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Bai C, Konings J, Ninivaggi M, Lancé M, de Laat B, de Laat-Kremers R. Assessing the individual roles of FII, FV, and FX activity in the thrombin generation process. Front Cardiovasc Med 2022; 9:1000812. [PMID: 36204573 PMCID: PMC9530111 DOI: 10.3389/fcvm.2022.1000812] [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: 07/22/2022] [Accepted: 08/26/2022] [Indexed: 12/02/2022] Open
Abstract
Thrombin generation (TG) is known as a physiological approach to assess the hemostatic function. Although it correlates well with thrombosis and bleeding, in the current setup it is not sensitive to the effects of fluctuations in single coagulation factors. We optimized the calibrated automated thrombinography (CAT) method to quantify FII, FV and FX activity within the coagulation system. The CAT assay was fine-tuned for the assessment of FII, FV and FX by diluting the samples in FII-, FV-, or FX-deficient plasma, respectively, and measuring TG. Plasma FII levels correlated linearly with the ETP up to a plasma concentration of 100% FII. FV and FX levels correlated linearly with the peak height up to a plasma level of 2.5% FV and 10% FX, respectively. Sensitized CAT protocols were designed by adding a fixed volume of a pre-diluted patient sample to FII, FV, and FX deficient plasma in TG experiments. This approach makes the TG measurement dependent on the activity of the respective coagulation factor. The ETP or peak height were quantified as readouts for the coagulation factor activity. The intra- and inter-assay variation coefficients varied from 5.0 to 8.6%, and from 3.5 to 5.9%, respectively. Reference values were determined in 120 healthy subjects and the assays were clinically validated in 60 patients undergoing coronary artery bypass grafting (CABG). The sensitized CAT assays revealed that the contribution of FII, FV, and FX to the TG process was reduced after CABG surgery, leading to reduced prothrombin conversion and subsequently, lower TG.
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Affiliation(s)
- Cuicui Bai
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, Netherlands
- Department of Protein Engineering, Synapse Research Institute, Maastricht, Netherlands
| | - Joke Konings
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, Netherlands
- Department of Platelet Pathophysiology, Synapse Research Institute, Maastricht, Netherlands
| | - Marisa Ninivaggi
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, Netherlands
| | - Marcus Lancé
- Department of Anesthesiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Bas de Laat
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, Netherlands
- Department of Data Analysis and Artificial Intelligence, Synapse Research Institute, Maastricht, Netherlands
| | - Romy de Laat-Kremers
- Department of Data Analysis and Artificial Intelligence, Synapse Research Institute, Maastricht, Netherlands
- *Correspondence: Romy de Laat-Kremers
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2
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Yao Y, Li X, Wang Z, Ji Q, Xu Q, Yan Y, Lv Q. Interaction of Lipids, Mean Platelet Volume, and the Severity of Coronary Artery Disease Among Chinese Adults: A Mediation Analysis. Front Cardiovasc Med 2022; 9:753171. [PMID: 35174229 PMCID: PMC8841779 DOI: 10.3389/fcvm.2022.753171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/03/2022] [Indexed: 12/30/2022] Open
Abstract
Objective Currently, coronary artery disease (CAD) is regarded as one of the leading global disease burdens. Evidence proved that platelet activation in dyslipidemia induced CAD, however, their interaction has not been well-established in vivo. This study aims to assess the mediation effects of mean platelet volume (MPV) in lipids and the severity of CAD. Methods We prospectively enrolled 5,188 consecutive subjects who underwent coronary angiography between 2015 and 2020. Participants were grouped according to their CAD events, which was defined as stenosis ≥50% in at least one coronary artery, and whose severity was evaluated by the Gensini score (GS). A lipid index was drawn by principal component analysis to weight related lipid parameters including total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-HDL-C, apolipoprotein (apo) A1 B. The interaction of lipids and MPV in atherosclerosis was evaluated by the mediation analysis. Results Lipid index increased with elevated GS irrespective of statin status (not on statin: β = 0.100, p < 0.001; on statin: β = 0.082, p < 0.001). Multiple linear regression indicated positive correlation between MPV and GS after adjustment (β = 0.171, p < 0.001). Subjects in the highest MPV tertile had higher levels of atherogenic lipid parameters and lipid index (p < 0.001). The adjusted odds ratios were greater among individuals undergoing statin medications who had high GS and higher MPV levels by elevated lipid index tertiles [1.168 (0.893–1.528) vs. 2.068 (1.552–2.756) vs. 1.764 (1.219–2.551)]. The combination of lipid index and MPV provided better prediction for high GS than individual lipid index or MPV, as shown by receiver-operating characteristic (ROC) curves (areas under ROC curves were 0.700 and 0.673 in subjects on or not on statin treatment, respectively). Significantly, mediation analysis revealed the mediation interaction of lipid index on GS by MPV, whose effect size reached 20.71 and 20.07% in participants with or without statin medications. Conclusion The increased risk of dyslipidemia on CAD was partly enhanced by elevated MPV levels, whose mediating effect was around 20%.
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Affiliation(s)
- Yao Yao
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoye Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zi Wang
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiuyi Ji
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qing Xu
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Yan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Yan Yan
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
- Qianzhou Lv
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3
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Parkkila K, Valtonen RIP, Hiltunen L, Hintsala HE, Jaakkola JJK, Ikäheimo TM. The effects of submaximal exercise and cold exposure on blood coagulation parameters in coronary artery disease patients. BMC Cardiovasc Disord 2021; 21:93. [PMID: 33593303 PMCID: PMC7885551 DOI: 10.1186/s12872-021-01907-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/21/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Both exercise and cold exposure increase blood coagulation potential but their combined effects are not known. The purpose of the present study was to assess blood coagulation factors in response to submaximal exercise in the cold environment among patients with stable coronary artery disease (CAD). METHODS Sixteen men (61.1 ± 7.1 years) with stable CAD participated in three 30-min experimental conditions (seated rest in - 15 °C and exercise in both + 22 °C and - 15 °C) in random order. The employed exercise consisted of brisk walking (66-69% of maximal heart rate). Factor VII (FVII), fibrinogen, D-dimer and von Willebrand factor (vWF) were analyzed from blood samples obtained before, immediately and one hour after each experiment. RESULTS On average, FVII activity (95% confidence interval, CI) was 123 (108-143) %, 123 (106-140) %, 121 (103-139) % (baseline, recovery 1, recovery 2), fibrinogen concentration (95% CI) 3.81 (3.49-4.12) g/l, 3.71 (3.34-4.08) g/l, 3.65 (3.26-4.05) g/l, D-dimer concentration (95% CI) 0.42 (0.28-0.56) µg/ml, 0.42 (0.29-.55) µg/ml and 0.39 (0.29-0.49) µg/ml, and vWF activity (95% CI) 184 (135-232) %, 170 (128-212) % and 173 (129-217) % after exercise in the cold. Average FVII activity varied from 122 to 123%, fibrinogen concentration from 3.71 to 3.75 g/l, D-dimer concentration from 0.35 to 0.51 µg/ml and von Willebrand factor activity from 168 to 175% immediately after each three experimental condition. CONCLUSIONS Our findings suggest that submaximal lower body exercise carried out in a cold environment does not significantly affect blood coagulation parameters among patients with stable CAD.
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Affiliation(s)
- Karri Parkkila
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
| | - Rasmus I P Valtonen
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.,Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Leena Hiltunen
- Department of Hemostasis, Finnish Red Cross Blood Service, Helsinki, Finland.,Hemostasis and Platelet Laboratory, Fimlab Laboratoriot Oy Ltd, Vantaa, Finland
| | - Heidi E Hintsala
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.,Centria University of Applied Sciences, Kokkola, Finland
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.,Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Tiina M Ikäheimo
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, P.O. Box 5000, 90014, Oulu, Finland. .,Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland.
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4
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Pieters M, Ferreira M, de Maat MPM, Ricci C. Biomarker association with cardiovascular disease and mortality - The role of fibrinogen. A report from the NHANES study. Thromb Res 2020; 198:182-189. [PMID: 33360152 DOI: 10.1016/j.thromres.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/26/2020] [Accepted: 12/09/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND While fibrinogen is a known cardiovascular disease (CVD) risk marker, its quantitative input to mortality risk is a topic of debate. METHODS We investigated the contribution of fibrinogen, among that of other biomarkers, to prevalent CVD and incident CVD mortality in 4487 participants of the US National Health and Nutrition Examination Survey (NHANES). Participants were observed for a median period of 14 years, resulting in more than 58,000 person-years. RESULTS At baseline 551 participants had CVD and during follow up, 1339 all-cause deaths occurred, 321 (24%) of which were due to CVD. Hierarchical cluster analysis and principal component analysis (PCA) were performed to derive clusters of association between biomarkers. Next, structural equation modelling was performed to investigate the association of these clusters with baseline CVD and all-cause and CVD mortality during follow-up. Mediation analysis was used to determine which biomarkers played a mediatory role between prevalent CVD and future mortality. Fibrinogen clustered with C-reactive protein only and was associated with CVD at baseline (p < 0.0001) and with all-cause (p < 0.001) and CVD (p < 0.001) mortality at follow-up. Only fibrinogen (4.7%), followed by gamma-glutamyl transferase (GGT) (3.5%) and uric acid (2.3%) were identified as possible mediators between CVD status and all-cause mortality, with fibrinogen (3.2%) and GGT (3.1%) the only mediators between CVD status and CVD mortality. CONCLUSION This data shows that fibrinogen is not only cross-sectionally associated with CVD, but also contributes to all-cause and CVD mortality at follow-up. It furthermore appears to mediate the association between prevalent CVD and both all-cause and CVD mortality.
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Affiliation(s)
- Marlien Pieters
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa; Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
| | - Maylene Ferreira
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Moniek P M de Maat
- Department of Hematology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Cristian Ricci
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa; Pediatric Epidemiology, Department of Pediatrics, University Medicine Leipzig, Leipzig, Germany
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5
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Kris-Etherton PM, Stewart PW, Ginsberg HN, Tracy RP, Lefevre M, Elmer PJ, Berglund L, Ershow AG, Pearson TA, Ramakrishnan R, Holleran SF, Dennis BH, Champagne CM, Karmally W. The Type and Amount of Dietary Fat Affect Plasma Factor VIIc, Fibrinogen, and PAI-1 in Healthy Individuals and Individuals at High Cardiovascular Disease Risk: 2 Randomized Controlled Trials. J Nutr 2020; 150:2089-2100. [PMID: 32492148 PMCID: PMC7398773 DOI: 10.1093/jn/nxaa137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/12/2019] [Accepted: 04/21/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Factor VIIc, fibrinogen, and plasminogen activator inhibitor 1 (PAI-1) are cardiovascular disease (CVD) risk factors and are modulated, in part, by fat type and amount. OBJECTIVE We evaluated fat type and amount on the primary outcomes: factor VIIc, fibrinogen, and PAI-1. METHODS In the Dietary Effects on Lipoproteins and Thrombogenic Activity (DELTA) Trial, 2 controlled crossover feeding studies evaluated substituting carbohydrate or MUFAs for SFAs. Study 1: healthy participants (n = 103) were provided with (8 wk) an average American diet [AAD; designed to provide 37% of energy (%E) as fat, 16% SFA], a Step 1 diet (30%E fat, 9% SFA), and a diet low in SFA (Low-Sat; 26%E fat, 5% SFA). Study 2: participants (n = 85) at risk for CVD and metabolic syndrome (MetSyn) were provided with (7 wk) an AAD, a step 1 diet, and a high-MUFA diet (designed to provide 37%E fat, 8% SFA, 22% MUFA). RESULTS Study 1: compared with AAD, the Step 1 and Low-Sat diets decreased mean factor VIIc by 1.8% and 2.6% (overall P = 0.0001), increased mean fibrinogen by 1.2% and 2.8% (P = 0.0141), and increased mean square root PAI-1 by 0.0% and 6.0% (P = 0.0037), respectively. Study 2: compared with AAD, the Step 1 and high-MUFA diets decreased mean factor VIIc by 4.1% and 3.2% (overall P < 0.0001), increased mean fibrinogen by 3.9% and 1.5% (P = 0.0083), and increased mean square-root PAI-1 by 2.0% and 5.8% (P = 0.1319), respectively. CONCLUSIONS Replacing SFA with carbohydrate decreased factor VIIc and increased fibrinogen in healthy and metabolically unhealthy individuals and also increased PAI-1 in healthy subjects. Replacing SFA with MUFA decreased factor VIIc and increased fibrinogen but less than carbohydrate. Our results indicate an uncertain effect of replacing SFA with carbohydrate or MUFA on cardiometabolic risk because of small changes in hemostatic factors and directionally different responses to decreasing SFA. This trial was registered at https://clinicaltrials.gov/ct2/show/NCT00000538?term=NCT00000538&rank=1 as NCT00000538.
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Affiliation(s)
- Penny M Kris-Etherton
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA,Address correspondence to PMK-E (e-mail: )
| | - Paul W Stewart
- Department of Biostatistics, Collaborative Studies Coordinating Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Henry N Ginsberg
- Department of Medicine, Irving Center for Clinical Research, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Russell P Tracy
- Colchester Research Facility, University of Vermont, Colchester, VT, USA
| | - Michael Lefevre
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA,Present address for ML: Department of Nutrition, Dietetics and Food Sciences, Utah State University, 9815 Old Main Hill, Logan, UT 84322-9815
| | - Patricia J Elmer
- Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, MN, USA,Present address for PJE: Portland, OR
| | - Lars Berglund
- Department of Medicine, Irving Center for Clinical Research, Columbia University College of Physicians and Surgeons, New York, NY, USA,Present address for LB: Clinical and Translational Science Center, UC-Davis, School of Medicine, Sacramento, CA
| | - Abby G Ershow
- Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA,Present address for AGE: Office of Dietary Supplements, National Institutes of Health, Bethesda, MD
| | - Thomas A Pearson
- The Mary Imogene Bassett Research Institute, Cooperstown, NY, USA,School of Public Health, State University of New York at Albany, Albany, NY, USA,Columbia University College of Physicians and Surgeons, New York, NY, USA,Department of Community and Preventive Medicine, University of Rochester, Rochester, NY, USA,Present address for TAP: Department of Epidemiology, University of Florida, Gainesville, FL
| | - Rajasekhar Ramakrishnan
- Department of Medicine, Irving Center for Clinical Research, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Stephen F Holleran
- Department of Medicine, Irving Center for Clinical Research, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Barbara H Dennis
- Department of Biostatistics, Collaborative Studies Coordinating Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Present address for BHD: Chapel Hill, NC
| | - Catherine M Champagne
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Wahida Karmally
- Department of Medicine, Irving Center for Clinical Research, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - for the DELTA Investigators
GinsbergHenryMDPrincipal Investigator12RamakrishnanRajasekharDSc12KarmallyWahidaDrPH RD, CDE12BerglundLarsMD, PhD12SiddiquiMalihaMS, RD12ChenNiem-TzuMS12HolleranSteveBS12JohnsonColleenRD12HolemanRoberta12ChirgwinKaren12StennettKellye12GangaLencey12TowolawaiTajsudeenMBA12MyersMinnieBS12NgaiColleenBS12FontenezNelsonBS12JonesJeffBS12RodriguezCarmen12UsecheNorma12LefevreMichaelPhD13RoheimPaul SMDCo-Principal Investigators13
Deceased RyanDonnaMD13MostMarlenePhD, RD13ChampagneCatherinePhD, RD13WilliamsonDonaldPhD13TulleyRichardPhD13BrockRickyRN13BodinDeonneBS, MT13KennedyBettyMPA13BarkateMichelleMS, RD13FoustElizabethBS13YorkDeshoinBS13Kris-EthertonPennyPhD, RDPrincipal Investigator14JonnalagaddaSatyaPhD14DerrJanicePhD14Farhat-WoodAbirMS14MustadVikkiePhD14MeakerKateMS14MillsEdwardPhD14TilleyMary-AnnMS, RD14Smiciklas-WrightHelenPhD14Sigman-GrantMadeleinePhD, RD14YuShaomeiMS, PhD14GuinardJean-XavierPhD14SechevichPamelaMS14ReddyC ChannaPhD14MastroAndrea MPhD14CooperAllen DMD14ElmerPatriciaPhDPrincipal Investigator15FolsomAaronMD15Van HeelNancyMS, RD15WoldChristineRD15FritzKayMA, RD15SlavinJoannePhD15JacobsDavidPhD15DennisBarbaraPhDFirst Principal Investigator16StewartPaulPhDSecond Principal Investigator16DavisCPhD16HoskingJamesPhD16AndersonNancyMSPH16BlackwellSusanBS16MartinLynnMS16BryanHopeMS16StewartW BrianBS16AbolafiaJeffreyMA16FoleyMalachyBS16ZienConroyBA16LeuSzu-YunMS16YoungbloodMarstonMPH16GoodwinThomasMAT16MilesMonica16WehbieJennifer16PearsonThomasMD, PhD17ReedRobertaPhD17TracyRussellPhD18CornellElaineBS18StewartKentPhD19PhillipsKatherinePhD19McGeeBernestinePhD, RD20WilliamsBrendaBS20BeecherGaryPhD21HoldenJoanneMS21DavisCarolBS21ErshowAbbyScD22GordonDavidMD, PhD22ProschanMichaelPhD22RifkindBasilMD, FRCP22Deceased
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6
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Arbab-Zadeh A, Fuster V. From Detecting the Vulnerable Plaque to Managing the Vulnerable Patient: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 74:1582-1593. [PMID: 31537269 DOI: 10.1016/j.jacc.2019.07.062] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 01/04/2023]
Abstract
The past decades have seen tremendous progress on elucidating mechanisms leading to acute coronary syndrome and sudden cardiac death. Pathology and imaging studies have identified features of coronary atherosclerosis that precede acute coronary events. However, many factors influence the risk of adverse events from coronary atherosclerotic disease and available data support our transition from focusing on individual "vulnerable plaque," coronary arterial stenosis, and inducible myocardial ischemia to understanding coronary heart disease as multifactorial, chronic disease. The concept of the vulnerable patient has evolved, with the atheroma burden, its metabolic activity, and the disposition to vascular thrombosis building a platform for assessing central aspects of coronary heart disease. In turn, this model has directed us to a focus on controlling the activity of atherosclerotic disease and on modifying the susceptibility of vascular thrombosis which has led to reduced morbidity and mortality from coronary heart disease.
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Affiliation(s)
- Armin Arbab-Zadeh
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Valentin Fuster
- Mount Sinai Heart Center, Icahn School of Medicine at Mount Sinai, New York, New York
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7
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Bauça JM, Yañez A, Fueyo L, de la Peña M, Pierola J, Sánchez-de-la-Torre A, Mediano O, Cabriada-Nuño V, Masdeu MJ, Teran-Santos J, Duran-Cantolla J, Masa JF, Abad J, Sanchez-de-la-Torre M, Barbé F, Barceló A. Cell Death Biomarkers and Obstructive Sleep Apnea: Implications in the Acute Coronary Syndrome. Sleep 2017; 40:3737643. [PMID: 28419383 DOI: 10.1093/sleep/zsx049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2017] [Indexed: 12/19/2022] Open
Abstract
Study Objectives Nucleosomes and cell-free double-stranded DNA (dsDNA) have been suggested as promising biomarkers in cell death-related diseases, such as acute coronary syndrome (ACS). Currently, the impact of obstructive sleep apnea (OSA) in patients with ACS is unclear. Our aim was to evaluate the relationship between OSA, dsDNA, and nucleosomes and to assess their potential implication in the development of ACS. Methods Up to 549 patients were included in the study and divided into four groups (145 ACS; 290 ACS + OSA; 62 OSA; 52 controls). All patients underwent a sleep study, and serum concentrations of dsDNA and nucleosomes were measured. Results Nucleosome and dsDNA levels were higher in patients with OSA than in controls (nucleosomes: 1.47 ± 0.88 arbitary units [AU] vs. 1.00 ± 0.33 AU; p < .001, dsDNA: 315.6 ± 78.0 ng/mL vs. 282.6 ± 55.4 ng/mL; p = .007). In addition, both biomarker levels were higher in patients with ACS than in non-ACS, independently of the presence of OSA. Conclusions Both nucleosomes and dsDNA are increased in patients with OSA and might be related with the high cardiovascular risk seen in these patients. The extensive cell lysis during a myocardial infarction seems to be the major contributor to the high biomarker levels, and OSA does not seem to be implicated in such elevation when this acute event occurs. Clinical trial registration NCT01335087 (clinicaltrials.gov).
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Affiliation(s)
- Josep Miquel Bauça
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain.,Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Balearic Islands, Spain
| | - Aina Yañez
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Balearic Islands, Spain.,Research Group on Evidence, Lifestyles and Health, Universitat Illes Balears, Palma, Spain
| | - Laura Fueyo
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain
| | - Mónica de la Peña
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Balearic Islands, Spain.,Respiratory Department, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Javier Pierola
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Balearic Islands, Spain
| | - Alicia Sánchez-de-la-Torre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Respiratory Department, Institut de Recerca Biomèdica, Lleida, Catalonia, Spain
| | - Olga Mediano
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Respiratory Department, Hospital Universitario de Guadalajara, Guadalajara, Castilla-La Mancha, Spain
| | | | - María José Masdeu
- Respiratory Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona. Sabadell, Catalonia, Spain
| | - Joaquin Teran-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Respiratory Department, Hospital Universitario Burgos, Burgos, Castilla-León, Spain
| | - Joaquin Duran-Cantolla
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Research Department, OSI Araba University Hospital, UPV/EHU, Vitoria, Basque Country, Spain
| | - Juan Fernando Masa
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Respiratory Department, Hospital San Pedro de Alcántara, Cáceres, Extremadura, Spain
| | - Jorge Abad
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Respiratory Department, Hospital Germans Trias i Pujol, Barcelona, Catalonia, Spain
| | - Manuel Sanchez-de-la-Torre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Respiratory Department, Institut de Recerca Biomèdica, Lleida, Catalonia, Spain
| | - Ferran Barbé
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.,Respiratory Department, Institut de Recerca Biomèdica, Lleida, Catalonia, Spain
| | - Antònia Barceló
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain.,Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Balearic Islands, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
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8
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Detection of the Vulnerable Coronary Atherosclerotic Plaque—Promises and Limitations. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9427-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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9
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Mjelva ØR, Pönitz V, Brügger-Andersen T, Grundt H, Staines H, Nilsen DW. Long-term prognostic utility of pentraxin 3 and D-dimer as compared to high-sensitivity C-reactive protein and B-type natriuretic peptide in suspected acute coronary syndrome. Eur J Prev Cardiol 2015; 23:1130-40. [PMID: 26635361 DOI: 10.1177/2047487315619733] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 11/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vascular inflammation plays a key role in the development of atherosclerosis and acute coronary syndrome (ACS), and pentraxin 3 (PTX3) is one of several novel, promising markers of inflammation. In addition, D-dimer might serve as a marker of thrombogenesis and a hypercoagulable state following plaque rupture. The present study assesses the prognostic utility of these two biomarkers as compared to high-sensitivity C-reactive protein (hsCRP) and B-type natriuretic peptide (BNP), in addition to conventional clinical risk factors for coronary heart disease in patients with suspected ACS. METHODS Chest pain patients with suspected ACS (n = 871) were consecutively included in a prospective, observational study with a follow-up time of 84 months. RESULTS At 7-year follow-up, 332 patients had died and 203 had suffered an adverse troponin T-positive, non-fatal cardiac event. In the multivariate analysis, levels of PTX3 above 5.88 ng/mL (median) and D-dimer above 436 µg/L (lower limit upper quartile) independently predicted mortality (HR 1.60 [95% CI 1.10-2.33]; p = 0.014 and HR 1.83 [95% CI 1.20-2.78]; p = 0.005, respectively). Also, BNP levels above 310.75 pg/mL (lower limit upper quartile) (HR 2.16 [95% CI 1.37-3.42]; p = 0.001), but not hsCRP, independently predicted mortality. Only hsCRP and BNP also predicted future myocardial infarction (HR 1.59 [95% CI 1.05-2.40]; p = 0.029 and HR 1.91 [95% CI 1.10-3.31]; p = 0.021, respectively). CONCLUSION High levels of PTX3, D-dimer and BNP were found to be independent, long-term predictors of all-cause mortality in chest pain patients with a suspected ACS. hsCRP and BNP also predicted future myocardial infarction.
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Affiliation(s)
- Øistein R Mjelva
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Volker Pönitz
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | | | - Heidi Grundt
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Dennis Wt Nilsen
- Department of Clinical Science, University of Bergen, Bergen, Norway Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
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10
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Cho HS, Lee SW, Kim ES, Shin J, Moon SD, Han JH, Cha BY. Serum bilirubin levels are inversely associated with PAI-1 and fibrinogen in Korean subjects. Atherosclerosis 2015; 244:204-10. [PMID: 26684255 DOI: 10.1016/j.atherosclerosis.2015.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/22/2015] [Accepted: 11/06/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Oxidative stress may contribute to atherosclerosis and increased activation of the coagulation pathway. Bilirubin may reduce activation of the hemostatic system to inhibit oxidative stress, which would explain its cardioprotective properties shown in many epidemiological studies. This study investigated the association of serum bilirubin with fibrinogen and plasminogen activator inhibitor-1 (PAI-1), respectively. METHODS A cross-sectional analysis was performed on 968 subjects (mean age, 56.0 ± 11.2 years; 61.1% men) undergoing a general health checkup. Serum biochemistry was analyzed including bilirubin subtypes, insulin resistance (using homeostasis model of assessment [HOMA]), C-reactive protein (CRP), fibrinogen, and PAI-1. RESULTS Compared with subjects with a total bilirubin (TB) concentration of <10.0 μmol/L, those with a TB concentration of >17.1 μmol/L had a smaller waist circumference, a lower triglyceride level, a lower prevalence of metabolic syndrome, and decreased HOMA-IR and CRP levels. Correlation analysis revealed linear relationships of fibrinogen with TB and direct bilirubin (DB), whereas PAI-1 was correlated with DB. After adjustment for confounding factors, bilirubin levels were inversely associated with fibrinogen and PAI-1 levels, respectively. Multivariate regression models showed a negative linear relationship between all types of bilirubin and fibrinogen, whereas there was a significant linear relationship between PAI-1 and DB. CONCLUSIONS High bilirubin concentrations were independently associated with low levels of fibrinogen and PAI-1, respectively. The association between TB and PAI-1 was confined to the highest TB concentration category whereas DB showed a linear association with PAI-1. Bilirubin may protect against the development of atherothrombosis by reducing the hemostatic response.
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Affiliation(s)
- Hyun Sun Cho
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Health Promotion Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Won Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Eun Sook Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Juyoung Shin
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Health Promotion Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Dae Moon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Je Ho Han
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Bong Yun Cha
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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11
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Loeffen R, van Oerle R, de Groot P, Waltenberger J, Crijns H, Spronk H, ten Cate H. Increased factor XIa levels in patients with a first acute myocardial infarction: The introduction of a new thrombin generation based factor XIa assay. Thromb Res 2014; 134:1328-34. [DOI: 10.1016/j.thromres.2014.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 09/09/2014] [Accepted: 09/12/2014] [Indexed: 12/01/2022]
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12
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Dundar O, Pektas MK, Bodur S, Bakır LV, Cetin A. Recurrent pregnancy loss is associated with increased red cell distribution width and platelet distribution width. J Obstet Gynaecol Res 2014; 41:551-8. [DOI: 10.1111/jog.12600] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 08/22/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Ozgur Dundar
- Department of Obstetrics and Gynecology; Haydarpasa Military Education and Research Hospital; GATA; Istanbul Turkey
| | - Mıne Kanat Pektas
- Depertment of Obstetrics and Gynecology; Kocatepe University School of Medicine; Afyon Turkey
| | - Serkan Bodur
- Department of Obstetrics and Gynecology and Dispensary of Oran; Beytepe Military Hospital; Ankara Turkey
| | - Lale Vuslat Bakır
- Department of Obstetrics and Gynecology; Haseki Education and Research Hospital; Istanbul Turkey
| | - Ahmet Cetin
- Department of Obstetrics and Gynecology; Haseki Education and Research Hospital; Istanbul Turkey
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13
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Borissoff JI, Joosen IA, Versteylen MO, Brill A, Fuchs TA, Savchenko AS, Gallant M, Martinod K, Ten Cate H, Hofstra L, Crijns HJ, Wagner DD, Kietselaer BLJH. Elevated levels of circulating DNA and chromatin are independently associated with severe coronary atherosclerosis and a prothrombotic state. Arterioscler Thromb Vasc Biol 2013; 33:2032-2040. [PMID: 23818485 DOI: 10.1161/atvbaha.113.301627] [Citation(s) in RCA: 307] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Aberrant neutrophil activation occurs during the advanced stages of atherosclerosis. Once primed, neutrophils can undergo apoptosis or release neutrophil extracellular traps. This extracellular DNA exerts potent proinflammatory, prothrombotic, and cytotoxic properties. The goal of this study was to examine the relationships among extracellular DNA formation, coronary atherosclerosis, and the presence of a prothrombotic state. APPROACH AND RESULTS In a prospective, observational, cross-sectional cohort of 282 individuals with suspected coronary artery disease, we examined the severity, extent, and phenotype of coronary atherosclerosis using coronary computed tomographic angiography. Double-stranded DNA, nucleosomes, citrullinated histone H4, and myeloperoxidase-DNA complexes, considered in vivo markers of cell death and NETosis, respectively, were established. We further measured various plasma markers of coagulation activation and inflammation. Plasma double-stranded DNA, nucleosomes, and myeloperoxidase-DNA complexes were positively associated with thrombin generation and significantly elevated in patients with severe coronary atherosclerosis or extremely calcified coronary arteries. Multinomial regression analysis, adjusted for confounding factors, identified high plasma nucleosome levels as an independent risk factor of severe coronary stenosis (odds ratio, 2.14; 95% confidence interval, 1.26-3.63; P=0.005). Markers of neutrophil extracellular traps, such as myeloperoxidase-DNA complexes, predicted the number of atherosclerotic coronary vessels and the occurrence of major adverse cardiac events. CONCLUSIONS Our report provides evidence demonstrating that markers of cell death and neutrophil extracellular trap formation are independently associated with coronary artery disease, prothrombotic state, and occurrence of adverse cardiac events. These biomarkers could potentially aid in the prediction of cardiovascular risk in patients with chest discomfort.
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Affiliation(s)
- Julian I Borissoff
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Laboratory for Clinical Thrombosis and Hemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ivo A Joosen
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mathijs O Versteylen
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alexander Brill
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Tobias A Fuchs
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Alexander S Savchenko
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Maureen Gallant
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Kimberly Martinod
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA, USA.,Immunology Graduate Program, Division of Medical Sciences, Harvard Medical School, Boston, MA, USA
| | - Hugo Ten Cate
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Harry J Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Denisa D Wagner
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA
| | - Bas L J H Kietselaer
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Radiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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14
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Loeffen R, Spronk HMH, ten Cate H. The impact of blood coagulability on atherosclerosis and cardiovascular disease. J Thromb Haemost 2012; 10:1207-16. [PMID: 22578148 DOI: 10.1111/j.1538-7836.2012.04782.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although the link between blood coagulation and atherogenesis has been long postulated, only recently, and through the extensive work on transgenic mice, crossbred on an atherogenic background, has the direction of this interaction become visible. In general, hypercoagulability in mice tends to increase atherosclerosis, whereas hypocoagulability reduces the atherosclerotic burden, depending on the mouse model used. The information on a direct relationship between coagulation and atherosclerosis in humans, however, is not that clear. Almost all coagulation proteins, including tissue factor, are found in atherosclerotic lesions in humans. In addition to producing local fibrin, a matrix for cell growth, serine proteases such as thrombin may be very important in cell signaling processes, acting through the activation of protease-activated receptors (PARs). Activation of PARs on vascular cells drives many complex processes involved in the development and progression of atherosclerosis, including inflammation, angiogenesis, and cell proliferation. Although current imaging techniques do not allow for a detailed analysis of atherosclerotic lesion phenotype, hypercoagulability, defined either by gene defects of coagulation proteins or elevated levels of circulating markers of activated coagulation, has been linked to atherosclerosis-related ischemic arterial disease. New, high-resolution imaging techniques and sensitive markers of activated coagulation are needed in order to study a causal contribution of hypercoagulability to the pathophysiology of atherosclerosis. Novel selective inhibitors of coagulation enzymes potentially have vascular effects, including inhibition of atherogenesis through attenuation of inflammatory pathways. Therefore, we propose that studying the long-term vascular side effects of this novel class of oral anticoagulants should become a clinical research priority.
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Affiliation(s)
- R Loeffen
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
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15
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Abstract
In the United States alone, more than 400,000 Americans die annually from coronary artery disease and more than 1,000,000 suffer acute coronary events, i.e., myocardial infarction and sudden cardiac death.1 Considering the aging of our population and increasing incidence of diabetes and obesity, the morbidity from coronary artery disease, and its associated costs, will place an increasing, substantial burden on our society.2 Between 2010 and 2030, total direct medical costs spent in the US for cardiovascular diseases are projected to triple from 273 to 818 billion dollars.2 Although effective treatments are available and considerable efforts are ongoing to identify new strategies for the prevention of coronary events, predicting such events in an individual has been challenging.3 In hopes of improving our ability to determine the risk of coronary events, it is prudent to review our knowledge of factors that lead to acute coronary events.
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