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Mayala HA, Bakari KH, Mghanga FP, ZhaoHui W. Clinical significance of PET-CT coronary flow reserve in diagnosis of non-obstructive coronary artery disease. BMC Res Notes 2018; 11:566. [PMID: 30081956 PMCID: PMC6080218 DOI: 10.1186/s13104-018-3667-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/01/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To improve current knowledge of coronary flow reserve and non-obstructive coronary artery disease in terms of definition, features and clinical implications of measurement of coronary flow reserve (CFR), is an integrated measure of focal, diffuse, and small vessel coronary artery disease, can also be explained as a calculated ratio of hyperaemic to rest absolute myocardial blood flow. Non-obstructive coronary artery disease is defined as atherosclerotic plaque that does not obstruct blood flow or result in anginal symptoms. We also aimed at knowing the significance of PET in diagnosing coronary microvascular disease. RESULTS In our study 92% were between 41 and 60 years. 83% were males and 17% females, more patients had hypertension about 50%, few had diabetes mellitus about 16%, while those with both hypertension and diabetes mellitus were 17%. About 83% had ST segment and T wave changes on ECG. All patients and controls had normal coronaries on coronary angiography TIMI 3 flow. On further investigation by Positron emission tomography/CT we found out 58% had abnormal CFR and 42% had normal coronary flow reserve. Our findings indicate PET/CT coronary flow reserve concept provides a platform for the diagnosis of non-obstructive coronary artery disease in patients with signs and symptoms of ischemia without angiographic obstructive CAD.
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Affiliation(s)
- Henry Anselmo Mayala
- Department of Cardiology 10th floor, Wuhan Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Internal medicine building number 1, Zhongshan avenue, Hankou, Wuhan, 43000, Hubei, China.
| | - Khamis Hassan Bakari
- Department of Radiology and Nuclear Medicine, Wuhan Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fabian Pius Mghanga
- Department of Internal Medicine, Archbishop James University College, Songea, Tanzania
| | - Wang ZhaoHui
- Department of Cardiology 10th floor, Wuhan Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Internal medicine building number 1, Zhongshan avenue, Hankou, Wuhan, 43000, Hubei, China
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Kenkre TS, Malhotra P, Johnson BD, Handberg EM, Thompson DV, Marroquin OC, Rogers WJ, Pepine CJ, Bairey Merz CN, Kelsey SF. Ten-Year Mortality in the WISE Study (Women's Ischemia Syndrome Evaluation). Circ Cardiovasc Qual Outcomes 2017; 10:e003863. [PMID: 29217675 PMCID: PMC5728666 DOI: 10.1161/circoutcomes.116.003863] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 09/18/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND The WISE study (Women's Ischemia Syndrome Evaluation) was a prospective cohort study of 936 clinically stable symptomatic women who underwent coronary angiography to evaluate symptoms and signs of ischemia. Long-term mortality data for such women are limited. METHODS AND RESULTS Obstructive coronary artery disease (CAD) was defined as ≥50% stenosis on angiography by core laboratory. We conducted a National Death Index search to assess the mortality of women who were alive at their final WISE contact date. Death certificates were obtained. All deaths were adjudicated as cardiovascular or noncardiovascular by a panel of WISE cardiologists masked to angiographic data. Multivariate Cox proportional hazards regression was used to identify significant independent predictors of mortality. At baseline, mean age was 58±12 years; 176 (19%) were non-white, primarily black; 25% had a history of diabetes mellitus, 59% hypertension, 55% dyslipidemia, and 59% had a body mass index ≥30. During a median follow-up of 9.5 years (range, 0.2-11.5 years), a total of 184 (20%) died. Of these, 115 (62%) were cardiovascular deaths; 31% of all cardiovascular deaths occurred in women without obstructive CAD (<50% stenosis). Independent predictors of mortality were obstructive CAD, age, baseline systolic blood pressure, history of diabetes mellitus, history of smoking, elevated triglycerides, and estimated glomerular filtration rate. CONCLUSIONS Among women referred for coronary angiography for signs and symptoms of ischemia, 1 in 5 died from predominantly cardiac pathogeneses within 9 years of angiographic evaluation. A majority of the factors contributing to the risk of death seem to be modifiable by existing therapies. Of note, 1 in 3 of the deaths in this cohort occurred in women without obstructive CAD, a condition often considered benign and without guideline-recommended treatments. Clinical trials are needed to provide treatment guidance for the group without obstructive CAD.
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Affiliation(s)
- Tanya S Kenkre
- From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (T.S.K., B.D.J., O.C.M., S.F.K.); Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (P.M., C.N.B.M.); Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville (E.M.H., C.J.P.); Division of Cardiology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA (D.V.T.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (O.C.M.); and Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham (W.J.R.).
| | - Pankaj Malhotra
- From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (T.S.K., B.D.J., O.C.M., S.F.K.); Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (P.M., C.N.B.M.); Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville (E.M.H., C.J.P.); Division of Cardiology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA (D.V.T.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (O.C.M.); and Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham (W.J.R.)
| | - B Delia Johnson
- From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (T.S.K., B.D.J., O.C.M., S.F.K.); Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (P.M., C.N.B.M.); Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville (E.M.H., C.J.P.); Division of Cardiology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA (D.V.T.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (O.C.M.); and Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham (W.J.R.)
| | - Eileen M Handberg
- From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (T.S.K., B.D.J., O.C.M., S.F.K.); Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (P.M., C.N.B.M.); Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville (E.M.H., C.J.P.); Division of Cardiology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA (D.V.T.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (O.C.M.); and Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham (W.J.R.)
| | - Diane V Thompson
- From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (T.S.K., B.D.J., O.C.M., S.F.K.); Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (P.M., C.N.B.M.); Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville (E.M.H., C.J.P.); Division of Cardiology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA (D.V.T.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (O.C.M.); and Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham (W.J.R.)
| | - Oscar C Marroquin
- From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (T.S.K., B.D.J., O.C.M., S.F.K.); Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (P.M., C.N.B.M.); Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville (E.M.H., C.J.P.); Division of Cardiology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA (D.V.T.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (O.C.M.); and Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham (W.J.R.)
| | - William J Rogers
- From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (T.S.K., B.D.J., O.C.M., S.F.K.); Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (P.M., C.N.B.M.); Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville (E.M.H., C.J.P.); Division of Cardiology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA (D.V.T.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (O.C.M.); and Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham (W.J.R.)
| | - Carl J Pepine
- From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (T.S.K., B.D.J., O.C.M., S.F.K.); Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (P.M., C.N.B.M.); Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville (E.M.H., C.J.P.); Division of Cardiology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA (D.V.T.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (O.C.M.); and Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham (W.J.R.)
| | - C Noel Bairey Merz
- From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (T.S.K., B.D.J., O.C.M., S.F.K.); Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (P.M., C.N.B.M.); Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville (E.M.H., C.J.P.); Division of Cardiology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA (D.V.T.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (O.C.M.); and Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham (W.J.R.)
| | - Sheryl F Kelsey
- From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (T.S.K., B.D.J., O.C.M., S.F.K.); Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (P.M., C.N.B.M.); Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville (E.M.H., C.J.P.); Division of Cardiology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA (D.V.T.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (O.C.M.); and Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham (W.J.R.)
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Taveira TH, Wu WC. Interventions to maintain cardiac risk control after discharge from a cardiovascular risk reduction clinic: a randomized controlled trial. Diabetes Res Clin Pract 2014; 105:327-35. [PMID: 24969964 DOI: 10.1016/j.diabres.2014.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/14/2014] [Accepted: 05/26/2014] [Indexed: 01/21/2023]
Abstract
AIMS To evaluate the efficacy of two maintenance strategies compared to usual care after discharge from a pharmacist-led cardiovascular risk reduction clinic (CRRC). METHODS Open-label, randomized-controlled trial of 200 consecutive CRRC patients that met clinic discharge criteria (HbA1c ≤7% (53 mmol/mol); blood pressure ≤140/80 mmHg for those with diabetes and ≤140/90 mmHg for those without diabetes; and an LDL-cholesterol ≤2.59 mmol/l). Participants were randomized to either quarterly group medical visits or quarterly CRRC individual clinic visits, or a usual care control arm with the standard primary care alone first in a 1:1:1 ratio, followed by a 2:2:1 ratio after first 100 patients. Primary outcome measures were time to failure for guideline recommended goals of HbA1c and blood pressure over 12-months. RESULTS Of the 200 participants randomized, 89% had diabetes and were similar in other cardiovascular risk factors. After 1-year, the HbA1c failure rate was 0.36 [95% CI, 0.28-0.47] per quarter for the group medical visit arm, 0.24 [95% CI, 0.18-0.33] per quarter for the quarterly CRRC individual arm and, 0.82 [95% CI, 0.69-0.96] per quarter for the usual care control arm, p<0.001. The rate of failure for blood pressure was 0.31 [95% CI, 0.23-0.41] per quarter for the group medical visit arm, 0.22 [95% CI, 0.16-0.30] per quarter for the CRRC individual arm and, 0.53 [95% CI, 0.40-0.71] per quarter the control arm, p<0.001. CONCLUSION After discharge from a CRRC program, both individual and group interventions are more effective in maintaining glycemia and blood pressure control for patients with diabetes than usual care after 1-year of follow-up.
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Affiliation(s)
- Tracey H Taveira
- Providence VA Medical Center, Providence, RI, United States; University of Rhode Island, Kingston, RI, United States; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Wen-Chih Wu
- Providence VA Medical Center, Providence, RI, United States; University of Rhode Island, Kingston, RI, United States; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States.
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Puesta al día en el manejo de las dislipidemias. REVISTA MÉDICA CLÍNICA LAS CONDES 2012. [DOI: 10.1016/s0716-8640(12)70368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Mancini GBJ, Bates ER, Maron DJ, Hartigan P, Dada M, Gosselin G, Kostuk W, Sedlis SP, Shaw LJ, Berman DS, Berger PB, Spertus J, Mavromatis K, Knudtson M, Chaitman BR, O'Rourke RA, Weintraub WS, Teo K, Boden WE. Quantitative results of baseline angiography and percutaneous coronary intervention in the COURAGE trial. Circ Cardiovasc Qual Outcomes 2009; 2:320-7. [PMID: 20031857 DOI: 10.1161/circoutcomes.108.830091] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND COURAGE compared outcomes in stable coronary patients randomized to optimal medical therapy plus percutaneous coronary intervention (PCI) versus optimal medical therapy alone. METHODS AND RESULTS Angiographic data were analyzed by treatment arm, health care system (Veterans Administration, US non-Veterans Administration, Canada), and gender. Veterans Administration patients had higher prevalence of coronary artery bypass graft surgery and left ventricular ejection fraction < or =50%. Men had worse diameter stenosis of the most severe lesion, higher prevalence of prior coronary artery bypass graft surgery, lower left ventricular ejection fraction, and more 3-vessel disease that included a proximal left anterior descending lesion (P<0.0001 for all comparisons versus women). Failure to cross rate (3%) and visual angiographic success of stent procedures (97%) were similar to contemporary practice in the National Cardiovascular Data Registry. Quantitative angiographic PCI success was 93% (residual lesion <50% in-segment) and 82% (<20% in-stent), with only minor nonsignificant differences among health care systems and genders. Event rates were higher in patients with higher jeopardy scores and more severe vessel disease, but rates were similar irrespective of treatment strategy. Within the PCI plus optimal medical therapy arm, complete revascularization was associated with a trend toward lower rate of death or nonfatal myocardial infarction. Complete revascularization was similar between genders and among health care systems. CONCLUSIONS PCI success and completeness of revascularization did not differ significantly by health care system or gender and were similar to contemporary practice. Angiographic burden of disease affected overall event rates but not response to an initial strategy of PCI plus optimal medical therapy or optimal medical therapy alone.
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Affiliation(s)
- G B John Mancini
- Vancouver Hospital, Cardiovascular Imaging Research Core Laboratory, University of British Columbia, Vancouver, Canada.
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Abstract
In multiple randomized, controlled clinical trials, statin treatment of elevated low-density lipoprotein cholesterol in women at increased risk of or with coronary heart disease decreased the risk of coronary events: coronary death, nonfatal myocardial infarction, and myocardial revascularization procedures. Total mortality was unchanged, potentially reflecting the underrepresentation of women in these trials and consequent small number of fatal events. Statin therapy provided comparable benefit for women and men with acute coronary syndromes. Application of lipid-lowering therapy with statin drugs is currently underutilized in women, and represents an opportunity to improve clinical cardiovascular outcomes for women.
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Affiliation(s)
- Nanette K Wenger
- Department of Medicine (Cardiology), Emory University School of Medicine, the Department of Cardiology, Grady Memorial Hospital, and the Emory Heart & Vascular Center, Atlanta, Georgia 30303, USA.
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Bittner V. Perspectives on Dyslipidemia and Coronary Heart Disease in Women. J Am Coll Cardiol 2005; 46:1628-35. [PMID: 16256860 DOI: 10.1016/j.jacc.2005.05.089] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2005] [Revised: 04/26/2005] [Accepted: 05/02/2005] [Indexed: 11/28/2022]
Abstract
Coronary heart disease (CHD) remains the leading cause of death among American women. Numerous differences exist between younger and older women and between women and men with respect to the pathology of CHD and its incidence and prevalence over the life cycle. Differences in lipoprotein levels and lipid fractions play an important role in CHD risk. Hormonal influences on lipoprotein levels in women are complex, change throughout the life span, and are influenced by the administration of oral contraceptives and hormone replacement therapy. Women with obesity, metabolic syndrome, or diabetes have lipid profiles that adversely affect CHD risk. To date, no randomized trials testing the impact of lifestyle changes on lipoprotein levels and subsequent CHD events in non-institutionalized women have been performed, and women have not been well represented in clinical end point trials of pharmacologic lipid-lowering therapy. Available evidence suggests that lipid-lowering therapy with statins does provide benefit in reducing the risk of coronary events in women; however, women remain undertreated, and more data are needed to determine optimal cardiovascular prevention and treatment in this population.
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Affiliation(s)
- Vera Bittner
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Mantel-Teeuwisse AK, Verschuren WMM, Klungel OH, Kromhout D, Lindemans AD, Avorn J, Porsius AJ, de Boer A. Undertreatment of hypercholesterolaemia: a population-based study. Br J Clin Pharmacol 2003; 55:389-97. [PMID: 12680888 PMCID: PMC1884230 DOI: 10.1046/j.1365-2125.2003.01769.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2002] [Accepted: 10/10/2002] [Indexed: 11/20/2022] Open
Abstract
AIMS To assess the level of undertreatment of hypercholesterolaemia in the general population, taking intra-person variability in serum cholesterol concentrations into account, and to identify determinants of undertreatment of hypercholesterolaemia. METHODS In this cross-sectional study, data from two population-based surveys on cardiovascular disease risk factors conducted between 1987 and 1997 in the Netherlands were used. For all 64 757 respondents aged 20-59 years, treatment eligibility for lipid-lowering drug use was established according to the Dutch Cholesterol Consensus. Multivariate logistic models were used to identify determinants of undertreatment. RESULTS During the study period, 56.8% of the study population had undesirable cholesterol concentrations (serum total cholesterol> 5 mmol l(-1)) and 5.5% of those were eligible for pharmacological treatment based on their absolute risk of coronary heart disease. Of those eligible for pharmacological treatment, 16.3% were treated, and 19.6% of those treated had their serum total cholesterol concentration controlled. Only 3.2% of those eligible for pharmacological treatment were both treated and controlled. We identified several determinants for undertreatment, e.g. male gender and younger age for primary prevention and female gender and older age for secondary prevention. Treatment has improved slightly in more recent years. CONCLUSIONS Over 95% of the population eligible for the pharmacological treatment of hypercholesterolaemia was either untreated or was uncontrolled. To decrease undertreatment, identification of high-risk patients should be increased. Those who are treated with lipid-lowering medication could further benefit from more aggressive treatment, especially with statins.
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Affiliation(s)
- A K Mantel-Teeuwisse
- Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, PO Box 80082, 3508 TB Utrecht, the Netherlands.
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Chen Q, Reis SE, Kammerer CM, McNamara DM, Holubkov R, Sharaf BL, Sopko G, Pauly DF, Merz CNB, Kamboh MI. Association between the severity of angiographic coronary artery disease and paraoxonase gene polymorphisms in the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. Am J Hum Genet 2003; 72:13-22. [PMID: 12454802 PMCID: PMC378617 DOI: 10.1086/345312] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2002] [Accepted: 09/23/2002] [Indexed: 12/13/2022] Open
Abstract
Paraoxonase (PON), a high-density lipoprotein-associated enzyme, is believed to protect against low-density lipoprotein oxidation and thus affects the risk of coronary artery disease (CAD). Three polymorphisms in the PON1 (Leu55Met and Gln192Arg) and PON2 (Ser311Cys) genes have been shown to be associated with the risk of CAD in several European or European-derived populations. In the present study, we examined the associations between these three markers and the severity of CAD as determined by the number of diseased coronary artery vessels in 711 subjects (589 whites and 122 blacks) from the Women's Ischemia Syndrome Evaluation (WISE) study. WISE is a National Heart, Lung, and Blood Institute-sponsored multicenter study designed to address issues related to ischemic-heart-disease recognition and diagnosis in women. Subjects were classified as having normal/minimal CAD (<20% stenosis), mild CAD (20%-49% stenosis), and significant CAD (>/=50% stenosis). The women who had >/=50% stenosis were further classified into groups with one-, two-, or three-vessel disease if any of the three coronary arteries had diameter stenosis >/=50%. No significant association was found between the PON polymorphisms and stenosis severity in either white or black women. However, among white women, when data were stratified by the number of diseased vessels, the frequency of the PON1 codon 192 Arg/Arg genotype was significantly higher in the group with three-vessel disease than in the other groups (those with one-vessel and two-vessel disease) combined (17.02% vs. 4.58%; P=.0066). Similarly, the frequency of the PON2 codon 311 Cys/Cys genotype was significantly higher in the group with three-vessel disease than in the other groups combined (15.22% vs. 4.61%; P=.018). The adjusted odds ratios for the development of three-vessel disease were 2.80 (95% confidence interval 1.06-7.37; P=.038) for PON1 codon 192 Arg/Arg and 3.68 (95% confidence interval 1.26-10.68; P=.017) for PON2 codon 311 Cys/Cys. Our data indicate that the severity of CAD, in terms of the number of diseased vessels, may be affected by common genetic variation in the PON gene cluster, on chromosome 7.
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Affiliation(s)
- Qi Chen
- Department of Human Genetics and Cardiovascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh; Department of Family and Preventive Medicine, University of Utah, Salt Lake City; Division of Cardiology, Rhode Island Hospital, Providence; Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, Bethesda; Division of Cardiology, University of Florida, Gainesville; and Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles
| | - Steven E. Reis
- Department of Human Genetics and Cardiovascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh; Department of Family and Preventive Medicine, University of Utah, Salt Lake City; Division of Cardiology, Rhode Island Hospital, Providence; Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, Bethesda; Division of Cardiology, University of Florida, Gainesville; and Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles
| | - Candace M. Kammerer
- Department of Human Genetics and Cardiovascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh; Department of Family and Preventive Medicine, University of Utah, Salt Lake City; Division of Cardiology, Rhode Island Hospital, Providence; Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, Bethesda; Division of Cardiology, University of Florida, Gainesville; and Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles
| | - Dennis M. McNamara
- Department of Human Genetics and Cardiovascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh; Department of Family and Preventive Medicine, University of Utah, Salt Lake City; Division of Cardiology, Rhode Island Hospital, Providence; Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, Bethesda; Division of Cardiology, University of Florida, Gainesville; and Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles
| | - Richard Holubkov
- Department of Human Genetics and Cardiovascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh; Department of Family and Preventive Medicine, University of Utah, Salt Lake City; Division of Cardiology, Rhode Island Hospital, Providence; Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, Bethesda; Division of Cardiology, University of Florida, Gainesville; and Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles
| | - Barry L. Sharaf
- Department of Human Genetics and Cardiovascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh; Department of Family and Preventive Medicine, University of Utah, Salt Lake City; Division of Cardiology, Rhode Island Hospital, Providence; Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, Bethesda; Division of Cardiology, University of Florida, Gainesville; and Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles
| | - George Sopko
- Department of Human Genetics and Cardiovascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh; Department of Family and Preventive Medicine, University of Utah, Salt Lake City; Division of Cardiology, Rhode Island Hospital, Providence; Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, Bethesda; Division of Cardiology, University of Florida, Gainesville; and Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles
| | - Daniel F. Pauly
- Department of Human Genetics and Cardiovascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh; Department of Family and Preventive Medicine, University of Utah, Salt Lake City; Division of Cardiology, Rhode Island Hospital, Providence; Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, Bethesda; Division of Cardiology, University of Florida, Gainesville; and Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles
| | - C. Noel Bairey Merz
- Department of Human Genetics and Cardiovascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh; Department of Family and Preventive Medicine, University of Utah, Salt Lake City; Division of Cardiology, Rhode Island Hospital, Providence; Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, Bethesda; Division of Cardiology, University of Florida, Gainesville; and Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles
| | - M. Ilyas Kamboh
- Department of Human Genetics and Cardiovascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh; Department of Family and Preventive Medicine, University of Utah, Salt Lake City; Division of Cardiology, Rhode Island Hospital, Providence; Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, Bethesda; Division of Cardiology, University of Florida, Gainesville; and Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles
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Reis SE, Olson MB, Fried L, Reeser V, Mankad S, Pepine CJ, Kerensky R, Merz CNB, Sharaf BL, Sopko G, Rogers WJ, Holubkov R. Mild renal insufficiency is associated with angiographic coronary artery disease in women. Circulation 2002; 105:2826-9. [PMID: 12070108 DOI: 10.1161/01.cir.0000021597.63026.65] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mild renal insufficiency is associated with an increased risk for cardiovascular events in women with coronary artery disease (CAD). However, the relationship between mild renal insufficiency and atherosclerotic CAD in women is not known. Methods and Results- Women with chest pain who were referred for coronary angiography in the NHLBI Women's Ischemia Syndrome Evaluation (WISE) study underwent quantitative coronary angiography, blood measurements of creatinine, lipids, and homocysteine, and assessment of CAD risk factors. Fifty-six women had mild renal insufficiency (serum creatinine 1.2 to 1.9 mg/dL), and 728 had normal renal function (creatinine <1.2 mg/dL). Creatinine correlated with angiographic CAD severity score (r=0.11, P<0.004) and maximum coronary artery stenosis (r=0.11, P<0.003). Compared with women with normal renal function, those with mild renal insufficiency were more likely to have significant angiographic CAD (>/=50% diameter stenosis in >/=1 coronary artery) (61% versus 37%; P<0.001) and CAD in multiple vessels (P<0.001 for association) and had greater maximum percent diameter coronary stenosis (59+/-35% versus 38+/-36%; P<0.001). Mild renal insufficiency was associated with significant angiographic CAD independent of age and risk factors (OR=1.9, 95%CI=1.1 to 3.5). After controlling for homocysteine in 509 women, mild renal insufficiency remained predictive of CAD (OR=3.2, 95%CI=1.4 to 7.2). CONCLUSIONS In women with chest pain, mild renal insufficiency is an independent predictor of significant angiographic CAD. Mildly increased serum creatinine is probably a marker for unmeasured proatherogenic factors.
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Affiliation(s)
- Steven E Reis
- Cardiovascular Institute, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
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Mosca LJ. Contemporary management of hyperlipidemia in women. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 2002; 11:423-32. [PMID: 12165159 DOI: 10.1089/15246090260137590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this paper is to review prospective, large-scale studies of lipid-lowering therapy and hormone replacement therapy, and to provide clinical recommendations for the management of hyperlipidemia in women within the context of the revised National Cholesterol Education Program (NCEP) guidelines. METHODS Recent English language literature derived from a MEDLINE search (January 1990-July 2001) and bibliographies of relevant papers were reviewed, and data were abstracted from identified papers. RESULTS Hyperlipidemia is largely undertreated in women. Previously, hormone replacement therapy (HRT) was considered first-line treatment for the management of hypercholesterolemia to prevent coronary artery disease (CAD) in women. Recent studies, however, show no benefit of HRT for secondary prevention of coronary events, despite its beneficial effects on lipids. Large-scale, controlled clinical trials indicate that women, even those with only moderately elevated cholesterol, benefit from the lipid-lowering effects of statins for both high-risk primary and secondary prevention of CAD. Based on this evidence, the recently revised NCEP guidelines recommend statins as first-line therapy for women with hyperlipidemia, an approach that is supported by the American Heart Association and the American College of Cardiology. With its emphasis on aggressive intervention for persons with multiple risk factors, the new guidelines substantially increase the number of women eligible for pharmacological therapy. CONCLUSIONS All women with hyperlipidemia should receive counseling regarding lifestyle approaches for lowering cholesterol. The decision to use HRT should be made in the context of other conditions hormones may affect. Alternative hormonal regimens for lipid management may include selective estrogen receptor modulators and phytoestrogens, but results of randomized clinical trials are necessary before firm recommendations can be made regarding their clinical value in preventing CAD.
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Affiliation(s)
- Lori J Mosca
- Preventive Cardiology Program, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY10032, USA.
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