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Stein AP, Harder J, Holmes HR, Merz CNB, Pepine CJ, Keeley EC. Single Nucleotide Polymorphisms in Coronary Microvascular Dysfunction. J Am Heart Assoc 2024; 13:e032137. [PMID: 38348798 PMCID: PMC11010085 DOI: 10.1161/jaha.123.032137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024]
Abstract
Coronary microvascular dysfunction is an underdiagnosed pathologic process that is associated with adverse clinical outcomes. There are data to suggest that coronary microvascular dysfunction, in some cases, may be genetically determined. We present an updated review of single nucleotide polymorphisms in coronary microvascular dysfunction.
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Affiliation(s)
| | | | | | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart CenterSmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
| | - Carl J. Pepine
- Department of MedicineUniversity of FloridaGainesvilleFLUSA
- Division of Cardiovascular MedicineUniversity of FloridaGainesvilleFLUSA
| | - Ellen C. Keeley
- Department of MedicineUniversity of FloridaGainesvilleFLUSA
- Division of Cardiovascular MedicineUniversity of FloridaGainesvilleFLUSA
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Zhang W, Dai J, Shen L, Jiang Y, Zheng X, Xu K, Yang X, Wang X, Hao Z, Zhao Y, Wang D, Jiang L, Qiu X, Shen L, He B. Alprostadil vs. isosorbide dinitrate in ameliorating angina episodes in patients with coronary slow flow phenomenon: A randomized controlled trial. Front Cardiovasc Med 2022; 9:965364. [PMID: 36158840 PMCID: PMC9493040 DOI: 10.3389/fcvm.2022.965364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/26/2022] [Indexed: 12/04/2022] Open
Abstract
Background The optimum therapy for coronary slow flow phenomenon (CSFP) stays debatable. This study compared the effectiveness of alprostadil with isosorbide dinitrate in alleviating angina episodes in CSFP patients. Methods In this prospective, randomized controlled study, 102 patients with CSFP without severe coronary artery stenosis that exhibited stable angina were allocated randomly in a ratio of 1:1 to either the alprostadil group (40 μg, three times per day, n = 51) or the isosorbide dinitrate group (5 mg, three times per day, n = 51). Frequency of angina events, intensity of suffering, and the Canadian Cardiovascular Society (CCS) grading of angina pectoris were evaluated at baseline and one month after. Additionally, the Seattle Angina Questionnaire (SAQ) was assessed. Results Baseline characteristics were comparable between the two groups. At 1-month follow-up, patients administered with alprostadil experienced fewer angina episodes [episodes per week, 1 (2) vs. 2 (2), P < 0.001] and less pain intensity [self-evaluated pain score, 2 (3) vs. 3 (4), P < 0.001] than those with isosorbide dinitrate. In the alprostadil group, 78.4% of patients were classified as CCS class I, significantly higher than the 47.1% seen in the isosorbide dinitrate group (P = 0.001). Furthermore, treatment of alprostadil led to a significant improvement in the SAQ score (7.09 U, 95% CI: 4.22–9.96, P < 0.001) compared to isosorbide dinitrate. Additionally, fewer patients suffered headaches when receiving alprostadil (7.8% vs. 19.6%, P = 0.084). Conclusion Alprostadil was more effective in ameliorating angina symptoms in CSFP patients than isosorbide dinitrate. Clinical trial registration [www.chictr.org.cn], identifier [ChiCTR2000033233].
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Affiliation(s)
- Weifeng Zhang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinjie Dai
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lan Shen
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Yue Jiang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaowen Zheng
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ke Xu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoxiao Yang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaolei Wang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ziyong Hao
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Zhao
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Dong Wang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lisheng Jiang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xingbiao Qiu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Linghong Shen
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Ben He,
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Lv Y, Zhao W, Yu L, Yu JG, Zhao L. Angiotensin-Converting Enzyme Gene D/I Polymorphism in Relation to Endothelial Function and Endothelial-Released Factors in Chinese Women. Front Physiol 2020; 11:951. [PMID: 33041838 PMCID: PMC7526498 DOI: 10.3389/fphys.2020.00951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022] Open
Abstract
Many studies have investigated the relationship between angiotensin-converting enzyme (ACE) D/I polymorphism and cardiovascular disease or endothelial dysfunction; however, hardly any of these studies has taken aging or menopause into consideration. Furthermore, despite that many studies have examined the regulatory effects of endothelial-released factors (ERFs) on endothelial function, no study has evaluated the relationship between ERFs and endothelial function with respect to ACE D/I polymorphism and menopause status. To answer these questions, 391 healthy Chinese women over a wide range of ages (22-75 years) were enrolled and divided into pre-menopause group and post-menopause group. After ACE D/I genotype being identified, the women were then classified into either DI/II or DD genotype. Flow-mediated dilatation (FMD) of brachial endothelium and plasma levels of ERFs: nitric oxide (NO), endothelin-1 (ET-1), and angiotensin II (Ang II) were measured. The results showed that frequencies of ACE D/I genotypes were in accordance with the Hardy-Weinberg equilibrium, and the frequency of I allele was higher than D allele. In pre-menopause group, FMD was significantly higher in women of DI/II than DD (P = 0.032), and age-dependent in both genotypes (DD, P = 0.0472; DI/II, P < 0.0001). In post-menopause group, FMD was similar between women of DI/II and DD, and age-dependent only in women of DI/II (P < 0.0001). In pre-menopause group, Ang II level was significantly higher in women of DD than DI/II (P = 0.029), and FMD was significantly correlated with all ERFs in women of DD (NO, P = 0.032; ET-1, P = 0.017; Ang II, P = 0.002), but only with Ang II in women of DI/II (P = 0.026). In post-menopause group, no significant difference was observed in any ERF between women of DI/II and DD, and FMD was only significantly correlated with ET-1 in women of DD (P = 0.010). In summary, FMD in women of DI/II was superior to DD in pre-menopause and more age-dependent than DD in post-menopause, and FMD was closely associated with ERFs. In conclusion, Chinese women of DI/II seem to have lower risk than DD in pre-menopause, but similar risk as DD in post-menopause in developing cardiovascular disease.
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Affiliation(s)
- Yuanyuan Lv
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | | | - Laikang Yu
- Department of Strength and Conditioning Training, Beijing Sport University, Beijing, China
| | - Ji-Guo Yu
- Department of Community Medicine and Rehabilitation, Section of Sports Medicine, Umeå University, Umeå, Sweden
| | - Li Zhao
- Department of Exercise Physiology, Beijing Sport University, Beijing, China
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Wang Y, Liu MJ, Yang HM, Ma CY, Jia PY, Jia DL, Hou AJ. Association between increased serum alkaline phosphatase and the coronary slow flow phenomenon. BMC Cardiovasc Disord 2018; 18:138. [PMID: 29973151 PMCID: PMC6030765 DOI: 10.1186/s12872-018-0873-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 06/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite marked advances in our understanding of the pathophysiology of the coronary slow flow phenomenon (CSFP), the exact mechanism remains unclear. Previous studies have suggested that CSFP might be associated with generalized atherosclerosis, endothelial dysfunction, and low-grade chronic inflammation. High serum alkaline phosphatase (ALP) levels are associated with vascular calcification, atherosclerotic disease, and an increased risk of cardiovascular events. However, the relationship between ALP and CSFP is unclear. METHODS We investigated 64 patients with angiographically proven CSFP and 50 with normal coronary flow. Serum ALP levels were measured in all studied individuals. RESULTS Serum ALP levels in patients with CSFP were significantly higher than those in the control group (70.5 ± 17.1 vs. 61.9 ± 16.1 U/L, P = 0.007). A positive association was observed (r = 0.42, P = 0.032) between serum ALP levels and the mean thrombolysis in myocardial infarction frame count (mTFC). Regression analysis showed a high serum ALP level was the only independent predictor of the mTFC (β = 0.309, P < 0.001). Moreover, our study showed that a serum ALP level > 67.5 U/L was a predictor of CSFP (sensitivity = 83.3%, specificity = 84.1%). CONCLUSIONS Patients with CSFP show high serum ALP levels, which may be associated with the pathogenesis of CSFP. A high serum ALP level is a predictor of CSFP. Future studies are needed to clarify the role of ALP in patients with CSFP.
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Affiliation(s)
- Yong Wang
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, No. 33, Wenyi road, Shenhe District, Shenyang City, Liaoning Province, China
| | - Mou-Jie Liu
- Department of Cardiology, The First Affiliated Hospital of China Medical University, No. 155, Nanjing road, Heping District, Shenyang City, Liaoning Province, China
| | - Hui-Min Yang
- Department of Cardiology, The First Affiliated Hospital of China Medical University, No. 155, Nanjing road, Heping District, Shenyang City, Liaoning Province, China
| | - Chun-Yan Ma
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, No. 155, Nanjing road, Heping District, Shenyang City, Liaoning Province, China
| | - Peng-Yu Jia
- Department of Cardiology, The First Affiliated Hospital of China Medical University, No. 155, Nanjing road, Heping District, Shenyang City, Liaoning Province, China
| | - Da-Lin Jia
- Department of Cardiology, The First Affiliated Hospital of China Medical University, No. 155, Nanjing road, Heping District, Shenyang City, Liaoning Province, China.
| | - Ai-Jie Hou
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, No. 33, Wenyi road, Shenhe District, Shenyang City, Liaoning Province, China.
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Circulating miRNA-155 as a Potential Biomarker for Coronary Slow Flow. DISEASE MARKERS 2018; 2018:6345284. [PMID: 30046360 PMCID: PMC6036848 DOI: 10.1155/2018/6345284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/11/2018] [Indexed: 01/08/2023]
Abstract
Objective Recent studies have demonstrated that miRNA-155 is involved in the occurrence and development of atherosclerosis. Furthermore, miRNA-155 has emerged as a new indirect marker for inflammation associated with adverse outcomes in oncology and cardiovascular diseases. This study investigated the correlation between the levels of miRNA-155 and coronary slow flow (CSF). Methods A total of 66 patients with CSF and 66 patients with normal coronary flow were enrolled in this study. Coronary flow velocity was determined using the thrombolysis in myocardial infarction frame count (TFC) method. The plasma levels of miRNA-155 were quantified using real-time quantitative polymerase chain reaction. Results The plasma levels of miRNA-155 were significantly higher in the CSF group compared to the control group (P < 0.05). In addition, miRNA-155 levels were positively correlated with TFC and high-sensitivity C-reactive protein (hs-CRP) levels (P < 0.05 for both parameters). Multivariate linear regression analysis demonstrated that plasma miRNA-155 (OR = 2.384, 95% confidence interval 1.847–3.273, P = 0.032) and hs-CRP (OR = 1.273, 95% confidence interval 1.036–2.253, P = 0.013) were independent predictors for CSF. Using plasma miRNA-155 levels as the test variable, ROC curve analysis indicated that the area under the curve was 0.782 (P < 0.05). Conclusion Patients with CSF have higher plasma levels of miRNA-155, and this may play an important role in the pathogenesis of CSF, and an elevated plasma miRNA-155 level may be a predictor for CSF. A large-scale and multicenter study is required to elucidate the role of miRNA-155 as a potential biomarker for patients with CSF.
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Delshad N, Ghayour-Mobarhan M, Mirzaei H, Razavi-Azarkhiavi K, Moohebati M, Hassany M, Kasaian J, Etemadzadeh MR, Alavi MS, Behravan J. Angiotensin II Type 1 Receptor Gene A1166C Polymorphism Was Not Associated With Acute Coronary Syndrome in an Iranian Population. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e23942. [PMID: 28191332 PMCID: PMC5292135 DOI: 10.5812/ircmj.23942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/27/2014] [Accepted: 03/31/2015] [Indexed: 01/17/2023]
Abstract
Background There are very limited data for Iranian populations on the predisposing genetic factors for acute coronary syndrome (ACS). Objectives The objective of the present study was to investigate the association of the angiotensin II type 1 receptor (AT1R) gene polymorphism and ACS in an Iranian population. Patients and Methods This cross-sectional study was conducted among 263 subjects (97 men and 166 women). Patients (n = 128) aged 30 - 80 years with chest pain were recruited from the emergency department of Ghaem Hospital (Mashhad, Iran). A 12-lead electrocardiograph plus creatine kinase MB (CK-MB) levels were used as the basis for the diagnosis of myocardial ischemia. The control group was selected from age-matched healthy subjects (n = 135). Non-enzymatic kits were used for extraction of DNA from blood samples. Polymerase chain reaction (PCR) was performed to amplify the DNA fragments. For restriction fragment length polymorphism (RFLP) determination, the DdeI enzyme was used to digest the amplified DNA fragments. Statistical analyses were performed using SPSS version 13.0. Results There was no statistical difference in the genotype frequency of patients and healthy subjects with regard to age and gender (P > 0.05). Conclusions The AT1R A1166C polymorphism appeared not to be associated with the presence of ACS in the population studied.
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Affiliation(s)
- Navid Delshad
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Majid Ghayour-Mobarhan
- Cardiovascular Research Center, Avicenna Research institute, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Biochemistry and Nutrition Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Hamed Mirzaei
- Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Kamal Razavi-Azarkhiavi
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohsen Moohebati
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mitra Hassany
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Jamal Kasaian
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohammad Reza Etemadzadeh
- Cardiovascular Research Center, Avicenna Research institute, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Maryam Sadat Alavi
- Cardiovascular Research Center, Avicenna Research institute, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Javad Behravan
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding Author: Javad Behravan, Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5138823255, Fax: +98-5138823251, E-mail:
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Gazi E, Temiz A, Altun B, Barutcu A, Silan F, Colkesen Y, Ozdemir O. Endothelial function and germ-line ACE I/D, eNOS and PAI-1 gene profiles in patients with coronary slow flow in the Canakkale population: multiple thrombophilic gene profiles in coronary slow flow. Cardiovasc J Afr 2014; 25:9-14. [PMID: 24435163 PMCID: PMC3959185 DOI: 10.5830/cvja-2013-083] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 08/14/2013] [Indexed: 11/25/2022] Open
Abstract
Background We examined the effects of ACE, PAI-1 and eNOS gene polymorphisms on endothelial function. The genes are related to atherosclerosis and endothelial dysfunction in coronary slow flow (CSF). Methods Thirty-three patients with angiographically proven CSF and 48 subjects with normal coronary flow were enrolled in this study. Coronary flow patterns were determined by the thrombolysis in myocardial infarction (TIMI) frame count method. Endothelial function was assessed in the brachial artery by endothelium-dependent flow-mediated dilatation (FMD). PAI-1 4G/5G, eNOS T-786C and ACE I/D polymorphisms were determined by polymerase chain reaction (PCR) amplification. Results No difference was found between the groups regarding age, heart rate and blood pressure. Males were more prevalent among patients with CSF than control subjects (58.8 vs 29.8%, p = 0.009). Mean TIMI frame counts were significantly higher in CSF patients (24.2 ± 4.0 vs 13.1 ± 2.5 fpm, p = 0.001). FMD was significantly lower in CSF patients than in the controls (4.9 ± 6.6 vs 7.9 ± 5.6%, p = 0.029). TIMI frame count and FMD were found to be negatively correlated in a correlation analysis (r = –0.269, p = 0.015). PAI-1 4G/5G, eNOS T-786C and ACE I/D polymorphisms were similar in the two groups. Conclusions This study showed that endothelial function was impaired in patients with CSF. PAI-1, ACE and eNOS polymorphisms were not related to CSF in our study population.
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Affiliation(s)
- Emine Gazi
- Department of Cardiology, Faculty of Medicine, Canakkale Onsekiz mart University, Canakkale, Turkey
| | - Ahmet Temiz
- Department of Cardiology, Faculty of Medicine, Canakkale Onsekiz mart University, Canakkale, Turkey
| | - Burak Altun
- Department of Cardiology, Faculty of Medicine, Canakkale Onsekiz mart University, Canakkale, Turkey
| | - Ahmet Barutcu
- Department of Cardiology, Faculty of Medicine, Canakkale Onsekiz mart University, Canakkale, Turkey
| | - Fatma Silan
- Department of Medical Genetics, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Yucel Colkesen
- Department of Cardiology, Faculty of Medicine, Canakkale Onsekiz mart University, Canakkale, Turkey
| | - Ozturk Ozdemir
- Department of Medical Genetics, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
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Gazi E, Barutcu A, Altun B, Temiz A, Bekler A, Urfali M, Silan F, Colkesen Y, Ozdemir O. Intercellular adhesion molecule-1 K469E and angiotensinogen T207M polymorphisms in coronary slow flow. Med Princ Pract 2014; 23:346-50. [PMID: 24942509 PMCID: PMC5586901 DOI: 10.1159/000363451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 05/07/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate intercellular adhesion molecule-1 (ICAM1) and angiotensinogen (AGT) gene polymorphisms, as related to atherosclerosis and endothelial dysfunction, in coronary slow flow (CSF). SUBJECTS AND METHODS The participants in this study were 48 patients with CSF and 67 patients with normal coronary flow as controls. The K469E polymorphism of ICAM1 (rs5498) and the T207M polymorphism of AGT (rs4762) were determined using the polymerase chain reaction amplification method. RESULTS Baseline demographic parameters were similar in both groups. The mean thrombolysis in myocardial infarction frame count was significantly higher in patients with CSF (23.8 ± 5.1) compared to the controls (13.3 ± 2.6, p < 0.001). A significant association was found between the ICAM1 K allele and CSF (OR: 1.96, 95% CI: 1.15-3.35, p = 0.013). There was no difference in the frequency of AGT T207M genotypes in the patients with CSF and the control subjects. CONCLUSION This study showed that K469E polymorphisms of ICAM1 that play a role in atherosclerotic pathogenesis are related to CSF.
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Affiliation(s)
- Emine Gazi
- Department of Cardiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
- *Dr. Emine Gazi, MD, Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, TR-17100 Çanakkale (Turkey), E-Mail
| | - Ahmet Barutcu
- Department of Cardiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Burak Altun
- Department of Cardiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Ahmet Temiz
- Department of Cardiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Adem Bekler
- Department of Cardiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Mine Urfali
- Department of Medical Genetics, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Fatma Silan
- Department of Medical Genetics, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Yucel Colkesen
- Department of Cardiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Ozturk Ozdemir
- Department of Medical Genetics, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
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Yoon HJ, Jeong MH, Cho SH, Kim KH, Lee MG, Park KH, Sim DS, Yoon NS, Hong YJ, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Endothelial dysfunction and increased carotid intima-media thickness in the patients with slow coronary flow. J Korean Med Sci 2012; 27:614-8. [PMID: 22690091 PMCID: PMC3369446 DOI: 10.3346/jkms.2012.27.6.614] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 03/13/2012] [Indexed: 01/22/2023] Open
Abstract
Flow mediated brachial dilatation (FMD) and carotid intima-media thickness (IMT) have been a surrogate for early atherosclerosis. Slow coronary flow in a normal coronary angiogram is not a rare condition, but its pathogenesis remains unclear. A total of 85 patients with angina were evaluated of their brachial artery FMD, carotid IMT and conventional coronary angiography. Coronary flow was quantified using the corrected thrombosis in myocardial infarction (TIMI) frame count method. Group I was a control with normal coronary angiography (n = 41, 56.1 ± 8.0 yr) and group II was no significant coronary stenosis with slow flow (n = 44, 56.3 ± 10.0 yr). Diabetes was rare but dyslipidemia and family history were frequent in group II. Heart rate was higher in group II than in group I. White blood cells, especially monocytes and homocysteine were higher in group II. The FMD was significantly lower in group II than in group I. Elevated heart rate, dyslipidemia and low FMD were independently related with slow coronary flow in regression analysis. Therefore, endothelial dysfunction may be an earlier vascular phenomenon than increased carotid IMT in the patients with slow coronary flow.
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Affiliation(s)
- Hyun Ju Yoon
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Sook Hee Cho
- Department of Nursing, Nambu University, Gwangju, Korea
| | - Kye Hun Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Min Goo Lee
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Keun Ho Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Nam Sik Yoon
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jung Chaee Kang
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
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Wang X, Geng LL, Nie SP. Coronary slow flow phenomenon: a local or systemic disease? Med Hypotheses 2010; 75:334-7. [PMID: 20385447 DOI: 10.1016/j.mehy.2010.03.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 03/17/2010] [Indexed: 12/01/2022]
Abstract
Coronary slow flow phenomenon (CSFP) is an important, angiographic entity characterized by delayed progression of the contrast medium injected into the coronary tree. Since definition of this phenomenon in 1972, there has not been any clear-cut etiology. Original data often focused on histological or pathological changes in coronary artery itself. It was confirmed that small vessel structural defect as well as an underlying residual microvascular resistance abnormality coexists in the coronary microcirculation. Early atherosclerosis was also detected in epicardial coronary arteries by intravascular ultrasound (IVUS). Taken together, it can be suggested that a combination of morphological and functional abnormalities in small vessels and epicardial coronary arteries contributes to the pathogenesis of CSFP. CSFP may be defined as a local disease confined to coronary arteries. However, another feature of CSFP is its frequent occurrence in association with more widespread vascular abnormalities. Reduced endothelial function is implicated in CSFP as measured by flow-mediated dilatation (FMD) of the brachial artery, suggesting that endothelial dysfunction appears to be a generalized process affecting both coronary and peripheral vasculature. In addition, several studies have now demonstrated that carotid intima-media thickness (IMT) is significantly increased in patients with CSFP and there was a significant correlation between coronary intima-media thickness and carotid IMT. Therefore, we hypothesize that CSFP is not an isolated finding but may be part of a systemic vascular disturbance. CSFP is not an infrequently detected finding typically observed in patients presenting with an acute coronary syndrome, usually unstable angina. The subsequent clinical course is characterized by high frequency of relapsing chest pain resulting in considerable impairment in quality of life. Accordingly, further experimental investigations and clinical studies are warranted to shed light into the pathogenesis as well as therapeutics of CSFP.
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Affiliation(s)
- Xiao Wang
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Chaoyang District, Beijing 100029, China
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Asymptomatic Mongolian middle-aged women with high homocysteine blood level and atherosclerotic disease. Heart Vessels 2010; 25:7-13. [PMID: 20091392 DOI: 10.1007/s00380-009-1156-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Accepted: 02/27/2009] [Indexed: 10/19/2022]
Abstract
Growing numbers of studies have shown that hyperhomocysteinemia is an independent, modifiable risk factor for cardiovascular diseases. Hyperhomocysteinemia has been found to be negatively associated with the vitamin B group, especially folate and cobalamin. Because of the relative scarcity of fruits and vegetables in Mongolian foods, and the high cardiovascular diseases rate in Mongolia, we examined homocysteine level and its relation with atherosclerotic change in middle-aged Mongolian women. This cross-sectional study included 79 female asymptomatic residents of Ulaanbaatar, Mongolia. Besides analysis of homocysteine and chemistry tests, participants were interviewed and underwent physical and Doppler ultrasound examination of extracranial vessels. The mean homocysteine level was 9.87 +/- 3.6 micromol/l, and the 2.5th and 97.5th percentiles were 2.2 micromol/l and 19.9 micromol/l. Participants with abnormal Doppler ultrasound finding had significantly higher homocysteine levels (12.8 +/- 4.5 micromol/l vs 8.7 +/- 2.3 micomol/l, P < 0.001) and homocysteine was significantly associated with having atherosclerotic change (odds ratio 2.2, 95% confidence interval = 1.42-3.49, P < 0.001) after adjustment for age, low-density lipoprotein, diastolic blood pressure, and body mass index. Hyperhomocysteinemia was found to be significantly associated with atherosclerotic change in female Mongolian adults. Further studies are necessary to determine factors associated with homocysteine elevation among the Mongolian population.
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Angiotensin converting enzyme DD genotype not associated with increased risk of coronary artery disease in the Iranian population. ACTA ACUST UNITED AC 2010; 17:163-7. [PMID: 20079615 DOI: 10.1016/j.pathophys.2009.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 09/25/2009] [Indexed: 11/23/2022]
Abstract
The coronary artery disease (CAD) is of the main causes of heart failure and there is evidence supporting the association of angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and the susceptibility to CAD. Therefore, the relevance of ACE polymorphism for CAD was determined in the Iranian population. 487 age-matched individuals including 224 patients with >50% angiographically established coronary stenosis and 263 healthy subjects genotyped for ACE gene I/D polymorphism by a standard method. Paraclinical characteristics including lipid profile were also determined for both groups. While the systolic (p<0.0001) and diastolic (p<0.0001) blood pressure, serum cholesterol (p<0.005) and LDL-C (p<0.05) were significantly increased in CAD patients, our results show that there was no increased risk of CAD in association with DD genotype in Iranian population. Allele frequencies were also similar in both groups. Although, we found a significant difference in ID (p<0.005) and II (p<0.05) genotype between patients and healthy subjects. The present study showed that DD genotype does not increase the CAD susceptibility in the studied Iranian population and may not be as a risk factor. Therefore, further studies together with the other polymorphisms of ACE gene may be required to determine the relation between cardiovascular disease susceptibility and ACE genetic variations in Iranian population.
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Park EY, Ahn HM, Lee JA, Hong YM. Insertion/deletion polymorphism of angiotensin converting enzyme gene in Korean hypertensive adolescents. Heart Vessels 2009; 24:193-8. [PMID: 19466520 DOI: 10.1007/s00380-008-1101-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Accepted: 08/08/2008] [Indexed: 10/20/2022]
Abstract
The essential role of the renin-angiotensin system (RAS) in controlling blood pressure has been well established. Genes encoding components of the RAS have been proposed as candidate genes that determine genetic predisposition to hypertension and the risk of developing cardiovascular complications. The purpose of this study was to analyze angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphisms in Korean hypertensive adolescents, and to determine the association between ACE genotype and cardiovascular risk. Forty hypertensive adolescents (16-17 years old, systolic blood pressure (BP) > or =140 mm Hg and/or diastolic BP > or =90 mm Hg) and a control group of twenty normotensive adolescents were included in the study. Obesity index (OI) and body mass index (BMI) were calculated. Skin fold thickness and arm circumference were also measured. Fat mass and fat distribution were analyzed by bioelectrical impedance. Blood pressure was measured at resting state by oscillometric methods. Serum aldosterone, renin, insulin, ACE, homocysteine, vitamin B12, and folate levels were evaluated after a fasting period of 12 h. The carotid intima-media thickness (IMT) and carotid artery diameter were measured by carotid ultrasound. Pulse wave velocity (PWV) and ankle-brachial index (ABI) were also measured. Polymerase chain reaction (PCR) was conducted to amplify DNA from blood samples of each individuals to analyze ACE I/D polymorphism. Genotype frequencies of I/I were 37.5%, I/D 45.0% and D/D 17.5%. Serum ACE levels were 33.5 +/- 8.7 U/l in I/I genotype, 48.6 +/- 19.8 U/l in I/D genotype and 61.4 +/- 22.7 U/l in D/D genotype, which showed that ACE levels were significantly higher in those with D/D or I/D genotype than in I/I genotype. Carotid IMT was significantly greater in D/D group than in I/I group. In conclusion, the D allele is associated with the increased level of ACE in Korean hypertensive adolescents.
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Affiliation(s)
- Eun Young Park
- Department of Pediatrics, School of Medicine, Ewha Womans University, 911-1 MokDong, YangCheon-Ku, Seoul 158-710, Republic of Korea
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Selcuk H, Selcuk MT, Temizhan A, Maden O, Saydam GS, Ulupinar H, Dogan M, Aydın C, Topcu DI, Sasmaz A. Decreased plasma concentrations of adiponectin in patients with slow coronary flow. Heart Vessels 2009; 24:1-7. [DOI: 10.1007/s00380-008-1074-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 06/01/2008] [Indexed: 10/21/2022]
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Yalcin AA, Kalay N, Caglayan AO, Kayaalti F, Duran M, Ozdogru I, Inanc MT, Dogan A, Basar E, Oguzhan A. The Relationship Between Slow Coronary Flow and Angiotensin Converting Enzyme and ATIIR1 Gene Polymorphisms. J Natl Med Assoc 2009; 101:40-5. [DOI: 10.1016/s0027-9684(15)30810-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Carotid intima-media thickness in pre- and postmenopausal women with suspected coronary artery disease. Heart Vessels 2008; 23:295-300. [PMID: 18810577 DOI: 10.1007/s00380-008-1044-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 01/11/2008] [Indexed: 01/27/2023]
Abstract
Carotid intima-media thickness (CIMT) is an early marker of coronary artery disease (CAD). This study aimed to evaluate CIMT value for CAD prediction in pre-and postmenopausal women referred for coronary angiography with angina-like symptoms and a positive result of the treadmill test. The study comprised 321 women referred for coronary angiography with symptoms suggesting CAD. Carotid intima-media thickness was measured in common, bifurcation, and internal carotid artery, and expressed as the mean maximum value. Coronary angiography showed coronary stenosis > or = 50% in 211 (65.7%) women, including 27 with regular menses (47.3 +/- 3.4 years) and 184 postmenopausal (65.8 +/- 7.2 years). Normal coronary arteries were found in 110 women: 17 (47.3 +/- 4.9 years) with regular menses and 93 postmenopausal (64.3 +/- 6.5 years). The highest CIMT values were found in postmenopausal CAD women (1.360 +/- 0.32 mm), as compared to premenopausal with CAD (1.178 +/- 0.36 mm, P = 0.005), pre- (0.860 +/- 0.23 mm, P < 0.001) and postmenopausal (1.022 +/- 0.30 mm, P < 0.001) women without CAD. Carotid intima-media thickness (P < 0.001), hyperlipidemia (P = 0.018), and myocardial infarction (P < 0.001), but not menopause itself or the number of years since menses cessation, were found to be independent CAD predictors. By receiver operating characteristic calculation, the mean maximum CIMT cut-off values discriminating CAD were lower in premenopausal (> or = 0.933 mm) than in postmenopausal women (> or = 1.075 mm; P < 0.05) resulting in similar sensitivity (85.2% and 82.6%) and specificity (70.6% and 69.9%). Carotid intima-media thickness is a strong CAD predictor in both pre- and postmenopausal women, in contrast to the menopausal status.
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The D allele of angiotensin I-converting enzyme gene insertion/deletion polymorphism is associated with the severity of atherosclerosis. Clin Chem Lab Med 2008; 46:446-52. [DOI: 10.1515/cclm.2008.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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