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Sasaki N, Maeda R, Ozono R, Yoshimura K, Nakano Y, Higashi Y. Differences in the impact of newly diagnosed type 2 diabetes on cardiovascular mortality between normotensive and hypertensive individuals. J Hypertens 2024; 42:610-619. [PMID: 38441184 DOI: 10.1097/hjh.0000000000003671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVE We investigated the interrelationship between hyperglycemia and hypertension on cardiovascular mortality in the middle-aged and elderly people. METHODS In this retrospective cohort study that used data from the Hiroshima Study on Glucose Metabolism and Cardiovascular Diseases, we included 16,564 participants without cardiovascular disease (mean age: 65.8 years; 6179 normoglycemic people, 3017 people with newly diagnosed type 2 diabetes, and 7368 people with prediabetes per the 75-g oral glucose tolerance test). Hypertension was defined as the use of antihypertensive medications and/or having a systolic/diastolic blood pressure of at least 140/90 mm Hg. RESULTS During a median follow-up period of 12.4 years, a total of 1513 cardiovascular death occurred. Cardiovascular death rates per 1000 participant-years were 4.01, 4.98, 8.33, 8.22, 8.81, and 11.1 among normotensive participants with normal glycemia, prediabetes, and diabetes and hypertensive participants with normal glycemia, prediabetes, and diabetes, respectively. Prediabetes was significantly associated with a high risk of cardiovascular mortality in normotensive individuals [hazard ratio: 1.24, 95% confidence interval (95% CI): 1.02-1.50] but not in hypertensive individuals. Type 2 diabetes was associated with a high risk of cardiovascular mortality in both normotensive (hazard ratio: 1.94, 95% CI: 1.55-2.43) and hypertensive individuals (hazard ratio: 1.35, 95% CI: 1.13-1.62). Stratified analyses revealed no significant impact of type 2 diabetes on cardiovascular mortality in hypertensive individuals aged at least 65 years. CONCLUSION The effect of hyperglycemia on cardiovascular death differed with age and the presence or absence of hypertension, demonstrating the clinical importance of case-specific risk assessments.
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Affiliation(s)
- Nobuo Sasaki
- Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Ryo Maeda
- Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council
| | - Ryoji Ozono
- Department of General Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kenichi Yoshimura
- Department of Biostatistics, Medical Center for Translational and Clinical Research, Hiroshima University Hospital
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukihito Higashi
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
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Gold ME, Woods E, Pobee D, Ibrahim R, Quyyumi AA. Multi-proteomic Biomarker Risk Scores for Predicting Risk and Guiding Therapy in Patients with Coronary Artery Disease. Curr Cardiol Rep 2023; 25:1811-1821. [PMID: 38079057 DOI: 10.1007/s11886-023-01995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE OF REVIEW Patients with established coronary artery disease (CAD) are at high residual risk for adverse events, despite guideline-based treatments. Herein, we aimed to determine whether risk scores based on multiple circulating biomarkers that represent activation of various pathophysiologically important pathways involved in atherosclerosis and myocardial dysfunction help identify those at greatest residual risk. RECENT FINDINGS Numerous circulating proteins, representing dysregulation of the pathways involved in the development and stability of coronary and myocardial diseases, have been identified. When aggregated together, biomarker risk scores (BRS) more accurately stratify patients with established CAD that may help target interventions in those individuals who are at elevated risk. Moreover, intensification of guideline-based therapies has been associated with parallel improvements in both BRS and outcomes, indicating that these risk scores may be employed clinically to target therapy. Multi-protein BRS are predictive of risk, independent of, and in addition to traditional risk factor assessments in patients with CAD. Those with elevated risk may benefit from optimization of therapies, and improvements in the BRS will identify those with improved outcomes.
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Affiliation(s)
- Matthew E Gold
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1760 Haygood Dr NE, Atlanta, GA, USA
| | - Edward Woods
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Darlington Pobee
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Rand Ibrahim
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1760 Haygood Dr NE, Atlanta, GA, USA.
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3
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Newman JD, Anthopolos R, Ruggles KV, Cornwell M, Reynolds HR, Bangalore S, Mavromatis K, Held C, Wallentin L, Kullo IJ, McManus B, Newby LKK, Rosenberg Y, Hochman JS, Maron DJ, Berger JS. Biomarkers and cardiovascular events in patients with stable coronary disease in the ISCHEMIA Trials. Am Heart J 2023; 266:61-73. [PMID: 37604357 PMCID: PMC10843480 DOI: 10.1016/j.ahj.2023.08.007] [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: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
IMPORTANCE Biomarkers may improve prediction of cardiovascular events for patients with stable coronary artery disease (CAD), but their importance in addition to clinical tests of inducible ischemia and CAD severity is unknown. OBJECTIVES To evaluate the prognostic value of multiple biomarkers in stable outpatients with obstructive CAD and moderate or severe inducible ischemia. DESIGN AND SETTING The ISCHEMIA and ISCHEMIA CKD trials randomized 5,956 participants with CAD to invasive or conservative management from July 2012 to January 2018; 1,064 participated in the biorepository. MAIN OUTCOME MEASURES Primary outcome was cardiovascular death, myocardial infarction (MI), or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. Secondary outcome was cardiovascular death or MI. Improvements in prediction were assessed by cause-specific hazard ratios (HR) and area under the receiver operating characteristics curve (AUC) for an interquartile increase in each biomarker, controlling for other biomarkers, in a base clinical model of risk factors, left ventricular ejection fraction (LVEF) and ischemia severity. Secondary analyses were performed among patients in whom core-lab confirmed severity of CAD was ascertained by computed cardiac tomographic angiography (CCTA). EXPOSURES Baseline levels of interleukin-6 (IL-6), high sensitivity troponin T (hsTnT), growth differentiation factor 15 (GDF-15), N-terminal pro-B-type natriuretic peptide (NT-proBNP), lipoprotein a (Lp[a]), high sensitivity C-reactive protein (hsCRP), Cystatin C, soluble CD 40 ligand (sCD40L), myeloperoxidase (MPO), and matrix metalloproteinase 3 (MMP3). RESULTS Among 757 biorepository participants, median (IQR) follow-up was 3 (2-5) years, age was 67 (61-72) years, and 144 (19%) were female; 508 had severity of CAD by CCTA available. In an adjusted multimarker model with hsTnT, GDF-15, NT-proBNP and sCD40L, the adjusted HR for the primary outcome per interquartile increase in each biomarker was 1.58 (95% CI 1.22, 2.205), 1.60 (95% CI 1.16, 2.20), 1.61 (95% 1.22, 2.14), and 1.46 (95% 1.12, 1.90), respectively. The adjusted multimarker model also improved prediction compared with the clinical model, increasing the AUC from 0.710 to 0.792 (P < .01) and 0.714 to 0.783 (P < .01) for the primary and secondary outcomes, respectively. Similar findings were observed after adjusting for core-lab confirmed atherosclerosis severity. CONCLUSIONS AND RELEVANCE Among ISCHEMIA biorepository participants, biomarkers of myocyte injury/distension, inflammation, and platelet activity improved cardiovascular event prediction in addition to risk factors, LVEF, and assessments of ischemia and atherosclerosis severity. These biomarkers may improve risk stratification for patients with stable CAD.
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Affiliation(s)
- Jonathan D Newman
- Department of Medicine, NYU Grossman School of Medicine, New York, NY.
| | - Rebecca Anthopolos
- Division of Biostatistics, Department of Population Health, NYU Langone Health, New York, NY
| | - Kelly V Ruggles
- Department of Medicine, NYU Grossman School of Medicine, New York, NY
| | | | | | - Sripal Bangalore
- Department of Medicine, NYU Grossman School of Medicine, New York, NY
| | - Kreton Mavromatis
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Iftikar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Bruce McManus
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - L Kristin K Newby
- Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Durham, NC
| | - Yves Rosenberg
- Division of Cardiovascular Sciences, National Health Lung and Blood Institute, National Institute of Health, Bethesda, MD
| | - Judith S Hochman
- Department of Medicine, NYU Grossman School of Medicine, New York, NY
| | - David J Maron
- Department of Medicine, Stanford University, Stanford, CA
| | - Jeffrey S Berger
- Department of Medicine, NYU Grossman School of Medicine, New York, NY
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4
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Guo X, Su W, Wang H, Li N, Song Q, Liang Q, Sun C, Liang M, Zhou Z, Song EJ, Sun Y. Short-term exposure to ambient ozone and cardiovascular mortality in China: a systematic review and meta-analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:958-975. [PMID: 35438585 DOI: 10.1080/09603123.2022.2066070] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/09/2022] [Indexed: 06/14/2023]
Abstract
Air pollution is a major public health concern in China. Notwithstanding this, there is limited evidence regarding the impact of short-term exposure to ambient ozone on cardiovascular mortality in the Chinese population. Therefore, we conducted this meta-analysis to address this important question. The random-effects model was applied to pool the results from individual studies. Finally, 32 effect estimates extracted from 19 studies were pooled in this meta-analysis. The pooled relative risk for cardiovascular mortality for each 10 µg/m3 increment in ozone concentration was 1.0068 (95% CI: 1.0049, 1.0086). Ths significant positive association between ozone exposure and cardiovascular mortality was also observed in different two-pollutant models. This meta-analysis revealed that exposure to ozone was associated with an increased risk of cardiovascular mortality in China, and more efforts on controlling the population from ozone are needed to improve cardiovascular health of Chinese population.
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Affiliation(s)
- Xianwei Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, P.R. China
| | - Wanying Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, P.R. China
| | - Hao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, P.R. China
| | - Ning Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, P.R. China
| | - Qiuxia Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, P.R. China
| | - Qiwei Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, P.R. China
| | - Chenyu Sun
- Internal Medicine, AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, USA
| | - Mingming Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, P.R. China
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Evelyn J Song
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, P.R. China
- Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, P.R. China
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Motawea KR, Elhalag RH, Rouzan SS, Talat NE, Reyad SM, Chébl P, Mohamed MS, Shah J. Cyclophilin C as a Novel Diagnostic and Prognostic Biomarker of Coronary Artery Diseases. A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101812. [PMID: 37209796 DOI: 10.1016/j.cpcardiol.2023.101812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
We aimed to perform a meta-analysis to investigate the value of Cyclophilin C as a diagnostic and prognostic biomarker in Coronary Artery Disease. PubMed, Web of Science, Scopus and Cochrane library databases were searched. The inclusion criteria were any randomized control trials or controlled observational studies that measured the levels of Cyclophilin C in Coronary Artery disease patients and healthy controls. We excluded case reports, case series, reviews, editorials and animal studies. After search of the literature, 4 studies were included in the meta-analysis with a total number of 454 individuals included in the study. The pooled analysis showed a significant association between CAD group and increased levels of Cyclophilin C (MD = 28.94, 95% confidence interval (CI) = 19.28-38.60, P-value < 0.00001). Subgroup analysis showed a significant association between acute and chronic CAD group with increased levels of cyclophilin c compared with the control group (MD = 35.98, 95% CI = 19.84-52.11, P-value < 0.0001) and (MD = 26.36, 95% CI = 21.87 to 30.85, P-value < 0.00001), respectively. The pooled effect estimate showed that the ROC area for the cyclophillin c as a diagnostic biomarker of CAD was (ROC= 0.880, 95% CI =0.844-0.917, P-value < 0.001). Our study revealed a significant association between acute and chronic coronary artery disease with increased levels of Cyclophilin C. Cyclophilin C could be used as a novel diagnostic and prognostic biomarker in acute and chronic CAD. More research is warranted to support our results.
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Affiliation(s)
- Karam R Motawea
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rowan H Elhalag
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Samah S Rouzan
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Sarraa M Reyad
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Pensée Chébl
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
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6
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Desai SR, Dhindsa DS, Ko YA, Sandesara PB, Mehta A, Liu C, Tahhan AS, Hayek SS, Ejaz K, Hooda A, Alkhoder A, Islam SJ, Rogers SC, Beshiri A, Murtagh G, Kim JH, Wilson P, Almuwaqqat Z, Sperling LS, Quyyumi AA. Aggregate Clinical and Biomarker-Based Model Predicts Adverse Outcomes in Patients With Coronary Artery Disease. Am J Cardiol 2023; 203:315-324. [PMID: 37517126 PMCID: PMC10900119 DOI: 10.1016/j.amjcard.2023.06.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023]
Abstract
Despite guideline-based therapy, patients with coronary artery disease (CAD) are at widely variable risk for cardiovascular events. This variability demands a more individualized risk assessment. Herein, we evaluate the prognostic value of 6 biomarkers: high-sensitivity C-reactive protein, heat shock protein-70, fibrin degradation products, soluble urokinase plasminogen activator receptor, high-sensitivity troponin I, and B-type natriuretic peptide. We then develop a multi-biomarker-based cardiovascular event prediction model for patients with stable CAD. In total, 3,115 subjects with stable CAD who underwent cardiac catheterization at Emory (mean age 62.8 years, 17% Black, 35% female, 57% obstructive CAD, 31% diabetes mellitus) were randomized into a training cohort to identify biomarker cutoff values and a validation cohort for prediction assessment. Main outcomes included (1) all-cause death and (2) a composite of cardiovascular death and nonfatal myocardial infarction (MI) within 5 years. Elevation of each biomarker level was associated with higher event rates in the training cohort. A biomarker risk score was created using optimal cutoffs, ranging from 0 to 6 for each biomarker exceeding its cutoff. In the validation cohort, each unit increase in the biomarker risk score was independently associated with all-cause death (hazard ratio 1.62, 95% confidence interval [CI] 1.45 to 1.80) and cardiovascular death/MI (hazard ratio 1.52, 95% CI 1.35 to 1.71). A biomarker risk prediction model for cardiovascular death/MI improved the c-statistic (∆ 6.4%, 95% CI 3.9 to 8.8) and net reclassification index by 31.1% (95% CI 24 to 37), compared with clinical risk factors alone. Integrating multiple biomarkers with clinical variables refines cardiovascular risk assessment in patients with CAD.
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Affiliation(s)
- Shivang R Desai
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Devinder S Dhindsa
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Yi-An Ko
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Pratik B Sandesara
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Anurag Mehta
- Department of Preventive Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Chang Liu
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ayman S Tahhan
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Salim S Hayek
- Department of Medicine, Division of Cardiology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Kiran Ejaz
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Ananya Hooda
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Ayman Alkhoder
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Shabatun J Islam
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Steven C Rogers
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Agim Beshiri
- Diagnostics Division, Abbott Laboratories, North Chicago, Illinois
| | - Gillian Murtagh
- Diagnostics Division, Abbott Laboratories, North Chicago, Illinois
| | - Jonathan H Kim
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Peter Wilson
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Zakaria Almuwaqqat
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Laurence S Sperling
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia.
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7
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Degroote C, von Känel R, Thomas L, Zuccarella-Hackl C, Messerli-Bürgy N, Saner H, Wiest R, Wirtz PH. Lower diurnal HPA-axis activity in male hypertensive and coronary heart disease patients predicts future CHD risk. Front Endocrinol (Lausanne) 2023; 14:1080938. [PMID: 36967749 PMCID: PMC10036761 DOI: 10.3389/fendo.2023.1080938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/07/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Coronary heart disease (CHD) and its major risk factor hypertension have both been associated with altered activity of the hypothalamus-pituitary-adrenal (HPA)-axis but the biological mechanisms underlying prospective associations with adverse disease outcomes are unclear. We investigated diurnal HPA-axis activity in CHD-patients, hypertensive (HT) and healthy normotensive men (NT) and tested for prospective associations with biological CHD risk factors. METHODS Eighty-three male CHD-patients, 54 HT and 54 NT men repeatedly measured salivary cortisol over two consecutive days. Prospective CHD risk was assessed by changes between baseline and follow-up in the prothrombotic factors D-dimer and fibrinogen, the pro-inflammatory measures interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and acute phase protein C-reactive protein (CRP), as well as blood lipids in terms of total cholesterol (tChol)/high-density-lipoprotein cholesterol (HDL)-ratio. We aggregated coagulation and inflammatory measures to respective indices. RESULTS The groups differed in repeated daytime cortisol (dayCort) secretion (p=.005,η2 p=.03,f=0.18) and cortisol awakening response (CAR) (p=.006,η2 p=.03,f=0.18), with similarly lower overall dayCort and CAR in CHD-patients and HT, as compared to NT. The groups differed further in cortisol at awakening (p=.015,η2 p=.04,f=0.20) with highest levels in HT (p´s≤.050), and in diurnal slope between waking and evening cortisol (p=.033,η2 p=.04,f=0.20) with steepest slopes in HT (p´s≤.039), although in part not independent of confounders. Lower aggregated dayCort and CAR in terms of area-under-the-curve (AUC) independently predicted increases in future overall CHD risk (AUCdayCort: p=.021,η2 p=.10,f=0.33;AUCCAR: p=.028,η2 p=.09,f=0.31) 3.00 ± 0.06(SEM) years later, with risk prediction most pronounced in fibrinogen (AUCdayCort: p=.017,ΔR 2= 0.12;AUCCAR: p=.082). CONCLUSION We found evidence for an HPA-axis hypoactivity in CHD and HT with lower diurnal HPA-axis activity predicting increases in cardiovascular risk as evidenced by increases in circulating levels of biomarkers of atherothrombotic risk. Down-regulation of basal HPA-axis activity may contribute to the pathogenesis of atherosclerosis and thrombosis in CHD via effects on coagulation.
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Affiliation(s)
- Cathy Degroote
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Livia Thomas
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Claudia Zuccarella-Hackl
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Psychology, University of Bern, Bern, Switzerland
| | | | - Hugo Saner
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center of Advanced Neuroimaging, Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Petra H. Wirtz
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany
- Department of Psychology, University of Bern, Bern, Switzerland
- Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Konstanz, Germany
- *Correspondence: Petra H. Wirtz,
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8
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Gao J, Lu J, Sha W, Xu B, Zhang C, Wang H, Xia J, Zhang H, Tang W, Lei T. Relationship between the neutrophil to high-density lipoprotein cholesterol ratio and severity of coronary artery disease in patients with stable coronary artery disease. Front Cardiovasc Med 2022; 9:1015398. [PMID: 36505389 PMCID: PMC9729241 DOI: 10.3389/fcvm.2022.1015398] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the link between the neutrophil to HDL-C ratio (NHR) and the degree of coronary stenosis in patients with stable coronary artery disease (CAD). Materials and methods Totally 766 individuals who attended our clinic for coronary angiography between January 2019 and January 2021 were included in this study. The participants were divided into two groups, including the CAD group and control group. Spearman correlation analysis was used to investigate the association between NHR and Gensini score and logistic regression analysis was performed to determine the influence of NHR on CAD and severe CAD. Receiver operating characteristic (ROC) curve was constructed to analyze the predictive value of NHR for severe CAD. Results The CAD group had a substantially higher median NHR than the control group (3.7 vs. 3.2, P < 0.01). There was a positive correlation between NHR and Gensini score, as well as the frequency of coronary artery plaques. Logistic regression demonstrated that NHR was an independent contributor for CAD and severe CAD. In ROC analysis, the area under the ROC curve (AUC) for NHR was larger than that for neutrophil, HDL-C or LDL-C/HDL-C, and the differences were statistically significant (all P < 0.05). The NHR limit that offered the most accurate prediction of severe CAD according to the greatest possible value of the Youden index, was 3.88, with a sensitivity of 62.6% and a specificity of 66.2%. Conclusion NHR was not only associated with the occurrence and seriousness of CAD, but also a better predictor of severe CAD than neutrophil, HDL-C or LDL-C/HDL-C.
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Affiliation(s)
- Jie Gao
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Lu
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenjun Sha
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bilin Xu
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Cuiping Zhang
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongping Wang
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Juan Xia
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hong Zhang
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenjun Tang
- Heart Function Examination Room, Tongji Hospital, Tongji University, Shanghai, China
| | - Tao Lei
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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9
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Dong C, Yang Y, Wang Y, Hu X, Wang Q, Gao F, Sun S, Liu Q, Li L, Liu J, Tang Y, Zhang S, Wu C, Zhu H. Gut Microbiota Combined with Metabolites Reveals Unique Features of Acute Myocardial Infarction Patients Different from Stable Coronary Artery Disease. J Adv Res 2022; 46:101-112. [PMID: 35750287 PMCID: PMC10105070 DOI: 10.1016/j.jare.2022.06.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Acute myocardial infarction (AMI) accounts for the majority of deaths caused by coronary artery disease (CAD). Early warning of AMI, especially for patients with stable coronary artery disease (sCAD), is urgently needed. Our previous study showed that alterations in the gut microbiota were correlated with CAD severity. OBJECTIVES Herein, we tried to discover accurate and convenient biomarkers for AMI by combination of gut microbiota and fecal/blood/urinary metabolomics. METHODS We recruited 190 volunteers including 93 sCAD patients, 49 AMI patients, and 48 subjects with normal coronary artery (NCA), and measured their blood biochemical parameters, 16S rRNA-based gut microbiota and NMR-based fecal/blood/urinary metabolites. We further selected 20 subjects from each group and analyzed their gut microbiota by whole-metagenome shotgun sequencing. RESULTS Multi-omic analyses revealed that AMI patients exhibited specific changes in gut microbiota and serum/urinary/fecal metabolites as compared to subjects with sCAD or NCA. Fourteen bacterial genera and 30 metabolites (11 in feces, 10 in blood, 9 in urine) were closely related to AMI phenotypes and could accurately distinguish AMI patients from sCAD patients. Some species belonging to Alistipes, Streptococcus, Ruminococcus, Lactobacillus and Faecalibacterium were effective to distinguish AMI from sCAD and their predictive ability was confirmed in an independent cohort of CAD patients. We further selected nine indicators including 4 bacterial genera, 3 fecal and 2 urinary metabolites as a noninvasive biomarker set which can distinguish AMI from sCAD with an AUC of 0.932. CONCLUSION Combination of gut microbiota and fecal/urinary metabolites provided a set of potential useful and noninvasive predictive biomarker for AMI from sCAD.
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Affiliation(s)
- Chaoran Dong
- State Key Laboratory for Bioactive Substances and Functions of Natural Medicines, Beijing Key Laboratory of New Drug Mechanisms and Pharmacological Evaluation Study, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yanan Yang
- Pharmacology and Toxicology Research Center, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Yinghong Wang
- State Key Laboratory for Bioactive Substances and Functions of Natural Medicines, Beijing Key Laboratory of New Drug Mechanisms and Pharmacological Evaluation Study, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Xiaomin Hu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
| | - Qingchun Wang
- State Key Laboratory for Bioactive Substances and Functions of Natural Medicines, Beijing Key Laboratory of New Drug Mechanisms and Pharmacological Evaluation Study, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Feng Gao
- State Key Laboratory for Bioactive Substances and Functions of Natural Medicines, Beijing Key Laboratory of New Drug Mechanisms and Pharmacological Evaluation Study, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Shanshan Sun
- State Key Laboratory for Bioactive Substances and Functions of Natural Medicines, Beijing Key Laboratory of New Drug Mechanisms and Pharmacological Evaluation Study, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Qifeng Liu
- State Key Laboratory for Bioactive Substances and Functions of Natural Medicines, Beijing Key Laboratory of New Drug Mechanisms and Pharmacological Evaluation Study, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Lei Li
- Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
| | - Jianxun Liu
- Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
| | - Yida Tang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
| | - Chongming Wu
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
| | - Haibo Zhu
- State Key Laboratory for Bioactive Substances and Functions of Natural Medicines, Beijing Key Laboratory of New Drug Mechanisms and Pharmacological Evaluation Study, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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10
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Wu TT, Zheng YY, Xiu WJ, Wang WR, Xun YL, Ma YY, Kadir P, Pan Y, Ma YT, Xie X. White Blood Cell Counts to High-Density Lipoprotein Cholesterol Ratio, as a Novel Predictor of Long-Term Adverse Outcomes in Patients After Percutaneous Coronary Intervention: A Retrospective Cohort Study. Front Cardiovasc Med 2021; 8:616896. [PMID: 34307487 PMCID: PMC8295559 DOI: 10.3389/fcvm.2021.616896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/30/2021] [Indexed: 02/05/2023] Open
Abstract
Background: White blood cell (WBC) counts and high-density lipoprotein cholesterol (HDL-C) are widely available in clinical practice. However, the predictive value for cardiovascular disease (CVD) is uncertain. In the present study, we firstly assessed the prognostic value of WBC to HDL-C ratio (WHR) in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). Methods: Six thousand and fifty patients with CAD after PCI from a retrospective cohort study (identifier: ChiCTR-INR-16010153) were evaluated initially. Three hundred and seventy-one patients were excluded due to HDL cholesterol data not available, malignancy, dementia, psoriasis or eczema, systemic connective tissue disorders, multiple sclerosis, chronic liver disease, and chronic obstructive pulmonary disorder. Finally, 5,679 patients were included in the study. The primary outcome was long-term mortality. Secondary endpoints were mainly major adverse cardiovascular and cerebrovascular events (MACCEs), defined as a combination of stroke, cardiac death, stent thrombosis, recurrent myocardial infarction, and target vessel revascularization. The mean follow-up time of this study was 35.9 ± 22.5 months. We defined the best cutoff value of MHR according to the receiver operating curve (ROC), and then patients were divided into high and low WHR groups according to the cutoff value. We analyzed the data in both an acute coronary syndrome group (ACS) and a stable CAD subgroup, respectively. Results: Overall, there were 293 cases of long-term mortality during the follow-up period. According to the cutoff value (WHR = 8.25), 1,901 ACS patients were divided into high WHR group (n = 724) and low WHR group (n = 1,177). Compared to low WHR group, the incidence of all-cause mortality (ACM, 5.5 vs. 3.6%, p = 0.048) and cardiac death (4.7vs. 2.9%, p = 0.042) were significantly higher in the high WHR group. In stable CAD group, we also found the incidence of ACM and cardiac death were significantly higher in the high group compared to that in the low group. We did not find significant difference between the high and the low WHR group in the incidence of MACCEs. The multivariate Cox proportional hazards model showed that increased WHR level was independently correlated with the mortality. In the high WHR group, the risk of ACM increased two times in ACS [adjusted HR = 2.036 (1.258–3.296), p = 0.004] and 1.5 times in stable CAD [adjusted HR = 1.586 (1.178–2.136), p = 0.002]. Conclusion: The present study indicated that an increased WBC count to HDL-C ratio was independently associated with long-term mortality in CAD patients who underwent PCI.
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Affiliation(s)
- Ting-Ting Wu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ying-Ying Zheng
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wen-Juan Xiu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Wan-Rong Wang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yi-Li Xun
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yan-Yan Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Patigvl Kadir
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ying Pan
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiang Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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11
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Nicolau JC, Feitosa Filho GS, Petriz JL, Furtado RHDM, Précoma DB, Lemke W, Lopes RD, Timerman A, Marin Neto JA, Bezerra Neto L, Gomes BFDO, Santos ECL, Piegas LS, Soeiro ADM, Negri AJDA, Franci A, Markman Filho B, Baccaro BM, Montenegro CEL, Rochitte CE, Barbosa CJDG, Virgens CMBD, Stefanini E, Manenti ERF, Lima FG, Monteiro Júnior FDC, Correa Filho H, Pena HPM, Pinto IMF, Falcão JLDAA, Sena JP, Peixoto JM, Souza JAD, Silva LSD, Maia LN, Ohe LN, Baracioli LM, Dallan LADO, Dallan LAP, Mattos LAPE, Bodanese LC, Ritt LEF, Canesin MF, Rivas MBDS, Franken M, Magalhães MJG, Oliveira Júnior MTD, Filgueiras Filho NM, Dutra OP, Coelho OR, Leães PE, Rossi PRF, Soares PR, Lemos Neto PA, Farsky PS, Cavalcanti RRC, Alves RJ, Kalil RAK, Esporcatte R, Marino RL, Giraldez RRCV, Meneghelo RS, Lima RDSL, Ramos RF, Falcão SNDRS, Dalçóquio TF, Lemke VDMG, Chalela WA, Mathias Júnior W. Brazilian Society of Cardiology Guidelines on Unstable Angina and Acute Myocardial Infarction without ST-Segment Elevation - 2021. Arq Bras Cardiol 2021; 117:181-264. [PMID: 34320090 PMCID: PMC8294740 DOI: 10.36660/abc.20210180] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- José Carlos Nicolau
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Gilson Soares Feitosa Filho
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
- Centro Universitário de Tecnologia e Ciência (UniFTC), Salvador, BA - Brasil
| | - João Luiz Petriz
- Hospital Barra D'Or, Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
| | | | | | - Walmor Lemke
- Clínica Cardiocare, Curitiba, PR - Brasil
- Hospital das Nações, Curitiba, PR - Brasil
| | | | - Ari Timerman
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | - José A Marin Neto
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, SP - Brasil
| | | | - Bruno Ferraz de Oliveira Gomes
- Hospital Barra D'Or, Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | - Carlos Eduardo Rochitte
- Hospital do Coração (HCor), São Paulo, SP - Brasil
- Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Edson Stefanini
- Escola Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | - Felipe Gallego Lima
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - José Maria Peixoto
- Universidade José do Rosário Vellano (UNIFENAS), Belo Horizonte, MG - Brasil
| | - Juliana Ascenção de Souza
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Lilia Nigro Maia
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP - Brasil
| | | | - Luciano Moreira Baracioli
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luís Alberto de Oliveira Dallan
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luis Augusto Palma Dallan
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Luiz Carlos Bodanese
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS - Brasil
| | | | | | - Marcelo Bueno da Silva Rivas
- Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Múcio Tavares de Oliveira Júnior
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Nivaldo Menezes Filgueiras Filho
- Universidade do Estado da Bahia (UNEB), Salvador, BA - Brasil
- Universidade Salvador (UNIFACS), Salvador, BA - Brasil
- Hospital EMEC, Salvador, BA - Brasil
| | - Oscar Pereira Dutra
- Instituto de Cardiologia - Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Otávio Rizzi Coelho
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, SP - Brasil
| | | | | | - Paulo Rogério Soares
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | - Roberto Esporcatte
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Talia Falcão Dalçóquio
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - William Azem Chalela
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Wilson Mathias Júnior
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
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12
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Alkaline phosphatase-to-albumin ratio as a novel predictor of long-term adverse outcomes in coronary artery disease patients who underwent PCI. Biosci Rep 2021; 41:229001. [PMID: 34121126 PMCID: PMC8243337 DOI: 10.1042/bsr20203904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/23/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Alkaline phosphatase (ALP) and albumin (ALB) have been shown to be associated with coronary artery disease (CAD), and it has been reported that alkaline phosphatase-to-albumin ratio (AAR) is associated with the liver damage and poorer prognosis of patients with digestive system malignancy. Moreover, several previous studies showed that there was a higher incidence of malignancy in CAD patients. However, to our knowledge, the relationship between AAR and long-term adverse outcomes in CAD patients after undergoing percutaneous coronary intervention (PCI) has not been investigated. Therefore, we aim to access the relation between AAR and long-term adverse outcomes in post-PCI patients with CAD. Methods: A total of 3378 post-PCI patients with CAD were enrolled in the retrospective Clinical Outcomes and Risk Factors of Patients with Coronary Heart Disease after PCI (CORFCHD-ZZ) study from January 2013 to December 2017. The median duration of follow-up was 37.59 ± 22.24 months. The primary end point was long-term mortality including all-cause mortality (ACM) and cardiac mortality (CM). The secondary end points were major adverse cardiac events (MACEs) and major adverse cardiac and cerebrovascular events (MACCEs). Results: Kaplan–Meier analyses showed that an increased AAR was positively correlated with incidences of long-term ACM (log-rank, P=0.014), CM (log-rank, P=0.011), MACEs (log-rank, P=0.013) and MACCEs (log-rank, P=0.006). Multivariate Cox regression analyses showed that the elevated AAR was an independent predictor of long-term ACM (adjusted HR = 1.488 [1.031–2.149], P=0.034), CM (adjusted HR = 1.837 [1.141–2.959], P=0.012), MACEs (adjusted HR = 1.257 [1.018–1.551], P=0.033) and MACCEs (adjusted HR = 1.237 [1.029–1.486], P=0.024). Conclusion: An elevated AAR is a novel independent predictor of long-term adverse outcomes in CAD patients following PCI.
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13
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Ngo ATP, Jordan KR, Mueller PA, Hagen MW, Reitsma SE, Puy C, Revenko AS, Lorentz CU, Tucker EI, Cheng Q, Hinds MT, Fazio S, Monia BP, Gailani D, Gruber A, Tavori H, McCarty OJT. Pharmacological targeting of coagulation factor XI mitigates the development of experimental atherosclerosis in low-density lipoprotein receptor-deficient mice. J Thromb Haemost 2021; 19:1001-1017. [PMID: 33421301 PMCID: PMC8549080 DOI: 10.1111/jth.15236] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Human coagulation factor (F) XI deficiency, a defect of the contact activation system, protects against venous thrombosis, stroke, and heart attack, whereas FXII, plasma prekallikrein, or kininogen deficiencies are asymptomatic. FXI deficiency, inhibition of FXI production, activated FXI (FXIa) inhibitors, and antibodies to FXI that interfere with FXI/FXII interactions reduce experimental thrombosis and inflammation. FXI inhibitors are antithrombotic in patients, and FXI and FXII deficiencies are atheroprotective in apolipoprotein E-deficient mice. OBJECTIVES Investigate the effects of pharmacological targeting of FXI in experimental models of atherogenesis and established atherosclerosis. METHODS AND RESULTS Low-density lipoprotein receptor-knockout (Ldlr-/- ) mice were administered high-fat diet (HFD) for 8 weeks; concomitantly, FXI was targeted with anti-FXI antibody (14E11) or FXI antisense oligonucleotide (ASO). 14E11 and FXI-ASO reduced atherosclerotic lesion area in proximal aortas when compared with controls, and 14E11 also reduced aortic sinus lesions. In an established disease model, in which therapy was given after atherosclerosis had developed, Ldlr-/- mice were fed HFD for 8 weeks and then administered 14E11 or FXI-ASO weekly until 16 weeks on HFD. In this established disease model, 14E11 and FXI-ASO reduced atherosclerotic lesion area in proximal aortas, but not in aortic sinus. In cultures of human endothelium, FXIa exposure disrupted VE-Cadherin expression and increased endothelial lipoprotein permeability. Strikingly, we found that 14E11 prevented the disruption of VE-Cadherin expression in aortic sinus lesions observed in the atherogenesis mouse model. CONCLUSION Pharmacological targeting of FXI reduced atherogenesis in Ldlr-/- mice. Interference with the contact activation system may safely reduce development or progression of atherosclerosis.
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Affiliation(s)
- Anh T. P. Ngo
- Department of Biomedical Engineering, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Kelley R. Jordan
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Paul A. Mueller
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Matthew W. Hagen
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Stéphanie E. Reitsma
- Department of Biomedical Engineering, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Cristina Puy
- Department of Biomedical Engineering, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Christina U. Lorentz
- Department of Biomedical Engineering, School of Medicine, Oregon Health and Science University, Portland, OR, USA
- Aronora Inc, Portland, OR, USA
| | - Erik I. Tucker
- Department of Biomedical Engineering, School of Medicine, Oregon Health and Science University, Portland, OR, USA
- Aronora Inc, Portland, OR, USA
| | - Quifang Cheng
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA
| | - Monica T. Hinds
- Department of Biomedical Engineering, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Sergio Fazio
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | | | - David Gailani
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA
| | - András Gruber
- Department of Biomedical Engineering, School of Medicine, Oregon Health and Science University, Portland, OR, USA
- Aronora Inc, Portland, OR, USA
| | - Hagai Tavori
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Owen J. T. McCarty
- Department of Biomedical Engineering, School of Medicine, Oregon Health and Science University, Portland, OR, USA
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14
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McGranaghan P, Düngen HD, Saxena A, Rubens M, Salami J, Radenkovic J, Bach D, Apostolovic S, Loncar G, Zdravkovic M, Tahirovic E, Veskovic J, Störk S, Veledar E, Pieske B, Edelmann F, Trippel TD. Incremental prognostic value of a novel metabolite-based biomarker score in congestive heart failure patients. ESC Heart Fail 2020; 7:3029-3039. [PMID: 32860352 PMCID: PMC7524071 DOI: 10.1002/ehf2.12928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/07/2020] [Accepted: 07/19/2020] [Indexed: 01/29/2023] Open
Abstract
Aims The Cardiac Lipid Panel (CLP) is a newly discovered panel of metabolite‐based biomarkers that has shown to improve the diagnostic value of N terminal pro B type natriuretic peptide (NT‐proBNP). However, little is known about its usefulness in predicting outcomes. In this study, we developed a risk score for 4‐year cardiovascular death in elderly chronic heart failure (CHF) patients using the CLP. Methods and results From the Cardiac Insufficiency Bisoprolol Study in Elderly trial, we included 280 patients with CHF aged >65 years. A targeted metabolomic analysis of the CLP biomarkers was performed on baseline serum samples. Cox regression was used to determine the association of the biomarkers with the outcome after accounting for established risk factors. A risk score ranging from 0 to 4 was calculated by counting the number of biomarkers above the cut‐offs, using Youden index. During the mean (standard deviation) follow‐up period of 50 (8) months, 35 (18%) subjects met the primary endpoint of cardiovascular death. The area under the receiver operating curve for the model based on clinical variables was 0.84, the second model with NT‐proBNP was 0.86, and the final model with the CLP was 0.90. The categorical net reclassification index was 0.25 using three risk categories: 0–60% (low), 60–85% (intermediate), and >85% (high). The continuous net reclassification index was 0.772, and the integrated discrimination index was 0.104. Conclusions In patients with CHF, incorporating a panel of three metabolite‐based biomarkers into a risk score improved the prognostic utility of NT‐proBNP by predicting long‐term cardiovascular death more precisely. This novel approach holds promise to improve clinical risk assessment in CHF patients.
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Affiliation(s)
- Peter McGranaghan
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,Baptist Health South Florida, Coral Gables, FL, USA
| | - Hans-Dirk Düngen
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | | | - Muni Rubens
- Baptist Health South Florida, Coral Gables, FL, USA
| | | | - Jasmin Radenkovic
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Doris Bach
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Svetlana Apostolovic
- Clinic for Cardiovascular Diseases, Clinical Centre Niš, University of Niš, Niš, Serbia
| | - Goran Loncar
- Department of Cardiology, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Zdravkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Cardiology, University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia
| | - Elvis Tahirovic
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Jovan Veskovic
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Würzburg, Germany
| | - Emir Veledar
- Baptist Health South Florida, Coral Gables, FL, USA
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Tobias Daniel Trippel
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
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15
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Al‐Badri A, Tahhan AS, Sabbak N, Alkhoder A, Liu C, Ko Y, Vaccarino V, Martini A, Sidoti A, Goodwin C, Ghazzal B, Beshiri A, Murtagh G, Mehta PK, Quyyumi AA. Soluble Urokinase-Type Plasminogen Activator Receptor and High-Sensitivity Troponin Levels Predict Outcomes in Nonobstructive Coronary Artery Disease. J Am Heart Assoc 2020; 9:e015515. [PMID: 32301366 PMCID: PMC7428519 DOI: 10.1161/jaha.119.015515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Multiple biomarkers have been independently and additively associated with major adverse cardiovascular events in patients with coronary artery disease. We investigated the prognostic value of suPAR (soluble urokinase-type plasminogen activator receptor) and hsTnI (high-sensitivity troponin I) levels in symptomatic patients with no obstructive coronary artery disease. We hypothesized that high levels of these biomarkers will be associated with the risk of future adverse outcomes. Methods and Results Plasma levels of suPAR and hsTnI were measured in 556 symptomatic patients with no obstructive coronary artery disease. A biomarker risk score was calculated by counting the number of biomarkers above the median in this cohort (suPAR>2523 pg/mL and hsTnI>2.7 pg/mL). Survival analyses were performed with models adjusted for traditional risk factors. All-cause death and major adverse cardiovascular events (cardiovascular death, myocardial infarction, stroke, and heart failure) served as clinical outcomes over a median follow-up of 6.2 years. Mean age was 57±10 years, 49% of the cohort patients were female, and 68% had a positive stress test. High suPAR and hsTnI levels were independent predictors of all-cause death (hazard ratio=3.2 [95% CI, 1.8-5.7] and 1.3 [95% CI, 1.0-1.7], respectively; both P<0.04) and major adverse cardiovascular events (hazard ratio=2.7 [95% CI, 1.4-5.4] and 1.5 [95% CI, 1.2-2.0], respectively; both P<0.002). Compared with a biomarker risk score of 0, biomarker risk scores of 1 and 2 were associated with 19- and 14-fold increased risk of death and development of major adverse cardiovascular events, respectively. Conclusions Among symptomatic patients with no obstructive coronary artery disease, higher levels of suPAR and hsTnI were independently and additively associated with an increased risk of adverse events. Whether modification of these biomarkers will improve risk in these patients needs further investigation.
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Affiliation(s)
- Ahmed Al‐Badri
- Division of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Ayman Samman Tahhan
- Division of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Nabil Sabbak
- Division of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Ayman Alkhoder
- Division of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Chang Liu
- Departments of Biostatistics and BioinformaticsEmory University School of MedicineAtlantaGA
| | - Yi‐An Ko
- Departments of Biostatistics and BioinformaticsEmory University School of MedicineAtlantaGA
| | - Viola Vaccarino
- Department of Epidemiology and Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Afif Martini
- Division of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Arianna Sidoti
- Division of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Cydney Goodwin
- Division of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Bahjat Ghazzal
- Division of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Agim Beshiri
- Diagnostics DivisionAbbott LaboratoriesNorth ChicagoIL
| | | | - Puja K. Mehta
- Division of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Arshed A. Quyyumi
- Division of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
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16
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Eslava-Alcon S, Extremera-García MJ, González-Rovira A, Rosal-Vela A, Rojas-Torres M, Beltran-Camacho L, Sanchez-Gomar I, Jiménez-Palomares M, Alonso-Piñero JA, Conejero R, Doiz E, Olarte J, Foncubierta-Fernández A, Lozano E, García-Cozar FJ, Rodríguez-Piñero M, Alvarez-Llamas G, Duran-Ruiz MC. Molecular signatures of atherosclerotic plaques: An up-dated panel of protein related markers. J Proteomics 2020; 221:103757. [PMID: 32247173 DOI: 10.1016/j.jprot.2020.103757] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/14/2020] [Accepted: 03/23/2020] [Indexed: 12/11/2022]
Abstract
Atherosclerosis remains the leading cause of ischemic syndromes such as myocardial infarction or brain stroke, mainly promoted by plaque rupture and subsequent arterial blockade. Identification of vulnerable or high-risk plaques constitutes a major challenge, being necessary to identify patients at risk of occlusive events in order to provide them with appropriate therapies. Clinical imaging tools have allowed the identification of certain structural indicators of prone-rupture plaques, including a necrotic lipidic core, intimal and adventitial inflammation, extracellular matrix dysregulation, and smooth muscle cell depletion and micro-calcification. Additionally, alternative approaches focused on identifying molecular biomarkers of atherosclerosis have also been applied. Among them, proteomics has provided numerous protein markers currently investigated in clinical practice. In this regard, it is quite uncertain that a single molecule can describe plaque rupture, due to the complexity of the process itself. Therefore, it should be more accurate to consider a set of markers to define plaques at risk. Herein, we propose a selection of 76 proteins, from classical inflammatory to recently related markers, all of them identified in at least two proteomic studies analyzing unstable atherosclerotic plaques. Such panel could be used as a prognostic signature of plaque instability.
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Affiliation(s)
- S Eslava-Alcon
- Biomedicine, Biotechnology and Public Health Department, Cadiz University, Spain; Institute of Biomedical Research Cadiz (INIBICA), Spain
| | - M J Extremera-García
- Biomedicine, Biotechnology and Public Health Department, Cadiz University, Spain; Institute of Biomedical Research Cadiz (INIBICA), Spain
| | - A González-Rovira
- Biomedicine, Biotechnology and Public Health Department, Cadiz University, Spain; Institute of Biomedical Research Cadiz (INIBICA), Spain
| | - A Rosal-Vela
- Institute of Biomedical Research Cadiz (INIBICA), Spain
| | - M Rojas-Torres
- Biomedicine, Biotechnology and Public Health Department, Cadiz University, Spain; Institute of Biomedical Research Cadiz (INIBICA), Spain
| | - L Beltran-Camacho
- Biomedicine, Biotechnology and Public Health Department, Cadiz University, Spain; Institute of Biomedical Research Cadiz (INIBICA), Spain
| | | | - M Jiménez-Palomares
- Biomedicine, Biotechnology and Public Health Department, Cadiz University, Spain; Institute of Biomedical Research Cadiz (INIBICA), Spain
| | - J A Alonso-Piñero
- Biomedicine, Biotechnology and Public Health Department, Cadiz University, Spain; Institute of Biomedical Research Cadiz (INIBICA), Spain
| | - R Conejero
- Angiology & Vascular Surgery Unit, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - E Doiz
- Angiology & Vascular Surgery Unit, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - J Olarte
- Angiology & Vascular Surgery Unit, Virgen Macarena Hospital, Seville, Spain
| | - A Foncubierta-Fernández
- Institute of Biomedical Research Cadiz (INIBICA), Spain; UGC Joaquín Pece, Distrito Sanitario Bahía de Cádiz-La Janda, Cádiz, Spain
| | - E Lozano
- Institute of Biomedical Research Cadiz (INIBICA), Spain; Internal Medicine Unit, Hospital de Jerez, Jerez, Spain
| | - F J García-Cozar
- Biomedicine, Biotechnology and Public Health Department, Cadiz University, Spain; Institute of Biomedical Research Cadiz (INIBICA), Spain
| | - M Rodríguez-Piñero
- Angiology & Vascular Surgery Unit, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - G Alvarez-Llamas
- Immunology Department, IIS-Fundación Jimenez Diaz-UAM, Madrid, Spain; REDINREN, Madrid, Spain
| | - M C Duran-Ruiz
- Biomedicine, Biotechnology and Public Health Department, Cadiz University, Spain; Institute of Biomedical Research Cadiz (INIBICA), Spain.
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17
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Mehta A, Desai SR, Ko YA, Liu C, Dhindsa DS, Nayak A, Hooda A, Martini MA, Ejaz K, Sperling LS, Reiser J, Hayek SS, Quyyumi AA. Sex Differences in Circulating Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR) Levels and Adverse Outcomes in Coronary Artery Disease. J Am Heart Assoc 2020; 9:e015457. [PMID: 32089048 PMCID: PMC7335555 DOI: 10.1161/jaha.119.015457] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Women have higher circulating levels of soluble urokinase‐type plasminogen activator receptor (suPAR), and elevated suPAR is associated with cardiovascular risk. The independent association of sex with suPAR and the impact of sex on its association with cardiovascular risk are unknown. Methods and Results Plasma suPAR was measured using ELISA in 2 cohorts of 666 asymptomatic individuals (49 years, 65% women) and 4184 patients with coronary artery disease (63 years, 37% women). Independent association of sex with suPAR was studied using linear regression models adjusted for demographics, risk factors, and visceral adiposity in asymptomatic participants. Impact of sex on association of suPAR with all‐cause mortality was studied in patients with coronary artery disease using multivariable‐adjusted Cox models. Sex‐specific suPAR cutoffs for predicting all‐cause mortality were calculated. Asymptomatic women had 10% higher suPAR compared with men after adjusting for confounders, and visceral adiposity partly accounted for this association. Over a median follow‐up of 5.2 years, 795 deaths were recorded in patients with coronary artery disease. Log2‐transformed suPAR was independently associated with mortality (hazard ratio per 1‐SD 1.72, 95% CI 1.60–1.85) and an interaction with sex was noted (P=0.005). Association of suPAR with mortality was slightly weaker in women (hazard ratio 1.61, 95% CI 1.41–1.83) compared with men (hazard ratio 1.83, 95% CI 1.67–2.00). However, using sex‐specific suPAR cut‐offs (4392 pg/mL for women and 3187 pg/mL for men), a similar mortality incidence was observed for both sexes (38.5% and 35.5%, respectively, P=0.3). Conclusions Women have 10% higher plasma suPAR levels compared with men. Elevated sex‐specific plasma suPAR levels are equally predictive of risk of adverse events in both sexes.
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Affiliation(s)
- Anurag Mehta
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Shivang R Desai
- Department of Medicine Emory University School of Medicine Atlanta GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics Emory University Atlanta GA
| | - Chang Liu
- Department of Biostatistics and Bioinformatics Emory University Atlanta GA
| | - Devinder S Dhindsa
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Aditi Nayak
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Ananya Hooda
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Mohamed A Martini
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Kiran Ejaz
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Laurence S Sperling
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Jochen Reiser
- Department of Internal Medicine Rush University Medical Center Chicago IL
| | - Salim S Hayek
- Frankel Cardiovascular Center University of Michigan Ann Arbor MI
| | - Arshed A Quyyumi
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
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Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020; 41:407-477. [PMID: 31504439 DOI: 10.1093/eurheartj/ehz425] [Citation(s) in RCA: 3769] [Impact Index Per Article: 942.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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19
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Liu X, Zhang W, Chen N, Wang L, Wang S, Yu Y, Ao H. Can Preoperative C-Reactive Protein Predict Bleeding After On-Pump Coronary Artery Bypass Grafting? Ann Thorac Surg 2019; 109:541-546. [PMID: 31404545 DOI: 10.1016/j.athoracsur.2019.06.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 04/30/2019] [Accepted: 06/12/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Bleeding after cardiac surgery remains a challenge. Numerous studies suggest that higher level of C-reactive protein (CRP) increases cardiovascular risk. There is limited information revealing the association of preoperative CRP concentration and postoperative bleeding while undergoing on-pump coronary artery bypass grafting (CABG). This study aimed to investigate the relationship between preoperative CRP level and postoperative bleeding within 24 hours after CABG. METHODS Data on 1055 patients accepting isolated primary CABG at Fuwai Hospital, Chinese Academy of Medical Sciences from September 2017 to July 2018 were recorded. Preoperative CRP concentration, laboratory coagulation parameters, intraoperative data, and postoperative bleeding volume within 24 hours after surgery were recorded. The primary endpoint was bleeding volume within 24 hours after surgery. We analyzed the correlation between bleeding volume within 24 hours after surgery and preoperative data with univariate and multiple linear regression. RESULTS Preoperative CRP concentration (B = -0.094, P < .001), platelet count (B = -0.115, P < .01), thrombocytocrit (B = -0.127, P < .001), prothrombin time (B = 0.052, P < .01), and fibrinogen (B = -0.096, P < .01) were univariably correlated with postoperative bleeding volume. However preoperative CRP concentration (B = -0.089, P < .05) was an independent predictor of postoperative bleeding volume after multiple linear regression. Preoperative CRP concentration was also associated with body mass index (B = 0.068, P = .038), activated partial thromboplastin time (B = 0.089, P < .01), and fibrinogen (B = 0.519, P < .01) after multiple linear regression. CONCLUSIONS Our findings suggested that preoperative CRP concentration independently correlated with postoperative bleeding volume within 24 hours and that it could be a new potential coagulation biomarker for patients undergoing CABG surgery.
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Affiliation(s)
- Xiaojie Liu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenyuan Zhang
- Department of Anesthesiology, the First Affiliated Hospital, Nanchang University, Nanchang, China
| | | | - Lijuan Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sudena Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Yu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hushan Ao
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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20
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Kumar B, Shah MAA, Kumar R, Kumar J, Memon A. Comparison of Atorvastatin and Rosuvastatin in Reduction of Inflammatory Biomarkers in Patients with Acute Coronary Syndrome. Cureus 2019; 11:e4898. [PMID: 31423377 PMCID: PMC6689481 DOI: 10.7759/cureus.4898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction High-sensitivity C-reactive protein (hs-CRP) has emerged to be a very useful and reliable clinical marker of primary as well as secondary cardiovascular morbidity and mortality. Elevated hs-CRP contributes to underlying atherogenesis and worsens disease prognosis. Along with their lipid-lowering properties, statins also contribute to the alleviation of micro-inflammation and reduces pro-inflammatory markers. The aim of this study is to compare the effects of rosuvastatin and atorvastatin in lowering hs-CRP levels in statin-naive patients admitted with acute coronary syndrome (ACS). Methods In this prospective, open-label randomized trial, group A was given rosuvastatin 40 mg daily and group B was given atorvastatin 20 mg daily along with standard post-ACS therapy. Lipid profile (mg/dL), hs-CRP (mg/L) and erythrocyte sedimentation rate (ESR) (mm/Hr) were recorded and measured as the baseline (before starting therapy) and then again after four weeks. The data were analyzed using SPSS for Windows version 22.0 (IBM Corp., Armonk, NY). Results With four weeks of treatment, both group A and B showed statistically significant reduction in serum hs-CRP levels (p<0.0001). In group A, there was a mean 51% decrease in hs-CRP levels, and in group B, a 35% reduction was seen. Group A showed markedly low hs-CRP levels than group B after four weeks of therapy (18.46 ± 6.35 vs. 24.67 ± 8.45) (p<0.0001). Group A showed mean 16% decrease in ESR levels as compared to 14% decrease in group B. Group A showed lower ESR levels than group B after four weeks of therapy (19.59 ± 11.83 vs. 20.52 ± 12.13) (p<0.0001). Conclusion Rosuvastatin showed a 50% decrease and atorvastatin showed a 35% reduction in serum hs-CRP levels in statin-naive ACS patients. Rosuvastatin has a more effective role in reducing micro-inflammation in ACS patients.
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Affiliation(s)
- Besham Kumar
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
| | | | - Rajesh Kumar
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Jai Kumar
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Aurangzeb Memon
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
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21
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Topel ML, Sandesara PB, Stahl EP, Hayek SS, Tahhan AS, O'Neal WT, Ko YA, Alkhoder A, Gafeer MM, Kim JH, Wilson PWF, Shaw LJ, Epstein SE, Vaccarino V, Sperling LS, Quyyumi AA. Mechanisms underlying the J-curve for diastolic blood pressure: Subclinical myocardial injury and immune activation. Int J Cardiol 2019; 276:255-260. [PMID: 30217423 PMCID: PMC6324952 DOI: 10.1016/j.ijcard.2018.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/28/2018] [Accepted: 09/07/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Low diastolic blood pressure (DBP) is associated with increased risk of cardiovascular events. In patients with coronary artery disease (CAD), limitations in coronary blood flow and immune activity are implicated mechanisms, but evidence is lacking. We investigated the association between DBP, biomarkers of myocardial injury, inflammation, immune activation and incident events in patients with CAD. METHODS We studied 2448 adults (mean age 65 ± 12 years, 68% male, median follow-up 4.5 years) with CAD. DBP was categorized into 10 mm Hg increments. Biomarkers of myocardial injury (high sensitivity cardiac troponin-I [hs-cTnI]) and immune activity/inflammation (soluble urokinase plasminogen activator receptor [suPAR]) were dichotomized at their median values. DBP 70-79 mm Hg was used as the referent group, and individuals were followed prospectively for adverse outcomes. RESULTS After adjusting for demographic and clinical covariates, individuals with DBP < 60 mm Hg had increased odds of elevated levels of hs-cTnI (OR = 1.68; 95% CI = 1.07, 2.65) and suPAR (OR = 1.71; 95% CI = 1.10, 2.65) compared to the referent group. Additionally, DBP < 60 mm Hg was associated with increased adjusted risk of cardiovascular death or MI (HR = 2.04; 95% CI = 1.32, 3.16) and all-cause mortality (HR = 2.41; 95% CI = 1.69, 3.45). CONCLUSION In patients with CAD, DBP < 60 mm Hg is associated with subclinical myocardial injury, immune/inflammatory dysregulation and incident events. Aggressive BP control may be harmful in these patients, and further investigation is warranted to determine appropriate BP targets in patients with CAD.
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Affiliation(s)
- Matthew L Topel
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America.
| | - Pratik B Sandesara
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Eric P Stahl
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Salim S Hayek
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Ayman Samman Tahhan
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Wesley T O'Neal
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, United States of America
| | - Ayman Alkhoder
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Mohamad Mazen Gafeer
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Jonathan H Kim
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Peter W F Wilson
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Leslee J Shaw
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Stephen E Epstein
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Viola Vaccarino
- Rollins School of Public Health, Department of Epidemiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
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Mrgan M, Gram J, Hecht Olsen M, Dey D, Linde Nørgaard B, Gram J, Rønnow Sand NP. Sex differences in coronary plaque composition evaluated by coronary computed tomography angiography in newly diagnosed Type 2 diabetes: association with low-grade inflammation. Diabet Med 2018; 35:1588-1595. [PMID: 29931809 DOI: 10.1111/dme.13768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 12/23/2022]
Abstract
AIM To determine differences in coronary plaque composition and inflammatory biomarkers between men and women with newly diagnosed Type 2 diabetes without known cardiovascular disease. METHODS A total of 88 people with newly diagnosed (<1 year) Type 2 diabetes underwent contrast-enhanced coronary computed tomography angiography. Advanced coronary plaque analysis was performed using semi-automated software. Plasma concentrations of inflammatory biomarkers were determined. RESULTS There were no significant differences between men (n=60) and women (n=28) regarding age or cardiovascular risk factors (all P>0.05). The median (quartiles) serum levels of fibrinogen [10.9 (9.8-12.6) μmol/l vs 9.7 (8.8-10.9) μmol/l], fibrin d-dimer [0.3 (0.2-0.4) mg/l vs 0.27 (0.2-0.4) mg/l] and C-reactive protein [3.1 (1.1-5.2) mg/l vs (0.8-2.6) 1.6 mg/l] were significantly higher in women (all P<0.05). Overall, men more often had multi-vessel involvement [28 men (47%) vs 4 women (14%)], and higher total plaque burden [median (quartiles) 11.6 (2.3-36.0)% vs 2.0 (0.4-5.4)%; both P<0.05]. The median (quartiles) total plaque volume [269.9 (62.6-641.9) mm3 vs 61.1 (7.6-239.9) mm3 ] and absolute calcified plaque volume [33.5 (8.3-148.3) mm3 vs 4.7 (0.9-17.3) mm3 ] were higher in men (both P<0.05). Women had a lower relative proportion of the calcified plaque component [median (quartiles) 7.8 (4.7-15.4)% vs 23.7 (8.4-31.1)%] and a higher relative proportion (median [quartiles]) of the non-low-density non-calfied plaque component [77.6 (66.0-86.0)% vs 63.6 (54.0-72.9)%; both P<0.05]. CONCLUSIONS In people with newly diagnosed Type 2 diabetes, women had lower absolute coronary plaque volumes but a more unfavourable plaque composition and enhanced systemic inflammation compared with men.
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Affiliation(s)
- M Mrgan
- Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - J Gram
- Unit for Thrombosis Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - M Hecht Olsen
- Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - D Dey
- Department of Biomedical Sciences (Biomedical Imaging Research Institute), Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - B Linde Nørgaard
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - J Gram
- Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - N P Rønnow Sand
- Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark
- Institute of Regional Health Research, University of Southern, Denmark, Odense
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Cardiovascular Disease Progression: A Target for Therapy? Am J Med 2018; 131:1170-1173. [PMID: 29679538 DOI: 10.1016/j.amjmed.2018.03.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 01/10/2023]
Abstract
Clinical research aimed at preventing cardiovascular disease has focused on the effect of interventions to reduce risk factors on the incidence of future morbid events. Disease progression, which likely serves as a necessary prerequisite for morbid events, has not served as a target for therapy. The Rasmussen Center at the University of Minnesota has, for the past 18 years, been performing a noninvasive cardiovascular evaluation in individuals with no history of cardiovascular disease. The studies, performed in 1 hour in one room, provide a comprehensive noninvasive assessment of the severity of functional and structural abnormalities in the small arteries, the large arteries and the left ventricle, the target organs for most cardiovascular morbid events. Preliminary follow-up data have revealed a striking relationship between the Disease Score, which represents the sum of the abnormal tests, and the risk of future morbid events. In order to develop strategies to prolong cardiovascular disease-free life expectancy, studies in early stages of disease aimed at slowing disease progression should be encouraged.
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Klisić A, Kavarić N, Bjelaković B, Jovanović M, Zvrko E, Stanišić V, Ninić A, Šćepanović A. Cardiovascular Risk Assessed by Reynolds Risk Score in Relation to Waist Circumference in Apparently Healthy Middle-Aged Population in Montenegro. Acta Clin Croat 2018; 57:22-30. [PMID: 30256008 PMCID: PMC6400353 DOI: 10.20471/acc.2018.57.01.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
SUMMARY – Reynolds Risk Score (RRS) is regarded as a good screening tool for cardiovascular disease (CVD) risk. Since CVD is the leading cause of death in Montenegro, we aimed to assess the risk of CVD as assessed by RRS and to examine its association with cardiometabolic parameters in apparently healthy middle-aged population. In addition, we aimed to test whether obesity had an independent influence on RRS. A total of 132 participants (mean age 56.2±6.73 years, 69% females) were included. Body mass index (BMI), waist circumference (WC), blood pressure (BP) and biochemical parameters (fasting glucose, insulin, lipid parameters, creatinine and high sensitivity C-reactive protein) were determined. Insulin resistance (HOMA-IR) and glomerular filtration rate (eGFR) were calculated. Compared with females, a significantly higher number of males were in the high RRS subgroup (χ2=45.9, p<0.001). Furthermore, significantly higher fasting glucose (p=0.030), insulin, HOMA-IR, triglycerides (p<0.001 all), anthropometric parameters (e.g., BMI and WC; p=0.004 and p<0.001, respectively), and creatinine, but lower eGFR and HDL-c (p<0.001 both) were recorded in the high-risk subgroup compared with low and medium risk subgroups. In all participants, in addition to LDL-c, diastolic BP and creatinine, WC was independently positively associated with RRS (β=0.194, p=0.006; β=0.286, p=0.001; β=0.267, p=0.001; and β=0.305, p=0.019, respectively), and 40% of variation in RRS could be explained with this model. In conclusion, middle-aged population with higher WC should be screened for RRS in order to estimate CVD risk.
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Affiliation(s)
| | | | - Bojko Bjelaković
- University Department of Pediatrics, Faculty of Medicine, University of Niš, Niš, Serbia
| | | | - Elvir Zvrko
- Clinical Center of Montenegro, Podgorica, Montenegro
| | | | - Ana Ninić
- Department of Medical Biochemistry, University of Belgrade, Faculty of Pharmacy, Belgrade, Serbia
| | - Anđelka Šćepanović
- Department of Biology, Faculty of Natural Science and Mathematics, University of Montenegro, Podgorica, Montenegro
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Samman Tahhan A, Sandesara P, Hayek SS, Hammadah M, Alkhoder A, Kelli HM, Topel M, O'Neal WT, Ghasemzadeh N, Ko YA, Gafeer MM, Abdelhadi N, Choudhary F, Patel K, Beshiri A, Murtagh G, Kim J, Wilson P, Shaw L, Vaccarino V, Epstein SE, Sperling L, Quyyumi AA. High-Sensitivity Troponin I Levels and Coronary Artery Disease Severity, Progression, and Long-Term Outcomes. J Am Heart Assoc 2018; 7:JAHA.117.007914. [PMID: 29467150 PMCID: PMC5866331 DOI: 10.1161/jaha.117.007914] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background The associations between high‐sensitivity troponin I (hsTnI) levels and coronary artery disease (CAD) severity and progression remain unclear. We investigated whether there is an association between hsTnI and angiographic severity and progression of CAD and whether the predictive value of hsTnI level for incident cardiovascular outcomes is independent of CAD severity. Methods and Results In 3087 patients (aged 63±12 years, 64% men) undergoing cardiac catheterization without evidence of acute myocardial infarction, the severity of CAD was calculated by the number of major coronary arteries with ≥50% stenosis and the Gensini score. CAD progression was assessed in a subset of 717 patients who had undergone ≥2 coronary angiograms >3 months before enrollment. Patients were followed up for incident all‐cause mortality and incident cardiovascular events. Of the total population, 11% had normal angiograms, 23% had nonobstructive CAD, 20% had 1‐vessel CAD, 20% had 2‐vessel CAD, and 26% had 3‐vessel CAD. After adjusting for age, sex, race, body mass index, smoking, hypertension, diabetes mellitus history, and renal function, hsTnI levels were independently associated with the severity of CAD measured by the Gensini score (log 2 ß=0.31; 95% confidence interval, 0.18–0.44; P<0.001) and with CAD progression (log 2 ß=0.36; 95% confidence interval, 0.14–0.58; P=0.001). hsTnI level was also a significant predictor of incident death, cardiovascular death, myocardial infarction, revascularization, and cardiac hospitalizations, independent of the aforementioned covariates and CAD severity. Conclusions Higher hsTnI levels are associated with the underlying burden of coronary atherosclerosis, more rapid progression of CAD, and higher risk of all‐cause mortality and incident cardiovascular events. Whether more aggressive treatment aimed at reducing hsTnI levels can modulate disease progression requires further investigation.
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Affiliation(s)
- Ayman Samman Tahhan
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Pratik Sandesara
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Salim S Hayek
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Muhammad Hammadah
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Ayman Alkhoder
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Heval M Kelli
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Matthew Topel
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Wesley T O'Neal
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Nima Ghasemzadeh
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Mohamad Mazen Gafeer
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Naser Abdelhadi
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Fahad Choudhary
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Keyur Patel
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Agim Beshiri
- Diagnostics Division, Abbott Laboratories, North Chicago, IL
| | - Gillian Murtagh
- Diagnostics Division, Abbott Laboratories, North Chicago, IL
| | - Jonathan Kim
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Peter Wilson
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Leslee Shaw
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA.,Department of Epidemiology and Rollins School of Public Health, Emory University, Atlanta, GA
| | - Stephen E Epstein
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - Laurence Sperling
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Arshed A Quyyumi
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
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Abstract
Coronary artery disease (CAD) remains a significant cause of morbidity and mortality around the world. Patients with stable CAD can have an unpredictable clinical trajectory; thus, additional tools to prognosticate risk in this cohort are warranted. In recent years, a wide range of biomarkers has been recognized for their diagnostic capabilities in patients with stable CAD, identifying those with obstructive disease who may require more intensive preventive therapies or even consideration of percutaneous coronary intervention in some circumstances. In addition, a multiple-biomarker approach may identify stable CAD patients at highest risk for future major adverse cardiac events. Thus, randomized controlled trials to assess biomarker-guided preventive therapy in this cohort appear warranted.
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27
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Hammadah M, Sullivan S, Pearce B, Mheid IA, Wilmot K, Ramadan R, Tahhan AS, O’Neal WT, Obideen M, Alkhoder A, Abdelhadi N, Kelli HM, Ghafeer MM, Pimple P, Sandesara P, Shah AJ, Hosny KM, Ward L, Ko YA, Sun YV, Weng L, Kutner M, Bremner JD, Sheps DS, Esteves F, Raggi P, Vaccarino V, Quyyumi AA. Inflammatory response to mental stress and mental stress induced myocardial ischemia. Brain Behav Immun 2018; 68:90-97. [PMID: 28986223 PMCID: PMC5808921 DOI: 10.1016/j.bbi.2017.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/17/2017] [Accepted: 10/02/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Mental stress-induced myocardial ischemia (MSIMI) is associated with increased risk of adverse cardiovascular outcomes, yet the underlying mechanisms are not well understood. We measured the inflammatory response to acute laboratory mental stress in patients with coronary artery disease (CAD) and its association with MSIMI. We hypothesized that patients with MSIMI would have a higher inflammatory response to mental stress in comparison to those without ischemia. METHODS Patients with stable CAD underwent 99mTc sestamibi myocardial perfusion imaging during mental stress testing using a public speaking stressor. MSIMI was determined as impaired myocardial perfusion using a 17-segment model. Inflammatory markers including interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), matrix metallopeptidase 9 (MMP-9) and high-sensitivity C reactive protein (hsCRP) were measured at rest and 90 min after mental stress. Results were validated in an independent sample of 228 post-myocardial infarction patients. RESULTS Of 607 patients analyzed in this study, (mean age 63 ± 9 years, 76% male), 99 (16.3%) developed MSIMI. Mental stress resulted in a significant increase in IL-6, MCP-1, and MMP-9 (all p <0.0001), but not hsCRP. However, the changes in these markers were similar in those with and without MSIMI. Neither resting levels of these biomarkers, nor their changes with mental stress were significantly associated with MSIMI. Results in the replication sample were similar. CONCLUSION Mental stress is associated with acute increases in several inflammatory markers. However, neither the baseline inflammatory status nor the magnitude of the inflammatory response to mental stress over 90 min were significantly associated with MSIMI.
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Affiliation(s)
- Muhammad Hammadah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Samaah Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Brad Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Ibhar Al Mheid
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Kobina Wilmot
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ronnie Ramadan
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ayman Samman Tahhan
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Wesley T. O’Neal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Malik Obideen
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ayman Alkhoder
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Naser Abdelhadi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Heval Mohamed Kelli
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Mohamad Mazen Ghafeer
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Pratik Pimple
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Pratik Sandesara
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Amit J. Shah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States,Atlanta VA Medical Center, Decatur, GA, United States
| | - Kareem Mohammed Hosny
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Laura Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Yi-An Ko
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Yan V. Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Lei Weng
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Michael Kutner
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - J. Douglas Bremner
- Atlanta VA Medical Center, Decatur, GA, United States,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - David S. Sheps
- University of Florida Health Science Center, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States
| | - Fabio Esteves
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Paolo Raggi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States,Department of Radiology, Emory University School of Medicine, Atlanta, GA, United States,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - Arshed A. Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States,Corresponding authors at: Emory University, Department of Cardiology, Emory University School of medicine, 1462 Clifton Road N.E. Suite 507, Atlanta GA 30322. (V. Vaccarino), (A.A. Quyyumi)
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28
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Abstract
PURPOSE The Emory Cardiovascular Biobank (EmCAB) is an ongoing prospective registry of patients undergoing cardiac catheterisation, which was established to identify novel factors associated with the pathobiological process and treatment of cardiovascular disease. PARTICIPANTS Individuals aged 18 years and older undergoing cardiac catheterisation at three Emory Healthcare sites in Atlanta are asked to participate in this prospective registry. Around 95% agree to participate. Around 7000 unique patients have been enrolled. The current data set contains detailed phenotyping, patient outcomes, genomics, protein biomarkers, regenerative markers, transcriptomic analysis, metabolomics profiling and longitudinal follow-up for adverse cardiovascular outcomes. FINDINGS TO DATE Thus far, the EmCAB has approximately 3000 major cardiovascular events. About 48% of the EmCAB participants have more than 5 years of follow-up. It is a great resource for discovery of novel predictive factors for cardiovascular disease outcomes, including genomics, transcriptomics, protein biomarkers, oxidative stress markers and circulating progenitor cells. Several circulating inflammatory markers have shown to improve risk prediction metrics beyond standard risk factors. FUTURE PLANS Future integrative -omics analyses will provide the cardiovascular research community opportunities for subsequent mechanistic confirmation studies, which will promote the development of effective personalised therapy that leads to clinical care tailored to the individual patient.
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Affiliation(s)
- Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Salim Hayek
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Pratik Sandesara
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ayman Samman Tahhan
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Arshed Quyyumi
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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29
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Dhindsa DS, Khambhati J, Sandesara PB, Eapen DJ, Quyyumi AA. Biomarkers to Predict Cardiovascular Death. Card Electrophysiol Clin 2017; 9:651-664. [PMID: 29173408 DOI: 10.1016/j.ccep.2017.07.014] [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] [Indexed: 01/19/2023]
Abstract
This article reviews biomarkers that have been shown to identify subjects at increased risk for cardiovascular death within the general population, in those with established coronary artery disease, and in those with heart failure. Use of biomarkers for risk stratification for sudden cardiac death continues to evolve. It seems that a multimarker strategy for risk stratification using simple measures of circulating proteins and usual clinical risk factors, particularly in patients with known coronary artery disease, can be used to identify patients at near-term risk of death. Whether similar strategies in the general population will prove to be cost-effective needs to be investigated.
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Affiliation(s)
- Devinder S Dhindsa
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322, USA
| | - Jay Khambhati
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322, USA
| | - Pratik B Sandesara
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322, USA
| | - Danny J Eapen
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322, USA
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322, USA.
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30
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Schultz WM, Hayek SS, Samman Tahhan A, Ko YA, Sandesara P, Awad M, Mohammed KH, Patel K, Yuan M, Zheng S, Topel ML, Hartsfield J, Bhimani R, Varghese T, Kim JH, Shaw L, Wilson P, Vaccarino V, Quyyumi AA. Marital Status and Outcomes in Patients With Cardiovascular Disease. J Am Heart Assoc 2017; 6:e005890. [PMID: 29263033 PMCID: PMC5778993 DOI: 10.1161/jaha.117.005890] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 11/21/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Being unmarried is associated with decreased survival in the general population. Whether married, divorced, separated, widowed, or never-married status affects outcomes in patients with cardiovascular disease has not been well characterized. METHODS AND RESULTS A prospective cohort (inception period 2003-2015) of 6051 patients (mean age 63 years, 64% male, 23% black) undergoing cardiac catheterization for suspected or confirmed coronary artery disease was followed for a median of 3.7 years (interquartile range: 1.7-6.7 years). Marital status was stratified as married (n=4088) versus unmarried (n=1963), which included those who were never married (n=451), divorced or separated (n=842), or widowed (n=670). The relationship between marital status and primary outcome of cardiovascular death and myocardial infarction was examined using Cox regression models adjusted for clinical characteristics. There were 1085 (18%) deaths from all causes, 688 (11%) cardiovascular-related deaths, and 272 (4.5%) incident myocardial infarction events. Compared with married participants, being unmarried was associated with higher risk of all-cause mortality (hazard ratio [HR]: 1.24; 95% confidence interval [CI], 1.06-1.47), cardiovascular death (HR: 1.45; 95% CI, 1.18-1.78), and cardiovascular death or myocardial infarction (HR: 1.52; 95% CI, 1.27-1.83). Compared with married participants, the increase in cardiovascular death or myocardial infarction was similar for the participants who were divorced or separated (HR: 1.41; 95% CI, 1.10-1.81), widowed (HR: 1.71; 95% CI, 1.32-2.20), or never married (HR: 1.40; 95% CI, 0.97-2.03). The findings persisted after adjustment for medications and other socioeconomic factors. CONCLUSIONS Marital status is independently associated with cardiovascular outcomes in patients with or at high risk of cardiovascular disease, with higher mortality in the unmarried population. The mechanisms responsible for this increased risk require further study.
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Affiliation(s)
- William M Schultz
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Salim S Hayek
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Ayman Samman Tahhan
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Yi-An Ko
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health Emory University, Atlanta, GA
| | - Pratik Sandesara
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Mosaab Awad
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Kareem H Mohammed
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Keyur Patel
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Michael Yuan
- Department of Epidemiology, Rollins School of Public Health Emory University, Atlanta, GA
| | - Shuai Zheng
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
| | - Matthew L Topel
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Joy Hartsfield
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Ravila Bhimani
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Tina Varghese
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jonathan H Kim
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Leslee Shaw
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Peter Wilson
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Rollins School of Public Health Emory University, Atlanta, GA
- American Institutes for Research, Washington, DC
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
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31
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Ghasemzedah N, Hayek SS, Ko YA, Eapen DJ, Patel RS, Manocha P, Al Kassem H, Khayata M, Veledar E, Kremastinos D, Thorball CW, Pielak T, Sikora S, Zafari AM, Lerakis S, Sperling L, Vaccarino V, Epstein SE, Quyyumi AA. Pathway-Specific Aggregate Biomarker Risk Score Is Associated With Burden of Coronary Artery Disease and Predicts Near-Term Risk of Myocardial Infarction and Death. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.115.001493. [PMID: 28280039 DOI: 10.1161/circoutcomes.115.001493] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 01/11/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Inflammation, coagulation, and cell stress contribute to atherosclerosis and its adverse events. A biomarker risk score (BRS) based on the circulating levels of biomarkers C-reactive protein, fibrin degradation products, and heat shock protein-70 representing these 3 pathways was a strong predictor of future outcomes. We investigated whether soluble urokinase plasminogen activator receptor (suPAR), a marker of immune activation, is predictive of outcomes independent of the aforementioned markers and whether its addition to a 3-BRS improves risk reclassification. METHODS AND RESULTS C-reactive protein, fibrin degradation product, heat shock protein-70, and suPAR were measured in 3278 patients undergoing coronary angiography. The BRS was calculated by counting the number of biomarkers above a cutoff determined using the Youden's index. Survival analyses were performed using models adjusted for traditional risk factors. A high suPAR level ≥3.5 ng/mL was associated with all-cause death and myocardial infarction (hazard ratio, 1.83; 95% confidence interval, 1.43-2.35) after adjustment for risk factors, C-reactive protein, fibrin degradation product, and heat shock protein-70. Addition of suPAR to the 3-BRS significantly improved the C statistic, integrated discrimination improvement, and net reclassification index for the primary outcome. A BRS of 1, 2, 3, or 4 was associated with a 1.81-, 2.59-, 6.17-, and 8.80-fold increase, respectively, in the risk of death and myocardial infarction. The 4-BRS was also associated with severity of coronary artery disease and composite end points. CONCLUSIONS SuPAR is independently predictive of adverse outcomes, and its addition to a 3-BRS comprising C-reactive protein, fibrin degradation product, and heat shock protein-70 improved risk reclassification. The clinical utility of using a 4-BRS for risk prediction and management of patients with coronary artery disease warrants further study.
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Affiliation(s)
- Nima Ghasemzedah
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Salim S Hayek
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Yi-An Ko
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Danny J Eapen
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Riyaz S Patel
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Pankaj Manocha
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Hatem Al Kassem
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Mohamed Khayata
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Emir Veledar
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Dimitrios Kremastinos
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Christian W Thorball
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Tomasz Pielak
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Sergey Sikora
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - A Maziar Zafari
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Stamatios Lerakis
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Laurence Sperling
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Viola Vaccarino
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Stephen E Epstein
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.)
| | - Arshed A Quyyumi
- From the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.G., S.S.H., D.J.E., R.S.P., P.M., H.A.K., M.K., E.V., A.M.Z., S.L., L.S., V.V., A.A.Q.); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA (Y.-A.K.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Division of Cardiology, Atlanta VA Medical Center, GA (A.M.Z.); Department of Biostatistics, Florida International University, Miami (E.V.); Department of Cardiology, University of Athens School of Medicine, Greece (D.K.); Clinical Research Centre, Copenhagen University Hospital, Denmark (C.W.T., T.P.); Stemedica Cell Technologies, Inc., San Diego, CA (S.S.); Department of Epidemiology, Emory University, Atlanta, GA (V.V.); and MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.E.E.).
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Bornheimer R, Shea KM, Sato R, Weycker D, Pelton SI. Risk of exacerbation following pneumonia in adults with heart failure or chronic obstructive pulmonary disease. PLoS One 2017; 12:e0184877. [PMID: 29028810 PMCID: PMC5640217 DOI: 10.1371/journal.pone.0184877] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/03/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Recent evidence demonstrates increased short-term risk of cardiac complications and respiratory failure among patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD), respectively, concurrent with an episode of community-acquired pneumonia (CAP). We evaluated patients with pre-existing HF or COPD, beginning 30 days after CAP diagnosis, to determine if CAP had a prolonged impact on their underlying comorbidity. METHODS A retrospective matched-cohort design using US healthcare claims was employed. In each month of accrual, patients with HF or COPD who developed CAP ("CAP patients") were matched (1:1, without replacement, on demographic and clinical profiles) to patients with HF or COPD who did not develop CAP ("comparison patients"). All patients were aged ≥40 years, and were pneumonia free during prior 1-year period. Exacerbation beginning 30 days after the CAP diagnosis and for the subsequent 1-year period were compared between CAP and comparison patients. FINDINGS 38,010 (4·6%) HF patients and 48,703 (5·9%) COPD patients experienced a new CAP episode requiring hospitalization or outpatient care only, and were matched to comparison patients. In the HF subset, CAP patients were 47·2% more likely to experience an exacerbation vs patients without CAP (17·8% vs. 12·1%; p<0·001); in the COPD subset, CAP patients were 42·3% more likely to experience an exacerbation (16·2% vs. 11·4%; p<0·001). CONCLUSIONS Our data provide evidence that CAP foreshadows a prolonged increase in risk of exacerbation of underlying HF or COPD in adults, and suggests a potential benefit to CAP prevention strategies.
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Affiliation(s)
| | - Kimberly M. Shea
- Boston University Schools of Medicine and Public Health, Boston, MA, United States of America
| | - Reiko Sato
- Pfizer Inc., Collegeville, PA, United States of America
| | - Derek Weycker
- Policy Analysis Inc. (PAI), Brookline, MA, United States of America
| | - Stephen I. Pelton
- Boston University Schools of Medicine and Public Health, Boston, MA, United States of America
- Boston Medical Center, Boston, MA, United States of America
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Samman Tahhan A, Sandesara PB, Hayek SS, Alkhoder A, Chivukula K, Hammadah M, Mohamed-Kelli H, O'Neal WT, Topel M, Ghasemzadeh N, Ko YA, Aida H, Gafeer M, Sperling L, Vaccarino V, Liang Y, Jones DP, Quyyumi AA. Association between oxidative stress and atrial fibrillation. Heart Rhythm 2017; 14:1849-1855. [PMID: 28757307 DOI: 10.1016/j.hrthm.2017.07.028] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Oxidative stress (OS) may be a key mechanism underlying the development of atrial fibrillation (AF) in experimental studies, but data in humans remain limited. OBJECTIVE Systemic OS can be estimated by measurements of circulating levels of the aminothiols including glutathione, cysteine, and their oxidized products. We tested the hypothesis that the redox potentials of glutathione (EhGSH) and cysteine will be associated with prevalent and incident AF. METHODS Plasma levels of aminothiols were measured in 1439 patients undergoing coronary angiography, of whom 148 (10.3%) had a diagnosis of AF. After a median follow-up of 6.3 years, 104 of 917 patients (11.5%) developed incident AF. Multivariate logistic regression and Cox regression models were used to determine whether OS markers were independent predictors of prevalent and incident AF after adjustment for traditional risk factors, heart failure, coronary artery disease, and high-sensitivity C-reactive protein level. RESULTS For each 10% increase in EhGSH, the odds of prevalent AF was 30% higher (odds ratio [OR] 1.3; 95% confidence interval [CI] 1.1-1.7; P = .02) and 90% higher (OR 1.9; 95% CI 1.3-2.7; P = .004) when the median was used as a cutoff. The EhGSH level above the median was more predictive of chronic AF (OR 4.0; 95% CI 1.3-12.9; P = .01) than of paroxysmal AF (OR 1.7; 95% CI 1.1-2.7; P = .03). Each 10% increase in EhGSH level was associated with a 40% increase in the risk of incident AF (hazard ratio 1.4; 95% CI 1.1-1.7; P = .01). CONCLUSION Increased OS measured by the redox potentials of glutathione is associated with prevalent and incident AF. Therapies that modulate OS need to be investigated to treat and prevent AF.
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Affiliation(s)
- Ayman Samman Tahhan
- Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Pratik B Sandesara
- Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Salim S Hayek
- Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Ayman Alkhoder
- Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Kaavya Chivukula
- Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Muhammad Hammadah
- Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Heval Mohamed-Kelli
- Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Wesley T O'Neal
- Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Matthew Topel
- Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Nima Ghasemzadeh
- Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Yi-An Ko
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Hiroshi Aida
- Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Mazen Gafeer
- Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Laurence Sperling
- Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Viola Vaccarino
- Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yongliang Liang
- Division of Pulmonary, Allergy and Critical Care Medicine, Clinical Biomarkers Laboratory, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Dean P Jones
- Division of Pulmonary, Allergy and Critical Care Medicine, Clinical Biomarkers Laboratory, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia.
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Infante T, Forte E, Schiano C, Cavaliere C, Tedeschi C, Soricelli A, Salvatore M, Napoli C. An integrated approach to coronary heart disease diagnosis and clinical management. Am J Transl Res 2017; 9:3148-3166. [PMID: 28804537 PMCID: PMC5553869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/16/2017] [Indexed: 06/07/2023]
Abstract
The major issue in coronary heart disease (CHD) diagnosis and management is that symptoms onset in an advanced state of disease. Despite the availability of several clinical risk scores, the prediction of cardiovascular events is lacking, and many patients at risk are not well stratified according to the canonical risk factors alone. Therefore, adequate risk assessment remains the most challenging issue. Recently, the integration of imaging data with biochemical markers in a radiogenomic framework has been proposed in many fields of medicine as well as in cardiology. Multimodal imaging and advanced processing techniques can provide both direct (e.g., remodeling index, calcium score, total plaque volume, plaque burden) and indirect (e.g., myocardial perfusion index, coronary flow reserve) imaging features of CHD. Furthermore, the identification of novel non-invasive biochemical markers, mainly focused on plasma and/or serum samples, has increased the specificity of findings, reflecting several pathophysiological pathways of atherosclerosis, the principal actor in CHD. In this context, a multifaced approach, derived from the strengths of all these modalities, appears promising for finer risk stratification and treatment strategies, facilitating the decision-making and clinical management of patients. This review underlines the role of different imaging modalities in the quantification of coronary atherosclerosis and describes novel blood-based markers that could improve diagnosis and have a better predictive value in CHD.
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Affiliation(s)
| | | | | | | | - Carlo Tedeschi
- Department of Cardiology, San Giovanni Bosco HospitalASL Napoli 1, Naples, Italy
| | - Andrea Soricelli
- IRCCS SDNNaples, Italy
- Department of Motor Sciences and Healthiness, University of Naples ParthenopeNaples, Italy
| | | | - Claudio Napoli
- IRCCS SDNNaples, Italy
- U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology, Regional Reference Laboratory of Transplant Immunology, Department of Internal and Specialty Medicine Azienda Universitaria Policlinico (AOU), Università degli Studi della Campania “Luigi Vanvitelli”Naples, Italy
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Ghasemzadeh N, Brooks MM, Vlachos H, Hardison R, Sikora S, Sperling L, Quyyumi AA, Epstein SE. An Aggregate Biomarker Risk Score Predicts High Risk of Near-Term Myocardial Infarction and Death: Findings From BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes). J Am Heart Assoc 2017; 6:JAHA.116.003587. [PMID: 28673897 PMCID: PMC5586254 DOI: 10.1161/jaha.116.003587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background In a previous study, we found that a biomarker risk score (BRS) comprised of C‐reactive protein, fibrin‐degradation products, and heat shock protein‐70 predicts risk of myocardial infarction and death in coronary artery disease patients. We sought to: (1) validate the BRS in the independent BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) cohort, (2) investigate whether 1 year of intensive medical therapy is associated with improved BRS, and (3) elucidate whether an altered BRS parallels altered risk. Methods and Results Two thousand thirty‐two subjects with coronary artery disease were followed for 5.3±1.1 years for cardiovascular events. Biomarkers were measured at baseline and retested in 1304 subjects at 1 year. BRS was determined as the biomarker number above previously defined cut‐off values (C‐reactive protein >3 mg/L, heat shock protein‐70 >0.313 ng/mL, and fibrin‐degradation products >1 μg/mL). After adjustment for covariates, those with a BRS of 3 had a 4‐fold increased risk of all‐cause death and a 6.8‐fold increased risk of cardiac death compared with those with a BRS of 0 (95% CI, 2.9–16.0; P<0.0001). All individual biomarkers decreased by 1 year, with ≈80% of patients decreasing their BRS. BRS recalibrated at 1 year also predicted risk. Those with 1‐year BRS of 2 to 3 had a 4‐year mortality rate of 21.1% versus 7.4% for those with BRS of 0 to 1 (P<0.0001). Conclusions Our results validate the ability of the BRS to identify coronary artery disease patients at very high near‐term risk of myocardial infarction/death. After 1 year of intensive medical therapy, the BRS decreased significantly, and the reclassified BRS continued to track with risk. Our results suggest that repeated BRS measurements might be used to assess risk and recalibrate therapy.
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Affiliation(s)
| | - Maria M Brooks
- Graduate School of Public Health, University of Pittsburgh, PA
| | - Helen Vlachos
- Graduate School of Public Health, University of Pittsburgh, PA
| | - Regina Hardison
- Graduate School of Public Health, University of Pittsburgh, PA
| | | | | | | | - Stephen E Epstein
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
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McCarthy CP, van Kimmenade RR, Gaggin HK, Simon ML, Ibrahim NE, Gandhi P, Kelly N, Motiwala SR, Belcher AM, Harisiades J, Magaret CA, Rhyne RF, Januzzi JL. Usefulness of Multiple Biomarkers for Predicting Incident Major Adverse Cardiac Events in Patients Who Underwent Diagnostic Coronary Angiography (from the Catheter Sampled Blood Archive in Cardiovascular Diseases [CASABLANCA] Study). Am J Cardiol 2017; 120:25-32. [PMID: 28487034 DOI: 10.1016/j.amjcard.2017.03.265] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 01/12/2023]
Abstract
We sought to develop a multiple biomarker approach for prediction of incident major adverse cardiac events (MACE; composite of cardiovascular death, myocardial infarction, and stroke) in patients referred for coronary angiography. In a 649-participant training cohort, predictors of MACE within 1 year were identified using least-angle regression; over 50 clinical variables and 109 biomarkers were analyzed. Predictive models were generated using least absolute shrinkage and selection operator with logistic regression. A score derived from the final model was developed and evaluated with a 278-patient validation set during a median of 3.6 years follow-up. The scoring system consisted of N-terminal pro B-type natriuretic peptide (NT-proBNP), kidney injury molecule-1, osteopontin, and tissue inhibitor of metalloproteinase-1; no clinical variables were retained in the predictive model. In the validation cohort, each biomarker improved model discrimination or calibration for MACE; the final model had an area under the curve (AUC) of 0.79 (p <0.001), higher than AUC for clinical variables alone (0.75). In net reclassification improvement analyses, addition of other markers to NT-proBNP resulted in significant improvement (net reclassification improvement 0.45; p = 0.008). At the optimal score cutoff, we found 64% sensitivity, 76% specificity, 28% positive predictive value, and 93% negative predictive value for 1-year MACE. Time-to-first MACE was shorter in those with an elevated score (p <0.001); such risk extended to at least to 4 years. In conclusion, in a cohort of patients who underwent coronary angiography, we describe a novel multiple biomarker score for incident MACE within 1 year (NCT00842868).
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Samman Tahhan A, Hayek SS, Sandesara P, Hajjari J, Hammadah M, O'Neal WT, Kelli HM, Alkhoder A, Ghasemzadeh N, Ko YA, Aida H, Gafeer MM, Abdelhadi N, Mohammed KH, Patel K, Arya S, Reiser J, Vaccarino V, Sperling L, Quyyumi A. Circulating soluble urokinase plasminogen activator receptor levels and peripheral arterial disease outcomes. Atherosclerosis 2017; 264:108-114. [PMID: 28728756 DOI: 10.1016/j.atherosclerosis.2017.06.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 05/26/2017] [Accepted: 06/07/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Circulating soluble urokinase plasminogen activator receptor (suPAR) is a marker of immune activation associated with atherosclerosis. Whether suPAR levels are associated with prevalent peripheral arterial disease (PAD) and its adverse outcomes remains unknown and is the aim of the study. METHODS SuPAR levels were measured in 5810 patients (mean age 63 years, 63% male, 77% with obstructive coronary artery disease [CAD]) undergoing cardiac catheterization. The presence of PAD (n = 967, 17%) was classified as carotid (36%), lower/upper extremities (30%), aortic (15%) and multisite disease (19%). Multivariable logistic and Cox regression models were used to determine independent predictors of prevalent PAD and outcomes including all-cause death, cardiovascular death and PAD-related events after adjustment for age, gender, race, body mass index, smoking, diabetes, hypertension, hyperlipidemia, renal function, heart failure history, and obstructive CAD. RESULTS Plasma suPAR levels were 22.5% (p < 0.001) higher in patients with PAD compared to those without PAD. Plasma suPAR was higher in patients with more extensive PAD (≥2 compared to single site) p < 0.001. After multivariable adjustment, suPAR was associated with prevalent PAD; odds ratio (OR) for highest compared to lowest tertile of 2.0, 95% CI (1.6-2.5) p < 0.001. In Cox survival analyses adjusted for clinical characteristics and medication regimen, suPAR (in the highest vs. lowest tertile) remained an independent predictor of all-cause death [HR 3.1, 95% CI (1.9-5.3)], cardiovascular death [HR 3.5, 95% CI (1.8-7.0)] and PAD-related events [HR = 1.8, 95% CI (1.3-2.6) p < 0.001 for all]. CONCLUSIONS Plasma suPAR level is predictive of prevalent PAD and of incident cardiovascular and PAD-related events. Whether SuPAR measurement can help screen, risk stratify, or monitor therapeutic responses in PAD requires further investigation.
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Affiliation(s)
- Ayman Samman Tahhan
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Salim S Hayek
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Pratik Sandesara
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Jamal Hajjari
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Muhammad Hammadah
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Wesley T O'Neal
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Heval M Kelli
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ayman Alkhoder
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Nima Ghasemzadeh
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Emory University, United States
| | - Hiroshi Aida
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Mohamad Mazen Gafeer
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Naser Abdelhadi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Kareem Hosny Mohammed
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Keyur Patel
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Shipra Arya
- Department of Surgery, Emory University School of Medicine, United States
| | - Jochen Reiser
- Department of Medicine, Rush University Medical Center, United States
| | - Viola Vaccarino
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Laurence Sperling
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Arshed Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
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Wang J, Liu J, Guo W, Bai Y, Li H, Chen H, Han L, Lyu L, Xu C, Liu H. Multiple Biomarkers in the Context of Conventional Risk Factors in Patients With Coronary Artery Disease. J Am Coll Cardiol 2017; 69:2769-2770. [PMID: 28571643 DOI: 10.1016/j.jacc.2017.03.580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/01/2017] [Accepted: 03/26/2017] [Indexed: 12/25/2022]
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Zheng S, Lu JJ, Ghasemzadeh N, Hayek SS, Quyyumi AA, Wang F. Effective Information Extraction Framework for Heterogeneous Clinical Reports Using Online Machine Learning and Controlled Vocabularies. JMIR Med Inform 2017; 5:e12. [PMID: 28487265 PMCID: PMC5442348 DOI: 10.2196/medinform.7235] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Extracting structured data from narrated medical reports is challenged by the complexity of heterogeneous structures and vocabularies and often requires significant manual effort. Traditional machine-based approaches lack the capability to take user feedbacks for improving the extraction algorithm in real time. OBJECTIVE Our goal was to provide a generic information extraction framework that can support diverse clinical reports and enables a dynamic interaction between a human and a machine that produces highly accurate results. METHODS A clinical information extraction system IDEAL-X has been built on top of online machine learning. It processes one document at a time, and user interactions are recorded as feedbacks to update the learning model in real time. The updated model is used to predict values for extraction in subsequent documents. Once prediction accuracy reaches a user-acceptable threshold, the remaining documents may be batch processed. A customizable controlled vocabulary may be used to support extraction. RESULTS Three datasets were used for experiments based on report styles: 100 cardiac catheterization procedure reports, 100 coronary angiographic reports, and 100 integrated reports-each combines history and physical report, discharge summary, outpatient clinic notes, outpatient clinic letter, and inpatient discharge medication report. Data extraction was performed by 3 methods: online machine learning, controlled vocabularies, and a combination of these. The system delivers results with F1 scores greater than 95%. CONCLUSIONS IDEAL-X adopts a unique online machine learning-based approach combined with controlled vocabularies to support data extraction for clinical reports. The system can quickly learn and improve, thus it is highly adaptable.
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Affiliation(s)
- Shuai Zheng
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States
| | - James J Lu
- Department of Mathematics and Computer Science, Emory University, Atlanta, GA, United States
| | - Nima Ghasemzadeh
- Division of Cardiology, Emory School of Medicine, Emory University, Atlanta, GA, United States
| | - Salim S Hayek
- Division of Cardiology, Emory School of Medicine, Emory University, Atlanta, GA, United States
| | - Arshed A Quyyumi
- Division of Cardiology, Emory School of Medicine, Emory University, Atlanta, GA, United States
| | - Fusheng Wang
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States
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Thomas MR, Lip GYH. Novel Risk Markers and Risk Assessments for Cardiovascular Disease. Circ Res 2017; 120:133-149. [PMID: 28057790 DOI: 10.1161/circresaha.116.309955] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/01/2016] [Accepted: 11/21/2016] [Indexed: 12/21/2022]
Abstract
The use of risk markers has transformed cardiovascular medicine, exemplified by the routine assessment of troponin, for both diagnosis and assessment of prognosis in patients with chest pain. Clinical risk factors form the basis for risk assessment of cardiovascular disease and the addition of biochemical, cellular, and imaging parameters offers further refinement. Identifying novel risk factors may allow greater risk stratification and a steady, but gradual progression toward precision medicine. Indeed, the generation of data in this area of research is explosive and when combined with new technologies and techniques provides the potential for more refined, targeted approaches to cardiovascular medicine. Although discussing the most recent developments in this field, this review article aims to strike a balance between novelty and validity by focusing on recent large sample-size studies that have been validated in a separate cohort in most cases. Risk markers related to atherosclerosis, thrombosis, inflammation, cardiac injury, and fibrosis are introduced in the context of their pathophysiology. Rapidly developing new areas, such as assessment of micro-RNA, are also explored. Subsequently the prognostic ability of these risk markers in coronary artery disease, heart failure, and atrial fibrillation is discussed in detail.
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Affiliation(s)
- Mark R Thomas
- From the University of Birmingham Institute of Cardiovascular Sciences, City Hospital, University of Birmingham, United Kingdom (M.R.T., G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | - Gregory Y H Lip
- From the University of Birmingham Institute of Cardiovascular Sciences, City Hospital, University of Birmingham, United Kingdom (M.R.T., G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.).
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Hayek SS, Ko YA, Awad M, Ahmed H, Gray B, Hosny KM, Aida H, Tracy MJ, Wei C, Sever S, Reiser J, Quyyumi AA. Cardiovascular Disease Biomarkers and suPAR in Predicting Decline in Renal Function: A Prospective Cohort Study. Kidney Int Rep 2017; 2:425-432. [PMID: 29142970 PMCID: PMC5678674 DOI: 10.1016/j.ekir.2017.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 11/02/2016] [Accepted: 02/02/2017] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Soluble urokinase-type plasminogen activator receptor (suPAR) strongly predicts outcomes and incident chronic kidney disease (CKD) in patients with cardiovascular disease (CVD). Whether the association between suPAR and CKD is a reflection of its overall association with chronic inflammation and poor CVD outcomes is unclear. We examined whether CVD biomarkers, including high-sensitivity C-reactive protein (hs-CRP), fibrin-degradation products (FDPs), heat-shock protein 70 (HSP-70), and high-sensitivity troponin I (hs-TnI) were associated with a decline in kidney function in the Emory Cardiovascular Biobank cohort, in which suPAR levels were shown to be predictive of both incident CKD and CVD outcomes. METHODS We measured suPAR, hs-CRP, HSP-70, FDP, and hs-TnI plasma levels in 3282 adults (mean age 63 years, 64% male, 75% estimated glomerular filtration rate [eGFR] >60 ml/min per 1.73 m2). Glomerular filtration rate was estimated using Chronic Kidney Disease-Epidemiology Collaboration (eGFR) at enrollment (n = 3282) and follow-up (n = 2672; median 3.5 years). Urine protein by dipstick at baseline was available for 1335 subjects. RESULTS There was a weak correlation among biomarkers (r range: 0.17-0.28). hs-CRP, FDPs, hs-TnI, and suPAR were independently associated with baseline eGFR and proteinuria. The median yearly decline in eGFR was -0.6 ml/min per 1.73 m2. hs-CRP (β: -0.04; P = 0.46), FDPs (β: -0.13; P = 0.08), HSP-70 (β: 0.05; P = 0.84), or hs-TnI (β: -0.01; P = 0.76) were associated with eGFR decline. suPAR remained predictive of eGFR decline even after adjusting for all biomarkers. DISCUSSION hs-CRP, FDP, HSP-70, and hs-TnI were not associated with eGFR decline. The specific association of suPAR with eGFR decline supported its involvement in pathways specific to the pathogenesis of kidney disease.
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Affiliation(s)
- Salim S. Hayek
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yi-An Ko
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Mosaab Awad
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hina Ahmed
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brandon Gray
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Hiroshi Aida
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Melissa J. Tracy
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Changli Wei
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Sanja Sever
- Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jochen Reiser
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Arshed A. Quyyumi
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Kandhai-Ragunath JJ, de Wagenaar B, Doelman C, van Es J, Jørstad HT, Peters RJG, Doggen CJM, von Birgelen C. Endothelial function after ST-elevation myocardial infarction in patients with high levels of high-sensitivity CRP and Lp-PLA 2: A substudy of the RESPONSE randomized trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:202-206. [PMID: 28110894 DOI: 10.1016/j.carrev.2016.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/23/2016] [Accepted: 12/28/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The combination of high levels of high-sensitive C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase-A2 (Lp-PLA2) was recently shown to correlate with increased cardiovascular risk. Endothelial dysfunction is also known to be a risk factor for cardiovascular events. AIM To test among patients with previous ST-elevation myocardial infarction (STEMI) the hypothesis that high levels of both hs-CRP and Lp-PLA2 may be associated with impaired endothelium-dependent vasodilatation. METHODS In this substudy of the RESPONSE randomized trial, we used reactive hyperemia peripheral artery tonometry (RH-PAT) 4 to 6weeks after STEMI and primary percutaneous coronary intervention (PPCI) to non-invasively assess endothelial function (RH-PAT index <1.67 identified endothelial dysfunction). Reliable measurements of RH-PAT, hs-CRP, and Lp-PLA2 were obtained in 68 patients, who were classified as high-risk if levels of both hs-CRP and Lp-PLA2 were in the upper tertile (≥3.84mg/L and >239μg/L, respectively). RESULTS Patients were 57.4±9.7years and 53 (77.9%) were men. 11 (16%) patients were classified as high-risk and 57 (84%) as low-to-intermediate-risk. The RH-PAT index was 1.68±0.22 in high-risk and 1.95±0.63 in low-to-intermediate-risk patients (p=0.17). Endothelial dysfunction was present in 8 (72.7%) high-risk and 26 (45.6%) low-to-intermediate-risk patients (p=0.09). Framingham risk score, NT-proBNP and fibrinogen levels were higher in high-risk patients (p≤0.03). CONCLUSION In this population of patients with recent STEMI and PPCI, we observed between patients with high hs-CRP and Lp-PLA levels and all other patients no more than numerical differences in endothelial function that did not reach a statistical significance. Nevertheless, further research in larger study populations may be warranted.
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Affiliation(s)
| | - Bjorn de Wagenaar
- MESA, Institute for Nanotechnology, University of Twente, Enschede, Netherlands
| | - Cees Doelman
- Medlon Laboratory Diagnostics, Medisch Spectrum Twente, Enschede, Netherlands
| | - Jan van Es
- Department of Cardiology, Thoraxcentrum Twente, MST, Enschede, Netherlands
| | - Harald T Jørstad
- Department of Cardiology, Academisch Medisch Centrum, Amsterdam, Netherlands
| | - Ron J G Peters
- Department of Cardiology, Academisch Medisch Centrum, Amsterdam, Netherlands
| | - Carine J M Doggen
- Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, MST, Enschede, Netherlands; Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands.
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Hung OY, Lee SK, Eshtehardi P, Samady H. Novel biomarkers of coronary microvascular disease. Future Cardiol 2016; 12:497-509. [PMID: 27291585 PMCID: PMC5941701 DOI: 10.2217/fca-2016-0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 05/06/2016] [Indexed: 01/20/2023] Open
Abstract
Coronary microvascular disease in the absence of myocardial diseases has traditionally been diagnosed through coronary reactivity testing in the cardiac catheterization laboratory. Compared with invasive procedures, blood-based biomarkers may have reduced cost, less risk of physical harm and greater accessibility, making them ideal for an outpatient management strategy. There are a variety of biomarkers available with potential utility in the management of microvascular disease; however, none have yet been extensively validated or established in this clinical patient population.
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Affiliation(s)
- Olivia Y Hung
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Suegene K Lee
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Parham Eshtehardi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Habib Samady
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Fibrinogen and the Severity of Coronary Atherosclerosis among Adults with and without Statin Treatment: Lipid as a mediator. Heart Lung Circ 2016; 25:558-67. [PMID: 26839166 DOI: 10.1016/j.hlc.2016.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/24/2015] [Accepted: 01/02/2016] [Indexed: 12/30/2022]
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Oleksiak A, Kruk M, Lenarczyk E, Pawelec M, Rajska E, Wilkońska P, Dzielińska Z, Demkow M, Witkowski A, Pręgowski J, Kępka C, Rużyłło W. Biomarkers for risk stratification in secondary cardiovascular prevention. A role of red blood cell distribution width and calcium score. Atherosclerosis 2016; 246:57-62. [DOI: 10.1016/j.atherosclerosis.2015.12.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 12/24/2015] [Accepted: 12/25/2015] [Indexed: 12/30/2022]
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Corban MT, Hung OY, Mekonnen G, Eshtehardi P, Eapen DJ, Rasoul-Arzrumly E, Al Kassem H, Manocha P, Ko YA, Sperling LS, Quyyumi AA, Samady H. Elevated Levels of Serum Fibrin and Fibrinogen Degradation Products Are Independent Predictors of Larger Coronary Plaques and Greater Plaque Necrotic Core. Circ J 2016; 80:931-7. [PMID: 26911453 DOI: 10.1253/circj.cj-15-0768] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Co-existence of vulnerable plaque and pro-thrombotic state may provoke acute coronary events. It was hypothesized that elevated serum levels of fibrin and fibrinogen degradation products (FDP) are associated with larger total plaque and necrotic core (NC) areas. METHODS AND RESULTS Seventy-five patients presenting with stable anginal symptoms (69%) or stabilized acute coronary syndrome (ACS; 31%), and found to have non-obstructive coronary artery disease (CAD) with a fractional flow reserve >0.8, were studied. Invasive virtual histology intravascular ultrasound (VH-IVUS) was performed in 68 LAD arteries, 6 circumflex arteries, and 1 right coronary artery. Serum FDP levels were measured using ELISA technique. Plaque volumetrics and composition were assessed in each VH-IVUS frame and averaged. The median age of patients was 56 (47-63) years; 52% were men and 23% had diabetes. The average length of coronary artery studied was 62 mm. After adjustment for systemic risk factors, medications, CRP levels and ACS, male gender (P<0.001) and serum FDP levels (P=0.02) were independent predictors of a larger NC area. Older age (P<0.001), male gender (P<0.0001) and increased serum FDP level (P=0.03) were associated with a larger plaque area. CONCLUSIONS In patients with CAD, a higher serum level of FDP is independently associated with larger plaques and greater plaque NC.
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Affiliation(s)
- Michel T Corban
- Division of Cardiology, Department of Medicine, Emory University School of Medicine
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Scott JM, Armenian S, Giralt S, Moslehi J, Wang T, Jones LW. Cardiovascular disease following hematopoietic stem cell transplantation: Pathogenesis, detection, and the cardioprotective role of aerobic training. Crit Rev Oncol Hematol 2016; 98:222-34. [PMID: 26643524 PMCID: PMC5003053 DOI: 10.1016/j.critrevonc.2015.11.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 01/02/2023] Open
Abstract
Advances in hematopoietic cell transplantation (HCT) techniques and supportive care strategies have led to dramatic improvements in relapse mortality in patients with high-risk hematological malignancies. These improvements, however, conversely increase the risk of late-occurring non-cancer competing causes, mostly cardiovascular disease (CVD). HCT recipients have a significantly increased risk of CVD-specific mortality, including elevated incidence of coronary artery disease (CAD), cerebrovascular disease, and heart failure (HF) compared to age-matched counterparts. Accordingly, there is an urgent need to identify techniques for the detection of early CVD in HCT patients to inform early prevention strategies. Aerobic training (AT) is established as the cornerstone of primary and secondary disease prevention in multiple clinical settings, and may confer similar benefits in HCT patients at high-risk of CVD. The potential benefits of AT either before, immediately after, or in the months/years following HCT have received limited attention. Here, we discuss the risk and extent of CVD in adult HCT patients, highlight novel tools for early detection of CVD, and review existing evidence in oncology and non-oncology populations supporting the efficacy of AT to attenuate HCT-induced CVD. This knowledge can be utilized to optimize treatment, while minimizing CVD risk in individuals with hematological malignancies undergoing HCT.
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Affiliation(s)
- Jessica M Scott
- Universities Space Research Association NASA Johnson Space Center, Houston, TX, USA
| | - Saro Armenian
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Lee W Jones
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Patel RS, Ghasemzadeh N, Eapen DJ, Sher S, Arshad S, Ko YA, Veledar E, Samady H, Zafari AM, Sperling L, Vaccarino V, Jones DP, Quyyumi AA. Novel Biomarker of Oxidative Stress Is Associated With Risk of Death in Patients With Coronary Artery Disease. Circulation 2016; 133:361-9. [PMID: 26673559 PMCID: PMC4722941 DOI: 10.1161/circulationaha.115.019790] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/11/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Free radical scavengers have failed to improve patient outcomes, promoting the concept that clinically important oxidative stress may be mediated by alternative mechanisms. We sought to examine the association of emerging aminothiol markers of nonfree radical mediated oxidative stress with clinical outcomes. METHODS AND RESULTS Plasma levels of reduced (cysteine and glutathione) and oxidized (cystine and glutathione disulphide) aminothiols were quantified by high performance liquid chromatography in 1411 patients undergoing coronary angiography (mean age 63 years, male 66%). All patients were followed for a mean of 4.7 ± 2.1 years for the primary outcome of all-cause death (n=247). Levels of cystine (oxidized) and glutathione (reduced) were associated with risk of death (P<0.001 both) before and after adjustment for covariates. High cystine and low glutathione levels (>+1 SD and <-1 SD, respectively) were associated with higher mortality (adjusted hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.19-2.21; HR, 2.19; 95% CI, 1.50-3.19; respectively) compared with those outside these thresholds. Furthermore, the ratio of cystine/glutathione was also significantly associated with mortality (adjusted HR, 1.92; 95% CI, 1.39-2.64) and was independent of and additive to high-sensitivity C-reactive protein level. Similar associations were found for other outcomes of cardiovascular death and combined death and myocardial infarction. CONCLUSIONS A high burden of oxidative stress, quantified by the plasma aminothiols, cystine, glutathione, and their ratio, is associated with mortality in patients with coronary artery disease, a finding that is independent of and additive to the inflammatory burden. Importantly, these data support the emerging role of nonfree radical biology in driving clinically important oxidative stress.
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Affiliation(s)
- Riyaz S Patel
- From Department of Medicine, Emory University School of Medicine, Atlanta, GA (R.S.P., N.G., D.J.E., S.S., S.A., H.S., A.M.Z., L.S., V.V., D.P.J., A.A.Q.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA (Y.K.); Department of Medicine, Baptist Health South Florida, Miami, FL (E.V.); Department of Epidemiology, Rollins School of Public Health, Atlanta, GA (E.V., V.V.); and Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA (A.M.Z.)
| | - Nima Ghasemzadeh
- From Department of Medicine, Emory University School of Medicine, Atlanta, GA (R.S.P., N.G., D.J.E., S.S., S.A., H.S., A.M.Z., L.S., V.V., D.P.J., A.A.Q.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA (Y.K.); Department of Medicine, Baptist Health South Florida, Miami, FL (E.V.); Department of Epidemiology, Rollins School of Public Health, Atlanta, GA (E.V., V.V.); and Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA (A.M.Z.)
| | - Danny J Eapen
- From Department of Medicine, Emory University School of Medicine, Atlanta, GA (R.S.P., N.G., D.J.E., S.S., S.A., H.S., A.M.Z., L.S., V.V., D.P.J., A.A.Q.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA (Y.K.); Department of Medicine, Baptist Health South Florida, Miami, FL (E.V.); Department of Epidemiology, Rollins School of Public Health, Atlanta, GA (E.V., V.V.); and Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA (A.M.Z.)
| | - Salman Sher
- From Department of Medicine, Emory University School of Medicine, Atlanta, GA (R.S.P., N.G., D.J.E., S.S., S.A., H.S., A.M.Z., L.S., V.V., D.P.J., A.A.Q.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA (Y.K.); Department of Medicine, Baptist Health South Florida, Miami, FL (E.V.); Department of Epidemiology, Rollins School of Public Health, Atlanta, GA (E.V., V.V.); and Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA (A.M.Z.)
| | - Shawn Arshad
- From Department of Medicine, Emory University School of Medicine, Atlanta, GA (R.S.P., N.G., D.J.E., S.S., S.A., H.S., A.M.Z., L.S., V.V., D.P.J., A.A.Q.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA (Y.K.); Department of Medicine, Baptist Health South Florida, Miami, FL (E.V.); Department of Epidemiology, Rollins School of Public Health, Atlanta, GA (E.V., V.V.); and Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA (A.M.Z.)
| | - Yi-an Ko
- From Department of Medicine, Emory University School of Medicine, Atlanta, GA (R.S.P., N.G., D.J.E., S.S., S.A., H.S., A.M.Z., L.S., V.V., D.P.J., A.A.Q.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA (Y.K.); Department of Medicine, Baptist Health South Florida, Miami, FL (E.V.); Department of Epidemiology, Rollins School of Public Health, Atlanta, GA (E.V., V.V.); and Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA (A.M.Z.)
| | - Emir Veledar
- From Department of Medicine, Emory University School of Medicine, Atlanta, GA (R.S.P., N.G., D.J.E., S.S., S.A., H.S., A.M.Z., L.S., V.V., D.P.J., A.A.Q.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA (Y.K.); Department of Medicine, Baptist Health South Florida, Miami, FL (E.V.); Department of Epidemiology, Rollins School of Public Health, Atlanta, GA (E.V., V.V.); and Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA (A.M.Z.)
| | - Habib Samady
- From Department of Medicine, Emory University School of Medicine, Atlanta, GA (R.S.P., N.G., D.J.E., S.S., S.A., H.S., A.M.Z., L.S., V.V., D.P.J., A.A.Q.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA (Y.K.); Department of Medicine, Baptist Health South Florida, Miami, FL (E.V.); Department of Epidemiology, Rollins School of Public Health, Atlanta, GA (E.V., V.V.); and Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA (A.M.Z.)
| | - A Maziar Zafari
- From Department of Medicine, Emory University School of Medicine, Atlanta, GA (R.S.P., N.G., D.J.E., S.S., S.A., H.S., A.M.Z., L.S., V.V., D.P.J., A.A.Q.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA (Y.K.); Department of Medicine, Baptist Health South Florida, Miami, FL (E.V.); Department of Epidemiology, Rollins School of Public Health, Atlanta, GA (E.V., V.V.); and Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA (A.M.Z.)
| | - Laurence Sperling
- From Department of Medicine, Emory University School of Medicine, Atlanta, GA (R.S.P., N.G., D.J.E., S.S., S.A., H.S., A.M.Z., L.S., V.V., D.P.J., A.A.Q.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA (Y.K.); Department of Medicine, Baptist Health South Florida, Miami, FL (E.V.); Department of Epidemiology, Rollins School of Public Health, Atlanta, GA (E.V., V.V.); and Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA (A.M.Z.)
| | - Viola Vaccarino
- From Department of Medicine, Emory University School of Medicine, Atlanta, GA (R.S.P., N.G., D.J.E., S.S., S.A., H.S., A.M.Z., L.S., V.V., D.P.J., A.A.Q.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA (Y.K.); Department of Medicine, Baptist Health South Florida, Miami, FL (E.V.); Department of Epidemiology, Rollins School of Public Health, Atlanta, GA (E.V., V.V.); and Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA (A.M.Z.)
| | - Dean P Jones
- From Department of Medicine, Emory University School of Medicine, Atlanta, GA (R.S.P., N.G., D.J.E., S.S., S.A., H.S., A.M.Z., L.S., V.V., D.P.J., A.A.Q.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA (Y.K.); Department of Medicine, Baptist Health South Florida, Miami, FL (E.V.); Department of Epidemiology, Rollins School of Public Health, Atlanta, GA (E.V., V.V.); and Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA (A.M.Z.)
| | - Arshed A Quyyumi
- From Department of Medicine, Emory University School of Medicine, Atlanta, GA (R.S.P., N.G., D.J.E., S.S., S.A., H.S., A.M.Z., L.S., V.V., D.P.J., A.A.Q.); Institute of Cardiovascular Science, University College London, United Kingdom (R.S.P.); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA (Y.K.); Department of Medicine, Baptist Health South Florida, Miami, FL (E.V.); Department of Epidemiology, Rollins School of Public Health, Atlanta, GA (E.V., V.V.); and Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA (A.M.Z.).
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Systemic Inflammatory Markers Are Closely Associated with Atherogenic Lipoprotein Subfractions in Patients Undergoing Coronary Angiography. Mediators Inflamm 2015; 2015:235742. [PMID: 26688615 PMCID: PMC4673360 DOI: 10.1155/2015/235742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/21/2015] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate the relationship between inflammatory markers and atherogenic lipoprotein subfractions. METHODS We studied 520 eligible subjects who were not receiving any lipid-lowering therapy. The inflammatory markers including white blood cell (WBC) count, high-sensitivity C-reactive protein (hs-CRP), fibrinogen, erythrocyte sedimentation rate (ESR), and D-dimer were measured. A multimarker inflammatory index was developed. Low-density lipoprotein (LDL) and high-density lipoprotein (HDL) separation processes were performed using Lipoprint System. RESULTS In age- and sex-adjusted analysis, several inflammatory markers (WBC count, hs-CRP, fibrinogen, and ESR) were positively related to circulating non-HDL cholesterol and remnant cholesterol (p < 0.05, all). Among lipoprotein subfractions, we observed a positive association of inflammatory markers with very low-density lipoprotein cholesterol, small LDL cholesterol, and LDL score (p < 0.05, all). Meanwhile, a negative association was detected between inflammatory markers and mean LDL particle size (p < 0.05) or large HDL cholesterol (p < 0.05). Moreover, we found that the relationships between multimarker index quartiles and small LDL cholesterol, LDL score, and mean LDL particle size were slightly stronger in patients with CAD. CONCLUSIONS Systemic inflammatory markers are positively correlated with small LDL cholesterol and LDL score while being negatively linked with mean LDL particle size and large HDL cholesterol, highlighting the potential contribution to increased cardiovascular risk.
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50
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MacNamara J, Eapen DJ, Quyyumi A, Sperling L. Novel biomarkers for cardiovascular risk assessment: current status and future directions. Future Cardiol 2015; 11:597-613. [DOI: 10.2217/fca.15.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in the modern world. Traditional risk algorithms may miss up to 20% of CVD events. Therefore, there is a need for new cardiac biomarkers. Many fields of research are dedicated to improving cardiac risk prediction, including genomics, transcriptomics and proteomics. To date, even the most promising biomarkers have only demonstrated modest associations and predictive ability. Few have undergone randomized control trials. A number of biomarkers are targets to new therapies aimed to reduce cardiovascular risk. Currently, some of the most promising risk prediction has been demonstrated with panels of multiple biomarkers. This article reviews the current state and future of proteomic biomarkers and aggregate biomarker panels.
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Affiliation(s)
- James MacNamara
- Emory University School of Medicine, 1365 Clifton Road, NE, Building A, Suite 2200, Atlanta, GA 30322, USA
| | - Danny J Eapen
- Emory University School of Medicine, 1365 Clifton Road, NE, Building A, Suite 2200, Atlanta, GA 30322, USA
| | - Arshed Quyyumi
- Emory University School of Medicine, 1365 Clifton Road, NE, Building A, Suite 2200, Atlanta, GA 30322, USA
| | - Laurence Sperling
- Emory University School of Medicine, 1365 Clifton Road, NE, Building A, Suite 2200, Atlanta, GA 30322, USA
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