶联免疫吸附试验法检测患者血清中ADMA、CRP水平,采用超声检测患者颈动脉并评价动脉粥样硬化情况,对所有患者定期进行随访,记录患者心血管事件的发生,探讨ADMA、CRP水平与患者动脉粥样硬化及心血管事件的关系。结果 H型高血压患者ADMA、CRP水平以及动脉粥样硬化发生率高于对照组,差异有统计学意义(P0.05)。H型高血压患者中动脉粥样硬化37例,患者ADMA、CRP水平高于非动脉粥样硬化者,差异均有统计学意义(P0.05)。Logistic回归分析结果提示,平均动脉压、ADMA水平是患者心血管事件的独立风险因素(P0.05)。结论血清中ADMA水平与动脉粥样硬化密切相关,是H型高血压患者心血管事件的独立风险因素。     

Biomarkers in acute cardiovascular disease

Cardiovascular disease today remains a formidable foe affecting 1 in 3 Americans. The emergence of cardiac biochemical markers has provided clinicians unique insight into the state of the myocardium. In fact, cardiac biomarkers now represent an essential criterion in the definition of acute myocardial infarction. There has been impressive development of efficient and reliable assays to detect biomarkers in the serum. Together with patient history and electrocardiographic analysis, the invaluable information gained from serum cardiac biomarkers supports diagnosis, therapy selection, and determination of prognosis. Biomarkers such as troponin and creatine kinase MB have received well-deserved attention for their ability to detect myocardial ischemia. Clinicians today use cardiac markers to identify ischemia as well as alternate clinical states. B-type natriuretic peptide, for instance, reflects myocardial stretch as seen in heart failure exacerbations and may well have promising prognostic significance. The purpose of this review is to discuss current and emerging cardiac biomarkers in acutely ill patients. The advantages and disadvantages of biomarkers will also be presented in the context of their clinical uses. Present markers are highly sensitive and specific to myocardial injury; however they do not specifically identify the method of injury. An exciting potential exists for future biomarkers to demonstrate enhanced specificity and earlier detection of compromised myocardium.     

Impact of subclinical atherosclerosis on cardiovascular disease events in individuals with metabolic syndrome and diabetes: the multi-ethnic study of atherosclerosis

OBJECTIVE

While metabolic syndrome (MetS) and diabetes confer greater cardiovascular disease (CVD) risk, recent evidence suggests that individuals with these conditions have a wide range of risk. We evaluated whether screening for coronary artery calcium (CAC) and carotid intimal-medial thickness (CIMT) can improve CVD risk stratification over traditional risk factors (RFs) in people with MetS and diabetes.

RESEARCH DESIGN AND METHODS

We assessed CAC and CIMT in 6,603 people aged 45–84 years in the Multi-Ethnic Study of Atherosclerosis (MESA). Cox regression examined the association of CAC and CIMT with coronary heart disease (CHD) and CVD over 6.4 years in MetS and diabetes.

RESULTS

Of the subjects, 1,686 (25%) had MetS but no diabetes and 881 (13%) had diabetes. Annual CHD event rates were 1.0% among MetS and 1.5% for diabetes. Ethnicity and RF-adjusted hazard ratios for CHD for CAC 1–99 to ≥400 vs. 0 in subjects with neither MetS nor diabetes ranged from 2.6 to 9.5; in those with MetS, they ranged from 3.9 to 11.9; and in those with diabetes, they ranged from 2.9 to 6.2 (all P < 0.05 to P < 0.001). Findings were similar for CVD. CAC increased the C-statistic for events (P < 0.001) over RFs and CIMT in each group while CIMT added negligibly to prediction over RFs.

CONCLUSIONS

Individuals with MetS or diabetes have low risks for CHD when CAC or CIMT is not increased. Prediction of CHD and CVD events is improved by CAC more than by CIMT. Screening for CAC or CIMT can stratify risk in people with MetS and diabetes and support the latest recommendations regarding CAC screening in those with diabetes.Individuals with diabetes and/or metabolic syndrome (MetS) are more likely to have coronary heart disease (CHD) (1,2) and a poorer prognosis compared with those without these conditions (3,4). Those with diabetes without prior myocardial infarction (MI) were originally reported to have the same risk of subsequent MI as those without diabetes but before MI (5), suggesting that diabetes is a CHD risk equivalent. However, recently a large meta-analysis showed that those with diabetes without prior MI had a 43% lower risk of developing CHD events compared with those without diabetes but with a previous MI (6). Both coronary artery calcium (CAC) and carotid intimal-medial thicknesses (CIMTs) are increased in those with MetS and diabetes (7–9). Although the incremental value of CAC and CIMT over traditional risk factors (RFs) has been shown in the general population (10,11), thus reclassifying more individuals in a higher risk category (12), the utility of CAC and CIMT in those with diabetes and/or MetS is unclear (13,14), and screening has not been traditionally recommended in those with diabetes, given their status as having a CHD risk equivalent. We examined in the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective population-based study of cardiovascular disease (CVD), whether CAC and CIMT add predictive value for CVD events in MetS and diabetes and if there is a role for these tests in risk stratification of these populations. Our hypothesis was that CAC and CIMT levels would show a wide range in risks in individuals with MetS and diabetes, as in those without these conditions, and that many people with diabetes would not be at customarily assumed CHD risk equivalents.     

Biomarkers of outcome from cardiovascular disease

PURPOSE OF REVIEW: Recognition of the fact that low-grade local and systemic inflammation accompanies all stages of atherogenesis has led to the identification of a number of novel biomarkers of cardiovascular risk. We highlight recent epidemiological and experimental evidence concerning four emerging biomarkers: C-reactive protein, interleukin-6, D-dimer and white blood cell count. RECENT FINDINGS: Recent epidemiological and experimental data on C-reactive protein, the most extensively studied marker of systemic inflammation, produced in the liver in response to interleukin-6, has cast some doubt on its clinical utility and causal involvement in atherogenesis. However, a large number of studies still strongly support C-reactive protein as an independent predictor of future cardiovascular risk and a potent proatherogenic agent. Among all markers of inflammation studied to date, C-reactive protein seems the most suitable one for use in clinical practice. Regarding white blood cell count, recent studies focused on the differential leucocyte count in coronary-heart-disease risk assessment; neutrophil count represents the strongest predictor of incident coronary heart disease. SUMMARY: Thus, screening for low-grade inflammation using several novel biomarkers might provide an important tool to identify individuals at increased risk who would benefit most from targeted preventive interventions.     

Metabolic syndrome,cardiovascular risk and screening for subclinical atherosclerosis

The metabolic syndrome is a clustering of risk factors known to promote or increase the risk of diabetes development and subsequent cardiovascular disease. Screening for subclinical atherosclerosis using new imaging technologies or novel biomarkers could help to further risk-stratify patients with metabolic syndrome. In particular, noninvasive imaging of carotid intima-media thickness and coronary artery calcium scoring seem to have promising prognostic value in identifying patients at high risk. Early identification could lead to improved patient or physician adherence to risk-reducing behaviors or interventions and improve clinical outcomes.     

Biomarkers of structural remodelling and endothelial dysfunction for prediction of cardiovascular events or death in patients with atrial fibrillation

Introduction  

Atrial fibrillation (AF) is associated not only with inflammation but also with structural remodelling and altered endothelial activation which may contribute to clot formation, embolization and mortality. We aimed to determine the predictive value of single-time biomarker analysis for prediction of outcome in patients with AF.     

The genes of atherosclerosis and cardiovascular diseases

The aim of the work was to study polymorphism of atherosclerosis-related genes in patients with different forms of coronary heart disease (CHD) and chronic cerebral ischemia (CCI) in comparison with long-living subjects. Analysis included the distribution of genotypes and alleles of functional polymorphisms of lipid metabolism genes, viz. HindIII--polymorphism of lipoproteinase (LPL) gene; HhaI--polymorphism of apoE gene; TaqIB--polymorphism of cholesterol ether transfer protein (CETP) gene; I/D--polymorphism of angiotensin converting enzyme (ACE) in CHD and CCI patients of different age groups including long livers and those presenting with different clinical variants of CHD and CCI (FC II-III stable angina of effort, acute myocardial infarction, post-infarction cardiosclerosis, acute coronary syndrome) and control subjects. The study revealed potential molecular-genetic markers for primary and secondary prophylaxis of CHD and CCI. It was shown that DD genotypes of ACE gene, H+/+ of LPL gene and E3E4 are associated with an enhanced probability of myocardial infarction (IM) in CHD patients and can be regarded as high risk markers. The DD genotype is associated with an increased risk of recurrent MI, life-threatening post-IM complications and severe cardiac insufficiency as well as peculiar personality and behavioural traits (animosity and type A behaviour)--psychological risk factors of CHD and predictors of delayed application for medical aid. E2 allele of the ApoE gene and H allele of the LPL gene occur much more frequently in CHD patients aged above 90 years (long livers) than in younger subjects; hence, their value as markers of stable ischemic disease. Protective effect in terms of favourable clinical course of CCI and life expectancy is especially pronounced in subjects with a combination of genotypes with E2E3 + H+H-, E2E2 + H+H-, E3E3 + H-H-genes of ApoE and LPL. B2B2 genotype of CETP gene increases the risk of stable CCI and B1B1 genotype of CETP gene enhances predisposition to cardiovascular pathology.     

Acute psychosocial stress and cardiovascular events

Stressful life events can trigger acute myocardial infarction and sudden cardiac death. Victims of natural disasters, such as earthquakes and other conditions of extreme stress should be evaluated for physical injuries as well as for cardiac disease.     

Prediction of cerebrovascular and cardiovascular events in patients with subclinical carotid atherosclerosis: the role of C-reactive protein.

BACKGROUND: Several studies have suggested that inflammation and infection may be important for accelerated progression of atherosclerosis, but few data are available on subjects with early stages of atherosclerosis. METHODS AND RESULTS: We included, in a prospective 5-year follow-up study, 150 patients with subclinical carotid atherosclerosis, evaluating at baseline all established traditional cardiovascular risk factors (eg, older age, male sex, obesity, hypertension, diabetes, smoking, family history of coronary artery disease, and dyslipidemia); 2 markers of inflammation, fibrinogen, and high-sensitivity C-reactive protein (CRP); and the seropositivity to Helicobacter pylori, Chlamydia pneumoniae, and cytomegalovirus. After follow-up, cardiovascular and cerebrovascular events were registered in the 19% of patients, and the increment in CRP levels (in quintiles) was significantly associated with ischemic stroke (P = 0.0253), acute myocardial infarction (P = 0.0055), cardiovascular or cerebrovascular death (P = 0.0145), and the presence of any event (P = 0.0064). Most traditional cardiovascular risk factors (eg, older age, hypertension, diabetes, and dyslipidemia) were significantly associated with the events but only in the unadjusted analysis; in fact, at logistic regression analysis, among all baseline variables, only elevated CRP levels showed a predictive role (odds ratio, 7.0; 95% confidence interval, 2.2-18.4; P = 0.0247). CONCLUSIONS: Our findings suggest that elevated CRP concentrations may significantly influence the occurrence of cerebrovascular and cardiovascular events in patients with baseline subclinical carotid atherosclerosis. Notably, null findings were obtained by viral and bacteria titers, suggesting a greater role of inflammation (and not of infection) in the progression of atherosclerosis in our cohort. However, further studies are needed to evaluate the therapeutic implications in this category of patients.     

Emotional stressors trigger cardiovascular events

Aims: To describe the relation between emotional stress and cardiovascular events, and review the literature on the cardiovascular effects of emotional stress, in order to describe the relation, the underlying pathophysiology, and potential therapeutic implications. Materials and methods: Targeted PUBMED searches were conducted to supplement the authors’ existing database on this topic. Results: Cardiovascular events are a major cause of morbidity and mortality in the developed world. Cardiovascular events can be triggered by acute mental stress caused by events such as an earthquake, a televised high‐drama soccer game, job strain or the death of a loved one. Acute mental stress increases sympathetic output, impairs endothelial function and creates a hypercoagulable state. These changes have the potential to rupture vulnerable plaque and precipitate intraluminal thrombosis, resulting in myocardial infarction or sudden death. Conclusion: Therapies targeting this pathway can potentially prevent acute mental stressors from initiating plaque rupture. Limited evidence suggests that appropriately timed administration of beta‐blockers, statins and aspirin might reduce the incidence of triggered myocardial infarctions. Stress management and transcendental meditation warrant further study.     

低血糖与心血管事件风险

尽管低血糖是糖尿病治疗的最常见的并发症,本文通过对低血耱的定义、生理作用及与其相关临床事件的阐述,分析低血糖与心血管事件及临床死亡率的关系,提示在临床工作中不能盲目强化降糖,需要根据患者病情采用个性化的降糖策略.     

Independent association of matrix metalloproteinase-10, cardiovascular risk factors and subclinical atherosclerosis

OBJECTIVES: Circulating levels of matrix metalloproteinase (MMP)-10 are related to inflammation in asymptomatic subjects with cardiovascular risk factors. Whether MMP-10 is associated with the severity of atherosclerosis remains to be determined. This study examines the relationship of systemic MMP-10 levels with atherosclerotic risk factors and subclinical atherosclerosis. METHODS AND RESULTS: Circulating levels of MMP-1, -9 and -10, and markers of inflammation [fibrinogen, interleukin-6, von Willebrand factor, and high-sensitivity C-reactive protein (hs-CRP)] were measured in 400 subjects (mean age 54.3 years, 77.7% men) with cardiovascular risk factors but free from clinical cardiovascular disease. Subclinical atherosclerosis was evaluated by both the mean carotid intima-media thickness (IMT) and the presence of atherosclerotic plaques with the use of B-mode ultrasound in all subjects. MMP-10 levels were positively correlated with fibrinogen (r = 0.24, P < 0.001), hs-CRP (r = 0.14, P < 0.01) and carotid IMT (r = 0.17, P < 0.01). The association between MMP-10 and IMT remained significant in multiple regression analysis (P < 0.02) when controlling for traditional atherosclerotic risk factors and inflammatory markers. Such an association was not observed for MMP-1 and -9. Subjects in the highest MMP-10 tertile had significantly higher carotid IMT (adjusted odds ratio 6.3, 95% confidence interval 1.3-31.4, P = 0.024). In addition, MMP-10 levels were significantly higher in patients with carotid plaques (n = 78) than in those with no plaques after adjusting for age and sex (P < 0.01). CONCLUSION: Higher serum MMP-10 levels were associated with inflammatory markers, increased carotid IMT and atherosclerotic plaques in asymptomatic subjects. Circulating MMP-10 may be useful to identify subclinical atherosclerosis in subjects free from cardiovascular disease.