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García-Camarero T, Remuzgo-Martínez S, Genre F, López-Mejías R, Pulito-Cueto V, Veiga G, Lee Hwang DH, Sáinz Laso F, Gil Ongay A, González-Gay MÁ, de la Torre Hernández JM. Serum and genetic markers related to rapid clinical progression of coronary artery disease. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:1013-1020. [PMID: 37201714 DOI: 10.1016/j.rec.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION AND OBJECTIVES Patients with clinically evident coronary artery disease differ in their rate of progression, which impacts prognosis. We aimed to characterize serum and genetic markers in patients with rapid clinical progression (RCP) of coronary artery disease vs those with long standing stable (LSS) disease. METHODS Retrospective study of cases (RCP) and controls (LSS) (1:2). Patients requiring ≥ 2 revascularizations due to atherosclerotic progression in the 10 years after a first angioplasty were considered to be RCP and those without events during the same period after the first angioplasty were considered to have LSS disease. After patient selection, we analyzed serum values, mRNA expression and genetic polymorphisms of inflammatory markers, including interleukin-6, C-reactive protein, and tumor necrosis factor (TNF)-a, and atherogenic markers consisted of proprotein convertase subtilisin/kexin type 9 (PCSK9), low-density lipoprotein receptor, sterol regulatory element binding transcription factor 2, and apolipoprotein-B. RESULTS The study included 180 patients (58 RCP and 122 LSS). Demographic characteristics, classic risk factors and the extent of coronary disease were similar in the 2 groups. Patients with RCP showed higher serum levels of interleukin-6 and PCSK9 and higher TNF mRNA expression. Interleukin-6 rs180075C, TNF rs3093664 non-G and PCSK9 rs2483205 T alleles conferred a risk of RCP (P<.05 in all cases). Among patients with RCP, 51.7% had all 3 risk alleles vs 18% of those with LSS (P<.001). CONCLUSIONS We suggest the existence of specific phenotypic and genotypic markers associated with RCP of coronary artery disease that could help to individualize the type and intensity of treatment.
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Affiliation(s)
- Tamara García-Camarero
- Departamento de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla, Santander, Cantabria, Spain.
| | | | - Fernanda Genre
- Instituto de Investigación Valdecilla, Santander, Cantabria, Spain
| | | | | | - Gabriela Veiga
- Departamento de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla, Santander, Cantabria, Spain
| | - Dae-Hyun Lee Hwang
- Departamento de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla, Santander, Cantabria, Spain
| | - Fermín Sáinz Laso
- Departamento de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla, Santander, Cantabria, Spain
| | - Aritz Gil Ongay
- Departamento de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla, Santander, Cantabria, Spain
| | - Miguel Ángel González-Gay
- Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain; Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - José M de la Torre Hernández
- Departamento de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla, Santander, Cantabria, Spain
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Cederström S, Lundman P, Alfredsson J, Hagström E, Ravn-Fischer A, Söderberg S, Yndigegn T, Tornvall P, Jernberg T. Association between high-sensitivity C-reactive protein and coronary atherosclerosis in a general middle-aged population. Sci Rep 2023; 13:12171. [PMID: 37500663 PMCID: PMC10374905 DOI: 10.1038/s41598-023-39051-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
Despite abundant knowledge about the relationship between inflammation and coronary atherosclerosis, it is still unknown whether systemic inflammation measured as high-sensitivity C-reactive protein (hsCRP) is associated with coronary atherosclerosis in a general population. This study aimed to examine the association between hsCRP and coronary computed tomography angiography (CCTA)-detected coronary atherosclerosis in a population-based cohort. Out of 30,154 randomly invited men and women aged 50 to 64 years in the Swedish Cardiopulmonary Bioimage Study (SCAPIS), 25,408 had a technically acceptable CCTA and analysed hsCRP. Coronary atherosclerosis was defined as presence of plaque of any degree in any of 18 coronary segments. HsCRP values were categorised in four groups. Compared with hsCRP below the detection limit, elevated hsCRP (≥ 2.3 mg/L) was weakly associated with any coronary atherosclerosis (OR 1.15, 95% CI 1.07-1.24), coronary diameter stenosis ≥ 50% (OR 1.27, 95% CI 1.09-1.47), ≥ 4 segments involved (OR 1.13, 95% CI 1.01-1.26 ) and severe atherosclerosis (OR 1.33, 95% CI 1.05-1.69) after adjustment for age, sex and traditional risk factors. The associations were attenuated after further adjustment for body mass index (BMI), although elevated hsCRP still associated with noncalcified plaques (OR 1.16, 95% CI 1.02-1.32), proposed to be more vulnerable. In conclusion, the additional value of hsCRP to traditional risk factors in detection of coronary atherosclerosis is low. The association to high-risk noncalcified plaques, although unlikely through a causal pathway, could explain the relationship between hsCRP and clinical coronary events in numerous studies.
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Affiliation(s)
- Sofia Cederström
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Pia Lundman
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Alfredsson
- Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Annica Ravn-Fischer
- Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden
| | - Troels Yndigegn
- Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Yazdani AN, Pletsch M, Chorbajian A, Zitser D, Rai V, Agrawal DK. Biomarkers to monitor the prognosis, disease severity, and treatment efficacy in coronary artery disease. Expert Rev Cardiovasc Ther 2023; 21:675-692. [PMID: 37772751 PMCID: PMC10615890 DOI: 10.1080/14779072.2023.2264779] [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: 06/09/2023] [Accepted: 09/26/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Coronary Artery Disease (CAD) is a prevalent condition characterized by the presence of atherosclerotic plaques in the coronary arteries of the heart. The global burden of CAD has increased significantly over the years, resulting in millions of deaths annually and making it the leading health-care expenditure and cause of mortality in developed countries. The lack of cost-effective strategies for monitoring the prognosis of CAD warrants a pressing need for accurate and efficient markers to assess disease severity and progression for both reducing health-care costs and improving patient outcomes. AREA COVERED To effectively monitor CAD, prognostic biomarkers and imaging techniques play a vital role in risk-stratified patients during acute treatment and over time. However, with over 1,000 potential markers of interest, it is crucial to identify the key markers with substantial utility in monitoring CAD progression and evaluating therapeutic interventions. This review focuses on identifying and highlighting the most relevant markers for monitoring CAD prognosis and disease severity. We searched for relevant literature using PubMed and Google Scholar. EXPERT OPINION By utilizing the markers discussed, health-care providers can improve patient care, optimize treatment plans, and ultimately reduce health-care costs associated with CAD management.
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Affiliation(s)
- Armand N. Yazdani
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766
| | - Michaela Pletsch
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766
| | - Abraham Chorbajian
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766
| | - David Zitser
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766
| | - Vikrant Rai
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766
| | - Devendra K. Agrawal
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766
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Ohnishi N, Shiga Y, Tashiro K, Kawahira Y, Shibata Y, Inoue H, Morii J, Nishikawa H, Kato Y, Kuwano T, Sugihara M, Miura SI. Association between major adverse cardiovascular events and pentraxin-3 in patients who have undergone coronary computed tomography angiography: from the FU-CCTA registry. Heart Vessels 2023; 38:309-317. [PMID: 36169707 DOI: 10.1007/s00380-022-02171-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/31/2022] [Indexed: 02/07/2023]
Abstract
Chronic vasculitis is considered to be associated with future cardiovascular events. Here, we present major cardiovascular events (MACEs) in patients who underwent coronary computed tomography angiography (CCTA) for screening for coronary artery disease (CAD), and the association between MACEs and the inflammation marker pentraxin (PTX)-3 or highly sensitive C-reactive protein (hsCRP). The patients who underwent CCTA for the purpose of screening for CAD at Fukuoka University Hospital (FU-CCTA registry), 456 patients with suspected CAD or at least one cardiovascular risk factor were followed for up to 5 years. The levels of PTX-3 and hsCRP in blood were measured at the time of CCTA, and the patients were divided into two groups according to the presence (MACEs group) or absence (non-MACEs group) of MACEs. There were no differences in PTX-3 or hsCRP between the MACEs (-) and MACEs ( +) groups in all patients. A multivariate analysis related to the presence or absence of MACEs by logistic regression analysis of inflammation factors (PTX-3 and hsCRP) in addition to conventional risk factors as independent variables was performed. PTX-3 was a predictor of MACEs in males, whereas smoking, but not PTX-3, was a predictor of MACEs in females. PTX-3 could be a predictor of MACEs in males, but not females.
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Affiliation(s)
- Natsuki Ohnishi
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.,Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kohei Tashiro
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yuto Kawahira
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yuuka Shibata
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hiroko Inoue
- Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan
| | - Joji Morii
- Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan
| | - Hiroaki Nishikawa
- Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan
| | - Yuta Kato
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Makoto Sugihara
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan. .,Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan.
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Kelesoglu S, Yilmaz Y, Elcik D, Bireciklioglu F, Ozdemir F, Balcı F, Tuncay A, Kalay N. Increased Serum Systemic Immune-Inflammation Index is Independently Associated With Severity of Carotid Artery Stenosis. Angiology 2022:33197221144934. [DOI: 10.1177/00033197221144934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Stroke is a significant contributor to morbidity and mortality. The present study investigated how the systemic immune inflammation index (SII) could be used to predict the likelihood of developing carotid artery stenosis (CAS), which can be seen using carotid artery angiography (CAAG). This study comprised 418 individuals who underwent CAAG for CAS. SII was calculated by multiplying the platelet count by the neutrophil/lymphocyte ratio (NLR). The patients were divided into two groups: non-critical and critical CAS (stenosis below %70 and above ≥70%, respectively). Compared with the non-critical CAS, the critical CAS group had greater high sensitivity C-reactive protein levels (4.5 [3.1-5.7] vs 3.9 [2-5] [mg/L], P < .001), NLR (4.1 [2.9-7.5] vs 2.9 [1.8-3.7], P < .001), platelet/lymphocyte ratio (233 [110-297] vs 119 [96-197], P < .001), and SII (860 [608-2455] vs 604 [458-740], P < .001). Receiver Operating Characteristic Curve analysis demonstrated the best cutoff value of 672.3 for SII to predict the critical CAS with 71.2% sensitivity and 60.1% specificity. According to our study, an increase in SII is an independent predictor of the severity of CAS in patients undergoing CAAG.
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Affiliation(s)
- Saban Kelesoglu
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Yucel Yilmaz
- Department of Cardiology, Kayseri City Hospital, Kayseri, Turkey
| | - Deniz Elcik
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
- Department of Cardiovascular Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Fehmi Bireciklioglu
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Fatma Ozdemir
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Fatih Balcı
- Department of Anesthesiology and Reanimation, Kayseri City Hospital, Kayseri, Turkey
| | - Aydin Tuncay
- Department of Cardiovascular Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Nihat Kalay
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
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Wu X, Guo M, Shi S, Shi S, Deng Y, Wang S, Wang Y, Wang P, Chen K. Efficacy and Safety of Shenqisuxin Granule for Non-ST-segment Elevation Acute Coronary Syndrome: Study Protocol for a Randomized, Double-Blinded, Placebo-Controlled Trial. Front Cardiovasc Med 2022; 9:888724. [PMID: 35757330 PMCID: PMC9218484 DOI: 10.3389/fcvm.2022.888724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The Chinese herbal compound formula, Shenqisuxin granule (SQSX), promotes neovascularization and prevents in-stent restenosis in modern pharmaceutical studies and is expected to provide an effective strategy for non-ST-segment elevation acute coronary syndrome (NSTEACS). Thus, this study aims to examine the efficacy and safety of SQSX for NSTEACS and initially reveal its mechanism. Methods/Design The study is a randomized, double-blinded and placebo-controlled trial. A total of 66 participants will be randomly allocated to one of the following two groups. Participants in the SQSX group will receive conventional treatment plus SQSX, while the placebo group will receive conventional treatment plus placebo, both for 14 days. The primary outcome, hs-CRP, and secondary outcome the Seattle Angina Questionnaire (SAQ) will be assessed at baseline, 7 ± 3 days and 14 ± 3 days. At all visit windows, other indicators including creatine kinase (CK), creatine kinase-myocardial band (CK-MB), cardiac troponins I (cTnI), 12-lead electrocardiograph and the syndrome scores of Qi deficiency and blood stasis will be tested and metagenomic sequencing for intestinal flora will be performed. Echocardiography and safety assessment will be performed at baseline and 14 ± 3 days. Adverse events will be monitored during the trial. Discussion The purpose of the study is to examine the efficacy and safety of SQSX to improve NSTEACS and initially reveal its mechanism. Trial Registration China Clinical Trial Registry, ChiCTR2000029226. Registered on January 19, 2020.
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Affiliation(s)
- Xiaoping Wu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ming Guo
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shihua Shi
- Department of Geriatric, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
| | - Shengnan Shi
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanping Deng
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shenglan Wang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yabing Wang
- Department of Psychiatry and Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - Peili Wang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Peili Wang
| | - Keji Chen
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Keji Chen
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Mannarino MR, Bianconi V, Gigante B, Strawbridge RJ, Savonen K, Kurl S, Giral P, Smit A, Eriksson P, Tremoli E, Veglia F, Baldassarre D, Pirro M. Neutrophil to lymphocyte ratio is not related to carotid atherosclerosis progression and cardiovascular events in the primary prevention of cardiovascular disease: Results from the IMPROVE study. Biofactors 2022; 48:100-110. [PMID: 34761838 PMCID: PMC9299016 DOI: 10.1002/biof.1801] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/21/2021] [Indexed: 12/11/2022]
Abstract
Inflammation is a component of the pathogenesis of atherosclerosis and is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). The neutrophil to lymphocyte ratio (NLR) is a possible inflammation metric for the detection of ASCVD risk, although results of prospective studies are highly inconsistent on this topic. We investigated the cross-sectional relationship between NLR and carotid intima-media thickness (cIMT) in subjects at moderate-to-high ASCVD risk. The prospective association between NLR, cIMT progression, and incident vascular events (VEs) was also explored. In 3341 subjects from the IMT-Progression as Predictors of VEs (IMPROVE) study, we analyzed the association between NLR, cIMT, and its 15-month progression. The association between NLR and incident VEs was also investigated. NLR was positively associated with cross-sectional measures of cIMT, but not with cIMT progression. The association between NLR and cross-sectional cIMT measures was abolished when adjusted for confounders. No association was found between NRL and incident VEs. Similarly, there were no significant differences in the hazard ratios (HRs) of VEs across NLR quartiles. NLR was neither associated with the presence and progression of carotid atherosclerosis, nor with the risk of VEs. Our findings do not support the role of NLR as a predictor of the risk of atherosclerosis progression and ASCVD events in subjects at moderate-to-high ASCVD risk, in primary prevention. However, the usefulness of NLR for patients at a different level of ASCVD risk cannot be inferred from this study.
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Affiliation(s)
- Massimo R. Mannarino
- Unit of Internal Medicine, Department of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Vanessa Bianconi
- Unit of Internal Medicine, Department of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Bruna Gigante
- Division of Cardiovascular Medicine, Department of Medicine, SolnaKarolinska InstitutetStockholmSweden
| | - Rona J. Strawbridge
- Division of Cardiovascular Medicine, Department of Medicine, SolnaKarolinska InstitutetStockholmSweden
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
- Health Data Research UKGlasgowUK
| | - Kai Savonen
- Foundation for Research in Health Exercise and NutritionKuopio & Research Institute of Exercise MedicineKuopioFinland
- Department of Clinical Physiology and Nuclear MedicineKuopio University HospitalKuopioFinland
| | - Sudhir Kurl
- Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
| | - Philippe Giral
- Assistance Publique ‐ Hopitaux de ParisParisFrance
- Service Endocrinologie‐Metabolisme, Groupe Hôspitalier Pitie‐SalpetriereUnités de Prévention CardiovasculaireParisFrance
| | - Andries Smit
- Department of MedicineUniversity Medical Center GroningenGroningenthe Netherlands
- Department of MedicineIsala Clinics ZwolleZwolleThe Netherlands
| | - Per Eriksson
- Division of Cardiovascular Medicine, Department of Medicine, SolnaKarolinska InstitutetStockholmSweden
| | | | | | - Damiano Baldassarre
- Centro Cardiologico Monzino, IRCCSMilanItaly
- Department of Medical Biotechnology and Translational MedicineUniversità degli Studi di MilanoMilanItaly
| | - Matteo Pirro
- Unit of Internal Medicine, Department of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
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Zhang X, Cheng M, Gao N, Li Y, Yan C, Tian X, Liu D, Qiu M, Wang X, Luan B, Deng J, Wang S, Tian H, Wang G, Ma X, Stone GW, Han Y. Utility of S100A12 as an Early Biomarker in Patients With ST-Segment Elevation Myocardial Infarction. Front Cardiovasc Med 2021; 8:747511. [PMID: 34977174 PMCID: PMC8718434 DOI: 10.3389/fcvm.2021.747511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/22/2021] [Indexed: 01/16/2023] Open
Abstract
Importance: S100A12 is a calcium binding protein which is involved in inflammation and progression of atherosclerosis.Objective: We sought to investigate the utility of S100A12 as a biomarker for the early diagnosis and prognostication of patients presenting with ST-segment elevation myocardial infarction (STEMI).Design, Setting, and Participants: S100A12 was measured in 1023 patients presenting to the emergency department with acute chest pain between June 2012 and November 2015. An independent cohort of 398 patients enrolled at 3 different hospitals served as a validation cohort.Main Outcomes and Measures: The primary clinical endpoint of interest was major adverse cardiac and cerebral events (MACCE) defined as a composite of all-cause death, MI, stroke, or hospitalization for heart failure.Results: A total of 438/1023 patients (42.8%) in the diagnosis cohort were adjudicated as STEMI, among whom plasma S100A12 levels increased within 30 min and peaked 1–2 h after symptom onset. Compared with high-sensitivity cardiac troponin T and creatine kinase-MB isoenzyme, S100A12 more accurately identified STEMI, especially within the first 2 h after symptom onset (area under the curve 0.963 compared with 0.860 for hscTnT and 0.711 for CK-MB, both P < 0.05). These results were consistent in the 243-patient validation cohort. The 1-year rate of MACCE was greatest in patients in the highest peak S100A12 tertile, intermediate in the middle tertile and least in the lowest tertile (9.3 vs. 5.7 vs. 3.0% respectively, Ptrend = 0.0006). By multivariable analysis the peak plasma concentration of S100A12 was an independent predictor of MACCE within 1 year after STEMI (HR, 1.001, 95%CI, 1.000–1.002; P = 0.0104).Conclusions and Relevance: S100A12 rapidly identified patients with STEMI, more accurately than other cardiac biomarkers, especially within the first 2 h after symptom onset. The peak plasma S100A12 level was a strong predictor of 1-year prognosis after STEMI.
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Affiliation(s)
- Xiaolin Zhang
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Minghui Cheng
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Naijing Gao
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Yi Li
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Chenghui Yan
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaoxiang Tian
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Dan Liu
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Miaohan Qiu
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaozeng Wang
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Bo Luan
- Department of Cardiology, Liaoning Provincial People's Hospital, Shenyang, China
| | - Jie Deng
- Department of Cardiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shouli Wang
- Department of Cardiology, General Hospital of the Strategic Support Force of the Chinese People's Liberation Army, Beijing, China
| | - Hongyan Tian
- Department of Cardiology First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Geng Wang
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Xinliang Ma
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States
| | - Gregg W. Stone
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart and the Cardiovascular Research Foundation, New York, NY, United States
| | - Yaling Han
- Cardiovascular Research Institute and Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
- *Correspondence: Yaling Han
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Arroyo-Espliguero R, Viana-Llamas MC, Silva-Obregón A, Avanzas P. The Role of C-reactive Protein in Patient Risk Stratification and Treatment. Eur Cardiol 2021; 16:e28. [PMID: 34276813 PMCID: PMC8280753 DOI: 10.15420/ecr.2020.49] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/15/2021] [Indexed: 11/09/2022] Open
Abstract
Atherosclerosis is a chronic inflammatory disease. Several circulating inflammatory markers have been proposed for clinical use due to their ability to predict future cardiovascular events and may be useful for identifying people at high risk who might benefit from specific treatment to reduce this risk. Moreover, the identification of new therapeutic targets will allow the development of drugs that can help reduce the high residual risk of recurrence of cardiovascular events in patients with coronary artery disease. The clinical benefits of reducing recurrent major cardiovascular events recently shown by canakinumab and colchicine have renewed the cardiology community’s interest in inflammation as an aetiopathogenic mechanism for atherosclerosis. This review explores the use of C-reactive protein, which is the most frequently studied biomarker in this context; the concept of residual risk in primary and secondary cardiovascular prevention; and the current recommendations in international guidelines regarding the role of this inflammatory biomarker in cardiovascular risk stratification.
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Affiliation(s)
| | - María C Viana-Llamas
- Department of Cardiology, Hospital Universitario de Guadalajara Guadalajara, Spain
| | - Alberto Silva-Obregón
- Department of Intensive Medicine, Hospital Universitario de Guadalajara Guadalajara, Spain
| | - Pablo Avanzas
- Department of Cardiology, Hospital Universitario Central de Asturias Oviedo, Spain.,Department of Medicine, Universidad de Oviedo Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias Oviedo, Spain
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10
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van den Berg VJ, Umans VAWM, Brankovic M, Oemrawsingh RM, Asselbergs FW, van der Harst P, Hoefer IE, Kietselaer B, Crijns HJGM, Lenderink T, Oude Ophuis AJ, van Schaik RH, Kardys I, Boersma E, Akkerhuis KM. Stabilization patterns and variability of hs-CRP, NT-proBNP and ST2 during 1 year after acute coronary syndrome admission: results of the BIOMArCS study. Clin Chem Lab Med 2021; 58:2099-2106. [PMID: 32383686 DOI: 10.1515/cclm-2019-1320] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/13/2020] [Indexed: 11/15/2022]
Abstract
Objectives Details of the biological variability of high-sensitivity C-reactive protein (hs-CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and ST2 are currently lacking in patients with acute coronary syndrome (ACS) but are crucial knowledge when aiming to use these biomarkers for personalized risk prediction. In the current study, we report post-ACS kinetics and the variability of the hs-CRP, NT-proBNP and ST2. Methods BIOMArCS is a prospective, observational study with high frequency blood sampling during 1 year post-ACS. Using 1507 blood samples from 191 patients that remained free from adverse cardiac events, we investigated post-ACS kinetics of hs-CRP, NT-proBNP and ST2. Biological variability was studied using the samples collected between 6 and 12 months after the index ACS, when patients were considered to have stable coronary artery disease. Results On average, hs-CRP rose peaked at day 2 and rose well above the reference value. ST2 peaked immediately after the ACS but never rose above the reference value. NT-proBNP level rose on average during the first 2 days post-ACS and slowly declined afterwards. The within-subject variation and relative change value (RCV) of ST2 were relatively small (13.8%, RCV 39.7%), while hs-CRP (41.9%, lognormal RCV 206.1/-67.3%) and NT-proBNP (39.0%, lognormal RCV 185.2/-64.9%) showed a considerable variation. Conclusions Variability of hs-CRP and NT-proBNP within asymptomatic and clinically stable post-ACS patients is considerable. In contrast, within-patient variability of ST2 is low. Given the low within-subject variation, ST2 might be the most useful biomarker for personalizing risk prediction in stable post-ACS patients.
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Affiliation(s)
- Victor J van den Berg
- Erasmus University Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Milos Brankovic
- Erasmus University Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands
| | - Rohit M Oemrawsingh
- Erasmus University Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands
| | - Folkert W Asselbergs
- Netherlands Heart Institute, Utrecht, The Netherlands.,University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim van der Harst
- Netherlands Heart Institute, Utrecht, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
| | - Imo E Hoefer
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | - Anton J Oude Ophuis
- Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Working Group on Cardiovascular Research the Netherlands (WCN), Utrecht, The Netherlands
| | - Ron H van Schaik
- Erasmus University Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands
| | - Isabella Kardys
- Erasmus University Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands
| | - Eric Boersma
- Erasmus University Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands.,Erasmus MC, Department of Cardiology, Room Na 342, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - K Martijn Akkerhuis
- Erasmus University Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, The Netherlands
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11
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Tsou MT, Yun CH, Lin JL, Sung KT, Tsai JP, Huang WH, Liu CY, Hou CJY, Tsai IH, Su CH, Hung CL, Hung TC. Visceral Adiposity, Pro-Inflammatory Signaling and Vasculopathy in Metabolically Unhealthy Non-Obesity Phenotype. Diagnostics (Basel) 2020; 11:E40. [PMID: 33383705 PMCID: PMC7824214 DOI: 10.3390/diagnostics11010040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 12/17/2022] Open
Abstract
The debate regarding the actual cardiovascular burden in metabolically healthy obese or metabolically unhealthy non-obesity individuals is ongoing. Accumulating data have suggested a unique pathophysiological role of pro-inflammatory cytokines in mediating metabolic and cardiovascular disorders by dysregulated visceral adiposity. To compare the burden of visceral adiposity, the inflammatory marker high-sensitivity C-reactive protein (hs-CRP) and the prevalent atherosclerotic burden in metabolically healthy obese (MHO) or metabolically unhealthy (MU) populations, were compared to those of metabolically healthy non-obesity subjects (MHNO). Coronary artery calcification score (CACS) and visceral fat, including pericardial fat (PCF)/thoracic peri-aortic fat (TAT), were quantified in 2846 asymptomatic subjects using a CT dataset. A cross-sectional analysis comparing CACS, inflammatory marker hs-CRP, and visceral fat burden among four obesity phenotypes (MHNO, metabolically unhealthy non-obesity (MUNO), MHO, and metabolically unhealthy obese (MUO)) was performed. Both MUNO and MUO demonstrated significantly higher hs-CRP and greater CACS than MHNO/MHO (adjusted coefficient: 25.46, 95% confidence interval (CI): 5.29-45.63; 43.55, 95% CI: 23.38-63.73 for MUNO and MUO (MHNO as reference); both p < 0.05). Visceral fat (PCF/TAT) was an independent determinant of MU and was similarly higher in the MUNO/MHO groups than in the MHNO group, with the MUO group having the largest amount. PCF/TAT, obesity, and MU remained significantly associated with higher CACS even after adjustment, with larger PCF/TAT modified effects for MU and diabetes in CACS (both pinteraction < 0.05). MU tightly linked to excessive visceral adiposity was a strong and independent risk factor for coronary atherosclerosis even in lean individuals, which could be partially explained by its coalignment with pathological pro-inflammatory signaling.
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Affiliation(s)
- Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
- Department of Nursing, Mackay Junior College of Medicine, Nursing and Management, New Taipei 25245, Taiwan
| | - Chun-Ho Yun
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Department of Radiology, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Jiun-Lu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
| | - Kuo-Tzu Sung
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Jui-Peng Tsai
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Wen-Hung Huang
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Chia-Yuan Liu
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Charles Jia-Yin Hou
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - I.-Hsien Tsai
- Nutritional Medicine Center, MacKay Memorial Hospital, Taipei 10449, Taiwan;
| | - Cheng-Huang Su
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Institute of Biomedical Sciences, Mackay Medical College, New Taipei 25245, Taiwan
| | - Ta-Chuan Hung
- Department of Nursing, Mackay Junior College of Medicine, Nursing and Management, New Taipei 25245, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan; (C.-H.Y.); (K.-T.S.); (J.-P.T.); (W.-H.H.); (C.-Y.L.); (C.J.-Y.H.); (C.-H.S.)
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
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12
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Dekker M, Waissi F, Timmerman N, Silvis MJM, Timmers L, de Kleijn DPV. Extracellular Vesicles in Diagnosing Chronic Coronary Syndromes the Bumpy Road to Clinical Implementation. Int J Mol Sci 2020; 21:E9128. [PMID: 33266227 PMCID: PMC7729611 DOI: 10.3390/ijms21239128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 12/15/2022] Open
Abstract
Coronary artery disease (CAD), comprising both acute coronary syndromes (ACS) and chronic coronary syndromes (CCS), remains one of the most important killers throughout the entire world. ACS is often quickly diagnosed by either deviation on an electrocardiogram or elevated levels of troponin, but CCS appears to be more complicated. The most used noninvasive strategies to diagnose CCS are coronary computed tomography and perfusion imaging. Although both show reasonable accuracy (80-90%), these modalities are becoming more and more subject of debate due to costs, radiation and increasing inappropriate use in low-risk patients. A reliable, blood-based biomarker is not available for CCS but would be of great clinical importance. Extracellular vesicles (EVs) are lipid-bilayer membrane vesicles containing bioactive contents e.g., proteins, lipids and nucleic acids. EVs are often referred to as the "liquid biopsy" since their contents reflect changes in the condition of the cell they originate from. Although EVs are studied extensively for their role as biomarkers in the cardiovascular field during the last decade, they are still not incorporated into clinical practice in this field. This review provides an overview on EV biomarkers in CCS and discusses the clinical and technological aspects important for successful clinical application of EVs.
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Affiliation(s)
- Mirthe Dekker
- Department of Vascular Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (M.D.); (F.W.); (N.T.)
- Department of Cardiology, Amsterdam University Medical Centre, Mijbergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Farahnaz Waissi
- Department of Vascular Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (M.D.); (F.W.); (N.T.)
- Department of Cardiology, Amsterdam University Medical Centre, Mijbergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Nathalie Timmerman
- Department of Vascular Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (M.D.); (F.W.); (N.T.)
| | - Max J. M. Silvis
- Department of Cardiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Leo Timmers
- Department of Cardiology, St. Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands;
| | - Dominique P. V. de Kleijn
- Department of Vascular Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (M.D.); (F.W.); (N.T.)
- Netherlands Heart Institute, 3511 EP Utrecht, The Netherlands
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13
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Jia RF, Li L, Li H, Cao XJ, Ruan Y, Meng S, Wang JY, Jin ZN. Meta-analysis of C-Reactive Protein and Risk of Angina Pectoris. Am J Cardiol 2020; 125:1039-1045. [PMID: 32014245 DOI: 10.1016/j.amjcard.2020.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/29/2019] [Accepted: 01/03/2020] [Indexed: 11/16/2022]
Abstract
Associations between elevated C-reactive protein (CRP) levels and the angina pectoris risk have been reported for many years, but the results remain controversial. To address this issue, a meta-analysis was therefore conducted. Eligible studies were identified by searching PubMed, EMBASE, Cochrane library, and web of science up to January 2019. Altogether, 10 prospective cohort studies and 11 case-control studies were included, and they were published from 1997 to 2013 and summed up to 18,316 samples totally. The pooled mean difference of CRP levels was 4.44 (95% confidence interval 2.71 to 6.17) between angina patients and healthy controls. The combined odds ratio of CRP for major adverse cardiac events in angina patients was 1.67 (95% CI 1.23 to 2.26). In conclusion, the meta-analysis indicated that elevated CRP levels were associated with angina pectoris, especially unstable angina pectoris, and were probably a risk factor of major adverse cardiac events.
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Affiliation(s)
- Ruo-Fei Jia
- Department of Cardiovascular, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Long Li
- Department of Cardiovascular, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong Li
- Department of Cardiovascular, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Jing Cao
- Department of Cardiovascular, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Ruan
- Department of Cardiovascular, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuai Meng
- Department of Cardiovascular, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jia-Yu Wang
- Department of Cardiovascular, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ze-Ning Jin
- Department of Cardiovascular, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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14
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Cappelletti A, Astore D, Godino C, Bellini B, Magni V, Mazzavillani M, Pagnesi M, Agricola E, Chiesa R, Colombo A, Margonato A. Relationship between Syntax Score and prognostic localization of coronary artery lesions with conventional risk factors, plasma profile markers, and carotid atherosclerosis (CAPP Study 2). Int J Cardiol 2018; 257:306-311. [PMID: 29506713 DOI: 10.1016/j.ijcard.2017.12.012] [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: 10/13/2017] [Accepted: 12/05/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data concerning the relationship between cardiovascular risk factors, plasmatic markers, carotid disease and extent of coronary lesions are lacking. OBJECTIVES To evaluate the role of cardiovascular risk factors, plasmatic levels of high sensitivity C-reactive protein (hs-CRP), fibrinogen, lipoprotein(a), and carotid plaque extension in predicting the severity of coronary artery disease (CAD). METHODS We analyzed 574 subjects undergoing first coronary angiography. For angiographic analysis, we used the Syntax Score and we defined the prognostic localization of CAD as a critical stenosis of the left main and/or proximal segment of left anterior descending artery. Levels of hs-CRP >3mg/L, lipoprotein(a) plasma levels >30mg/dL and plasma fibrinogen >300mg/dL were considered critical. Significant carotid disease (SCD) was defined by the presence of lesions producing a 50% diameter stenosis with a peak systolic velocity >125cm/s. A mean carotid intima media thickness (IMT) >0.9mm was considered abnormal. RESULTS In the adjusted analysis the presence of SCD was found to be an independent predictor of high Syntax Score (p<0.001), while high fibrinogen levels were independently associated with the presence of CAD in prognostic localization (p=0.04). In the sub-group of patients without SCD, IMT >0.9mm was found to be an independent predictor of the presence of CAD (p<0.001). CONCLUSIONS SCD strongly predicts high Syntax Score, while IMT shows excellent positive predictive value for the presence of CAD. In addition, high plasma fibrinogen levels are associated with coronary stenoses in prognostic localization.
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Affiliation(s)
- Alberto Cappelletti
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy.
| | - Domenico Astore
- Department of Vascular Surgery, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Cosmo Godino
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Barbara Bellini
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Valeria Magni
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Monica Mazzavillani
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Matteo Pagnesi
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Eustachio Agricola
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Antonio Colombo
- Department of Interventional Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Alberto Margonato
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
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15
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Payne GA, Overton ET. The hidden risk: Incorporating inflammation and HIV serostatus into coronary artery disease screening. J Nucl Cardiol 2018; 25:884-886. [PMID: 27853986 DOI: 10.1007/s12350-016-0731-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 11/03/2016] [Indexed: 10/20/2022]
Abstract
CAD is a well-established comorbidity associated with HIV infection. This association is in large part due to ongoing inflammation propagated by viremia and dysregulation of the immune system. Despite this knowledge, evidence to guide clinical management and screening for CAD among HIV-infected patients is lacking. The following editorial discusses recent evidence that HIV-infected patients with abnormal cardiovascular stress testing are more likely to undergo subsequent percutaneous coronary intervention. Importantly, the cardiovascular consequences of HIV infection and potential clinical implications are discussed.
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Affiliation(s)
- Gregory A Payne
- Division of Cardiovascular Disease, University of Alabama at Birmingham, School of Medicine, Tinsley Harrison Tower, 1900 University Boulevard, Suite 311, Birmingham, AL 35233, USA.
| | - Edgar Turner Overton
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
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16
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Dan K, Miyoshi T, Nakahama M, Mizuno T, Kagawa K, Naito Y, Kawada S, Ito H. Impact of Chronic Kidney Disease on Cardiovascular and Renal Events in Patients Undergoing Percutaneous Coronary Intervention with Everolimus-Eluting Stent: Risk Stratification with C-Reactive Protein. Cardiorenal Med 2018; 8:151-159. [PMID: 29617004 DOI: 10.1159/000486971] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 01/18/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) and inflammation play critical roles in atherosclerosis. There is limited evidence regarding the relationship between CKD and patients receiving second-generation drug-eluting stents for coronary artery disease. OBJECTIVE This study aimed to investigate the effect of CKD on cardiovascular and renal events in patients undergoing percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES). METHODS We analyzed 504 consecutive patients with stable angina pectoris and significant coronary artery stenosis treated with EES. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 before coronary angiography. The primary outcome was the occurrence of major adverse renal and cardiovascular events (MARCE) including cardiac death, revascularization, heart failure, cerebral infarction, worsening renal function > 25% from baseline, and renal replacement therapy at 1 year. RESULTS Patients were divided into the a MARCE (n = 126) and a non-MARCE (n = 378) group. The incidence of CKD was 51% in all subjects (including those on hemodialysis) and was significantly higher in the MARCE group than in the non-MARCE group (p = 0.00001). Multivariate logistic regression analysis identified that CKD was independently associated with MARCE (adjusted odds ratio 2.03, 95% confidence interval 1.21-3.39, p = 0.007). Patients were divided into four groups based on CKD and C-reactive protein (CRP) level prior to initial coronary angiography. Cox proportional hazards analysis revealed that patients with CKD and high CRP (≥0.3 mg/dL) had the worst prognosis (hazard ratio 4.371, 95% confidence interval 2.634-7.252, p = 0.00001) compared to patients without CKD and with low CRP. CONCLUSION CKD combined with CRP predicted more clinical events in patients undergoing PCI with EES.
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Affiliation(s)
- Kazuhiro Dan
- Department of Cardiovascular Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Makoto Nakahama
- Department of Cardiovascular Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Tomofumi Mizuno
- Department of Cardiovascular Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Kenzo Kagawa
- Department of Cardiovascular Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Yoichiro Naito
- Department of Cardiovascular Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Satoshi Kawada
- Department of Cardiovascular Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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17
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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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18
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Larsen SB, Grove EL, Würtz M, Neergaard-Petersen S, Hvas AM, Kristensen SD. The influence of low-grade inflammation on platelets in patients with stable coronary artery disease. Thromb Haemost 2017; 114:519-29. [DOI: 10.1160/th14-12-1007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 05/07/2015] [Indexed: 12/19/2022]
Abstract
SummaryInflammation is likely to be involved in all stages of atherosclerosis. Numerous inflammatory biomarkers are currently being studied, and even subtle increases in inflammatory biomarkers have been associated with increased risk of cardiovascular events in patients with coronary artery disease (CAD). Low-grade inflammation may influence both platelet production and platelet activation potentially leading to enhanced platelet aggregation. Thrombopoietin is considered the primary regulator of platelet production, but it likely acts in conjunction with numerous cytokines, of which many have altered levels in CAD. Previous studies have shown that high-sensitive C-reactive protein (CRP) independently predicts increased platelet aggregation in stable CAD patients. Increased levels of CRP, fibrinogen, interleukin-6, stromal cell-derived factor-1, CXC motif ligand 16, macrophage migration inhibitory factor, RANTES, calprotectin, and copeptin have been associated with increased risk of cardiovascular events in CAD patients. Additionally, some of these inflammatory markers have been associated with enhanced platelet activation and aggregation. However, CRP and other inflammatory markers provide only limited additional predictive value to classical risk factors such as smoking, blood pressure, and cholesterol levels. Existing data do not clarify whether inflammation simply accompanies CAD and increased production and aggregation of platelets, or whether a causal relationship exists. In this review, we provide a comprehensive overview of inflammatory markers in stable CAD with particular emphasis on platelet production, activation, and aggregation in CAD patients.
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19
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Marini A, Naka KK, Vakalis K, Bechlioulis A, Bougiakli M, Giannitsi S, Nikolaou K, Antoniadou EI, Gartzonika C, Chasiotis G, Bairaktari E, Katsouras CS, Triantis G, Sionis D, Michalis LK. Extent of coronary artery disease in patients undergoing angiography for stable or acute coronary syndromes. Hellenic J Cardiol 2017; 58:115-121. [PMID: 28495650 DOI: 10.1016/j.hjc.2016.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 08/31/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND We aimed to investigate whether the angiographic extent of coronary artery disease (CAD) differs in patients undergoing coronary angiography for stable CAD or acute coronary syndrome (ACS) and identify predictors of CAD extent in these patients. METHODS We enrolled 584 consecutive patients (463 with stable CAD, 121 with ACS) with angiographically established CAD (≥1 stenosis >25%). The Gensini score was used to assess the extent of coronary atherosclerosis. RESULTS Stable CAD patients had greater Framingham risk score and greater prevalence of hypertension, hypercholesterolemia, and diabetes (p<0.05 for all). Fasting glucose and systolic and diastolic blood pressure were higher, while high-sensitivity C-reactive protein (hsCRP) levels were lower in patients with stable CAD than in those with ACS (p<0.05 for all). No difference in Gensini score was observed between the two groups (p=0.118), but patients with ACS were more likely to have at least one significant epicardial angiographic lesion (>50% stenosis) (OR 2.0, p=0.022). Higher Gensini score was independently associated with (i) higher hsCRP and glucose levels, hypercholesterolemia, and increased age in stable CAD patients (R2 0.15, p<0001) and (ii) increased age and higher glucose and hsCRP levels in patients with ACS (R2 0.17, p<0001). CONCLUSIONS Patients undergoing coronary angiography for ACS or stable CAD presented with a similar extent of angiographic CAD, although patients with ACS had a higher prevalence of significant lesions in the presence of a better cardiovascular risk profile and higher inflammation levels. The extent of angiographic CAD in both the groups shared common determinants such as hsCRP, age, and hyperglycemia, but these appeared to explain only a small part of the variation of coronary atherosclerosis.
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Affiliation(s)
- Aikaterini Marini
- Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece
| | - Katerina K Naka
- Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece; 2(nd) Department of Cardiology, University of Ioannina, Ioannina, Greece
| | | | - Aris Bechlioulis
- Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece; 2(nd) Department of Cardiology, University of Ioannina, Ioannina, Greece
| | - Mara Bougiakli
- Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece
| | - Sophia Giannitsi
- Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece
| | | | | | | | - Georgios Chasiotis
- Laboratory of Biochemistry, University Hospital of Ioannina, Ioannina, Greece
| | - Eleni Bairaktari
- Laboratory of Biochemistry, University Hospital of Ioannina, Ioannina, Greece
| | - Christos S Katsouras
- Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece; 2(nd) Department of Cardiology, University of Ioannina, Ioannina, Greece
| | | | | | - Lampros K Michalis
- Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece; 2(nd) Department of Cardiology, University of Ioannina, Ioannina, Greece.
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Synetos A, Papaioannou S, Tousoulis D. Atherosclerosis and inflammation. Clinical aspects of a modern tale. Hellenic J Cardiol 2017; 58:122-123. [DOI: 10.1016/j.hjc.2017.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/10/2017] [Indexed: 10/19/2022] Open
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Toutouzas K, Klettas D, Anousakis-Vlachochristou N, Melidis K, Azilazian Z, Asimomiti M, Karanasos A, Spanos A, Tsiamis E, Nihoyannopoulos P, Tousoulis D. The -174 G>C Interleukin-6 Gene Polymorphism is Associated with Angiographic Progression of Coronary Artery Disease over a 4-Year Period. Hellenic J Cardiol 2017; 58:80-86. [PMID: 28212870 DOI: 10.1016/j.hjc.2017.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/01/2017] [Accepted: 02/03/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Inflammation is a key process underlying the clinical course of coronary artery disease (CAD). C-reactive protein (CRP) and interleukin-6 (IL-6) contribute to its pathophysiology and act as biomarkers. We sought to examine whether known single nucleotide polymorphisms (SNPs) impact CAD progression, reflecting increased inflammation. METHODS We retrospectively evaluated coronary angiographies of patients with established CAD who were re-investigated for stable/unstable angina after a time interval of >12 months. We defined progression of CAD as the emergence of a new plaque or a ≥20 % increase of a formerly non-significant lesion. We genotyped patients for the 1846 C>T CRP and -174 G>C IL-6 SNPs. The probability of CAD progression among the Mendelian randomization groups was evaluated using the Kaplan-Meier method. Data were analyzed using a Cox model that included relevant clinical factors. RESULTS A total of 157 patients were included. The serum levels of CRP and IL-6 differed significantly between genotypes. The genotype frequencies of IL-6 were consistent with Hardy-Weinberg equilibrium, whereas those for CRP were excluded from our conclusions. At 48 months, 83 patients (52.9 %) with the IL-6 C allele versus 74 (47.1 %) with the G allele exhibited CAD progression. Patients with the IL-6 C allele had a 52.8 % probability for progression versus 13.3 % for those with the G allele (p=0.005). The results were confirmed by multivariate analysis; dyslipidemia, family history, and IL-6 SNP emerged as significant factors. CONCLUSION Patients with established CAD who carried the -174 C allele of the IL-6 gene demonstrated an increased risk for the progression of coronary plaques over a four-year period. Further studies will be needed to validate these findings.
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Affiliation(s)
- Konstantinos Toutouzas
- First Department of Cardiology, Athens Medical School, Hippokration General Hospital, Greece.
| | - Dimitrios Klettas
- First Department of Cardiology, Athens Medical School, Hippokration General Hospital, Greece
| | | | - Konstantinos Melidis
- First Department of Cardiology, Athens Medical School, Hippokration General Hospital, Greece
| | - Zeta Azilazian
- First Department of Cardiology, Athens Medical School, Hippokration General Hospital, Greece
| | - Maria Asimomiti
- First Department of Cardiology, Athens Medical School, Hippokration General Hospital, Greece
| | - Antonios Karanasos
- First Department of Cardiology, Athens Medical School, Hippokration General Hospital, Greece
| | | | - Eleftherios Tsiamis
- First Department of Cardiology, Athens Medical School, Hippokration General Hospital, Greece
| | - Petros Nihoyannopoulos
- First Department of Cardiology, Athens Medical School, Hippokration General Hospital, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Athens Medical School, Hippokration General Hospital, Greece
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Karpov Y, Logunova N, Tomilova D, Buza V, Khomitskaya Y. Observational Prospective study to esTIMAte the rates of outcomes in patients undergoing PCI with drug-eluting stent implantation who take statins -follow-up (OPTIMA II). Curr Med Res Opin 2017; 33:253-259. [PMID: 27779436 DOI: 10.1080/03007995.2016.1253552] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The OPTIMA II study sought to evaluate rates of major adverse cardiac and cerebrovascular events (MACCEs) during the long-term follow-up of chronic statin users who underwent percutaneous coronary intervention (PCI) with implantation of a drug-eluting stent (DES). RESEARCH DESIGN AND METHODS OPTIMA II was a non-interventional, observational study conducted at a single center in the Russian Federation. Included patients were aged ≥18 years with stable angina who had received long-term (≥1 month) statin therapy prior to elective PCI with DES implantation and who had participated in the original OPTIMA study. Patients received treatment for stable angina after PCI as per routine study site clinical practice. Study data were collected from patient medical records and a routine visit 4 years after PCI. CLINICAL TRIAL REGISTRATION NCT02099565. MAIN OUTCOME MEASURES Rate of MACCEs 4 years after PCI. RESULTS Overall, 543 patients agreed to participate in the study (90.2% of patients in the original OPTIMA study). The mean (± standard deviation [SD]) duration of follow-up from the date of PCI to data collection was 4.42 ± 0.58 (range: 0.28-5.56) years. The frequency of MACCEs (including data in patients who died) was 30.8% (95% confidence interval: 27.0-34.7); half of MACCEs occurred in the first year of follow-up. After PCI, the majority of patients had no clinical signs of angina. Overall, 24.3% of patients discontinued statin intake in the 4 years after PCI. Only 7.7% of patients achieved a low-density lipoprotein (LDL) cholesterol goal of <1.8 mmol/L. Key limitations of this study related to its observational nature; for example, the sample size was small, the clinical results were derived from outpatients and hospitalized medical records, only one follow-up visit was performed at the end of the study (after 4 years' follow-up), only depersonalized medical information was made available for statistical analysis, and adherence to statin treatment was evaluated on the basis of patient questionnaire. CONCLUSIONS Long-term follow-up of patients who underwent PCI with DES implantation demonstrated MACCEs in nearly one-third of patients, which is comparable to data from other studies. PCI was associated with relief from angina or minimal angina frequency, but compliance with statin therapy and the achievement of LDL cholesterol targets 4 years after PCI were suboptimal.
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Affiliation(s)
- Yu Karpov
- a Russian Cardiology Research and Production Complex , Institute of Clinical Cardiology , Moscow , Russian Federation
| | - N Logunova
- b AstraZeneca , Moscow , Russian Federation
| | - D Tomilova
- a Russian Cardiology Research and Production Complex , Institute of Clinical Cardiology , Moscow , Russian Federation
| | - V Buza
- a Russian Cardiology Research and Production Complex , Institute of Clinical Cardiology , Moscow , Russian Federation
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Tanveer S, Banu S, Jabir NR, Khan MS, Ashraf GM, Manjunath NC, Tabrez S. Clinical and angiographic correlation of high-sensitivity C-reactive protein with acute ST elevation myocardial infarction. Exp Ther Med 2016; 12:4089-4098. [PMID: 28105138 DOI: 10.3892/etm.2016.3882] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/15/2016] [Indexed: 12/16/2022] Open
Abstract
Vascular inflammation and associated ongoing inflammatory responses are considered as the critical culprits in the pathogenesis of acute atherothrombotic events such as acute coronary syndrome (ACS) and myocardial infarction (MI). ST segment elevation myocardial infarction (STEMI) is considered as one of the prominent clinical forms of ACS. Moreover, C-reactive protein (CRP) is an important acute phase prsotein, which may be estimated using high-sensitivity methods (hs-CRP), and its elevated level in body fluids reflects chronic inflammatory status. The circulating hs-CRP level has been proposed as a promising inflammatory marker of coronary artery disease (CAD). The present study investigated the correlation of hs-CRP level with clinical and angiographic features of STEMI, various other traditional risk factors, complications of myocardial infarction and angiographically significant CAD. Out of 190 patients with STEMI that were analyzed, the interval between symptom onset and reperfusion therapy (window period) varied from 0.5 to 24 h. The hs-CRP value was found to be higher in non-diabetic patients (0.61 mg/dl) compared with diabetic patients (0.87 mg/dl). Moreover, a significant correlation between hs-CRP and hs-troponin T was also recorded (P<0.001). However, there was no significant difference in the mean hs-CRP values in patients with or without mortality. It is considered that the present study will increase the understanding of atherosclerosis in general and may also have clinical applications in the targeting of therapy for this harmful disease.
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Affiliation(s)
- Syed Tanveer
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Science and Research, Bangalore, Karnataka 560069, India
| | - Shaheena Banu
- Department of Biochemistry, Sri Jayadeva Institute of Cardiovascular Science and Research, Bangalore, Karnataka 560069, India
| | | | - Mohd Shahnawaz Khan
- Department of Biochemistry, College of Science, King Saud University, Riyadh 11451, Kingdom of Saudi Arabia
| | - Ghulam Md Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Kingdom of Saudi Arabia
| | | | - Shams Tabrez
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Kingdom of Saudi Arabia
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Comparison of Triggering and Nontriggering Factors in ST-Segment Elevation Myocardial Infarction and Extent of Coronary Arterial Narrowing. Am J Cardiol 2016; 117:1219-23. [PMID: 26902530 DOI: 10.1016/j.amjcard.2016.01.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 11/21/2022]
Abstract
Various physical, emotional, and extrinsic triggers have been attributed to acute coronary syndrome. Whether a correlation can be drawn between identifiable ischemic triggers and the nature of coronary artery disease (CAD) still remains unclear. In the present study, we evaluated the correlation between triggered versus nontriggered ischemic symptoms and the extent of CAD in patients with ST-segment elevation myocardial infarction (STEMI). We conducted a retrospective, single-center observational study including 1,345 consecutive patients with STEMI, treated with primary percutaneous coronary intervention. Acute physical and emotional triggers were identified in patients' historical data. Independent predictors of multivessel CAD were determined using a logistic regression model. A potential trigger was identified in 37% of patients. Physical exertion was found to be the most dominant trigger (65%) followed by psychological stress (16%) and acute illness (12%). Patients with nontriggered STEMI tended to be older and more likely to have co-morbidities. Patients with nontriggered STEMI showed a higher rate of multivessel CAD (73% vs 30%, p <0.001). In a multivariate regression model, nontriggered symptoms emerged as an independent predictor of multivessel CAD (odds ratio 8.33, 95% CI 5.74 to 12.5, p = 0.001). No specific trigger was found to predict independently the extent of CAD. In conclusion, symptoms onset without a recognizable trigger is associated with multivessel CAD in STEMI. Further studies will be required to elucidate the putative mechanisms underlying ischemic triggering.
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Park WC, Seo I, Kim SH, Lee YJ, Ahn SV. Association between Resting Heart Rate and Inflammatory Markers (White Blood Cell Count and High-Sensitivity C-Reactive Protein) in Healthy Korean People. Korean J Fam Med 2016; 38:8-13. [PMID: 28197327 PMCID: PMC5305667 DOI: 10.4082/kjfm.2017.38.1.8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/02/2016] [Accepted: 05/19/2016] [Indexed: 01/30/2023] Open
Abstract
Background Inflammation is an important underlying mechanism in the pathogenesis of atherosclerosis, and an elevated resting heart rate underlies the process of atherosclerotic plaque formation. We hypothesized an association between resting heart rate and subclinical inflammation. Methods Resting heart rate was recorded at baseline in the KoGES-ARIRANG (Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population) cohort study, and was then divided into quartiles. Subclinical inflammation was measured by white blood cell count and high-sensitivity C-reactive protein. We used progressively adjusted regression models with terms for muscle mass, body fat proportion, and adiponectin in the fully adjusted models. We examined inflammatory markers as both continuous and categorical variables, using the clinical cut point of the highest quartile of white blood cell count (≥7,900/mm3) and ≥3 mg/dL for high-sensitivity C-reactive protein. Results Participants had a mean age of 56.3±8.1 years and a mean resting heart rate of 71.4±10.7 beats/min; 39.1% were men. In a fully adjusted model, an increased resting heart rate was significantly associated with a higher white blood cell count and higher levels of high-sensitivity C-reactive protein in both continuous (P for trend <0.001) and categorical (P for trend <0.001) models. Conclusion An increased resting heart rate is associated with a higher level of subclinical inflammation among healthy Korean people.
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Affiliation(s)
- Woo-Chul Park
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Inho Seo
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Shin-Hye Kim
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Jae Lee
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Song Vogue Ahn
- Department of Preventive Medicine, Institute of Genomic Cohort, Yonsei University Wonju College of Medicine, Wonju, Korea
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Seo WW, Kim HL, Kim YJ, Yoon YE, Lee SP, Kim HK, Cho GY, Zo JH, Choi DJ, Sohn DW. Incremental prognostic value of high-sensitive C-reactive protein in patients undergoing coronary computed tomography angiography. J Cardiol 2015; 68:222-8. [PMID: 26481470 DOI: 10.1016/j.jjcc.2015.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/09/2015] [Accepted: 09/10/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study was performed to investigate whether combined use of high-sensitivity C-reactive protein (hs-CRP) levels and coronary computed tomography angiography (CCTA) results have additional prognostic value for predicting cardiovascular events in patients with suspected coronary artery disease (CAD). METHODS A total of 445 patients (61.6±9.3 years and 62.9% men) with suspected CAD who underwent both CCTA and hs-CRP measurement within one month were evaluated. Information on cardiovascular events, including cardiac death, non-fatal myocardial infarction, unstable angina and late (≥six months after CCTA) coronary revascularization was assessed. RESULTS One hundred and eighty-five patients (41.6%) had obstructive CAD on CCTA (stenosis ≥50%). Both high hs-CRP (≥2.25mg/L) and obstructive CAD were the independent predictors of cardiovascular events. Kaplan-Meier analysis showed that event rates were significantly different according to the presence of obstructive CAD and hs-CRP levels. Addition of hs-CRP levels to combined information of clinical factors and CCTA results further increased the predictive power for cardiovascular events (global chi-square ratio, from 13.51 to 19.14, p=0.022). Event risks were approximately 21.0-fold higher in the highest-risk group with both obstructive CAD and high hs-CRP levels than in the lowest-risk group with both insignificant CAD and low hs-CRP levels (p=0.007). CONCLUSIONS Combined use of hs-CRP levels and CCTA results provided a significant improvement in prognostic power for cardiovascular events in patients with suspected CAD. hs-CRP measurement may be a simple and useful method for determining risk stratification and treatment strategy in patients undergoing CCTA.
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Affiliation(s)
- Won-Woo Seo
- Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea; Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Boramae Medical Center, Seoul, Republic of Korea; Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Yong-Jin Kim
- Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yeonyee E Yoon
- Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung-Pyo Lee
- Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyung-Kwan Kim
- Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Goo-Yeong Cho
- Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joo-Hee Zo
- Division of Cardiology, Boramae Medical Center, Seoul, Republic of Korea; Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong-Ju Choi
- Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dae-Won Sohn
- Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
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Kave M, Shadman M, Alizadeh A, Samadi M. Analysis of the association between IL-23R rs11209026 polymorphism and incidence of atherosclerosis. Int J Immunogenet 2015; 42:341-5. [PMID: 26261042 DOI: 10.1111/iji.12223] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 05/07/2015] [Accepted: 07/05/2015] [Indexed: 11/26/2022]
Abstract
Th17/IL-23 axis is an important pro-inflammatory pathway in atherosclerosis. IL-23 receptor (IL-23R) pathway has an important role in T-helper cells 17 (Th17) differentiation and survival. We compared normal subjects and patients with atherosclerosis in terms of the R381Q variant of the IL-23R gene as a functional single-nucleotide polymorphism (SNP). This case-control study recruited 200 patients who presented with cardiovascular symptoms to Afshar Hospital, Yazd, Iran. The participants were allocated to five groups based on angiographic results. The severity of the disease was determined according to the numbers of involved vessels. Patients with normal coronary arteries, minimal coronary artery involvement, one involved vessel, two involved vessels and three-vessel disease were allocated to groups I-V, respectively. DNA was extracted from whole blood samples by the salting-out method. Genotyping was performed by polymerase chain reaction followed by restriction fragment length polymorphism assay and multinomial logistic regression for analyses The presence of SNP A>G rs11209026 of IL-23 receptor gene was significantly associated with disease severity (P = 0.008). The frequencies of the heterozygous (AG) genotype in the control group and subjects with minimal involvement, and patients with one-, two-, and three-vessel disease were 22.5%, 12.5%, 10%, 10.24% and 4.8%, respectively. Our results indicated an association between the rs11209026 G>A polymorphism of the IL-23 receptor gene and the risk of atherosclerosis. This genetic variant may in fact cause protection against atherosclerosis progression. However, further studies on gene polymorphism and cell expression are required to clarify the mechanisms involved in the pathogenesis of atherosclerosis.
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Affiliation(s)
- M Kave
- Department of Immunology, International Campus of Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - M Shadman
- Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Iran
| | - A Alizadeh
- Department of Epidemiology and Biostatistics, Faculty of Health, Tehran University of Medical Sciences, Tehran, Iran
| | - M Samadi
- Department of Immunology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Reproductive Immunology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Hada DS, Garg S, Ramteke GB, Ratre MS. Effect of Non-Surgical Periodontal Treatment on Clinical and Biochemical Risk Markers of Cardiovascular Disease: A Randomized Trial. J Periodontol 2015. [PMID: 26205747 DOI: 10.1902/jop.2015.150249] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Various studies have shown periodontal disease is one of the risk factors for coronary heart disease (CHD), and periodontal treatment of patients with CHD has also been correlated with reduction in systemic markers of CHD. The aim of this study is to evaluate the effect of non-surgical periodontal treatment (NSPT) on the cardiovascular clinical and biochemical status of patients with CHD. METHODS Seventy known patients with CHD were allocated randomly to either a control group (C; no periodontal therapy) (n = 35) or an experimental group (E; NSPT in the form of scaling and root planing [SRP]) (n = 35). Cardiovascular status was assessed using clinical parameters such as pulse, respiratory rate, blood pressure (BP), and biochemical parameters, such as high-sensitivity C-reactive protein (hsCRP), lipid profile, and white blood cell (WBC) count, at baseline and 1, 3, and 6 months. Intergroup and intragroup comparisons were performed using Student t test, and P <0.05 was considered statistically significant. RESULTS The complete data at the end of the study were provided by only 55 patients (group C, n = 25; group E, n = 30). Highly statistically significant reduction was observed in systolic BP (7.1 mm Hg) and very-low-density lipoproteins (VLDLs; 5.16 mg/dL) in group E. Changes were also observed in other cardiovascular biochemical and clinical parameters but were not statistically significant. CONCLUSIONS NSPT (in the form of SRP) positively affects limited cardiovascular (clinical and biochemical) status of patients with CHD. Reduction in triglyceride, VLDL, total WBC, lymphocyte, and neutrophil counts and increase in hsCRP, total cholesterol, high-density lipoprotein, and low-density lipoprotein levels were observed. Highly significant reduction in VLDL cholesterol levels and systolic BP was observed among the various parameters measured.
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Affiliation(s)
- Divya Singh Hada
- Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India
| | - Subhash Garg
- Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India
| | - Girish B Ramteke
- Department of Medicine, Maharaja Yeshwantrao Hospital, Indore, Madhya Pradesh, India.,Department of Medicine, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| | - Madhu Singh Ratre
- Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India
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Cheng JM, Oemrawsingh RM, Garcia-Garcia HM, Akkerhuis KM, Kardys I, de Boer SPM, Langstraat JS, Regar E, van Geuns RJ, Serruys PW, Boersma E. Relation of C-reactive protein to coronary plaque characteristics on grayscale, radiofrequency intravascular ultrasound, and cardiovascular outcome in patients with acute coronary syndrome or stable angina pectoris (from the ATHEROREMO-IVUS study). Am J Cardiol 2014; 114:1497-503. [PMID: 25248815 DOI: 10.1016/j.amjcard.2014.08.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 12/01/2022]
Abstract
The relation between C-reactive protein (CRP) and coronary atherosclerosis is not fully understood. This study aims to investigate the associations among high-sensitivity CRP, coronary plaque burden, and the presence of high-risk coronary lesions as measured by intravascular ultrasound (IVUS) and 1-year cardiovascular outcome. Between 2008 and 2011, grayscale and virtual histology IVUS imaging of a nonculprit coronary artery was performed in 581 patients who underwent coronary angiography for acute coronary syndrome (ACS) or stable angina pectoris. Primary end point consisted of 1-year major adverse cardiac events (MACEs), defined as all-cause mortality, ACS, or unplanned coronary revascularization. After adjustment for established cardiac risk factors, baseline CRP levels were independently associated with higher coronary plaque burden (p = 0.002) and plaque volume (p = 0.002) in the imaged coronary segment. CRP was also independently associated with the presence of large lesions (plaque burden ≥70%; p = 0.030) but not with the presence of stenotic lesions (minimal luminal area ≤4.0 mm(2); p = 0.62) or IVUS virtual histology-derived thin-cap fibroatheroma lesions (p = 0.36). Cumulative incidence of 1-year MACE was 9.7%. CRP levels >3 mg/L were independently associated with a higher incidence of MACE (hazard ratio 2.17, 95% confidence interval [CI] 1.01 to 4.67, p = 0.046) and of all-cause mortality and ACS only (hazard ratio 3.58, 95% CI 1.04 to 13.0, p = 0.043), compared with CRP levels <1 mg/L. In conclusion, in patients who underwent coronary angiography, high-sensitivity CRP is a marker of coronary plaque burden but is not related to the presence of virtual histology-derived thin-cap fibroatheroma lesions and stenotic lesions. CRP levels >3 mg/L are predictive for adverse cardiovascular outcome at 1 year.
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Affiliation(s)
- Jin M Cheng
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | | | | | | | - Isabella Kardys
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Evelyn Regar
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Eric Boersma
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
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Lian J, Li J, Dai D, Fang P, Zhou J, Duan S. A lack of association between the CRP rs2794520 polymorphism and coronary artery disease. Biomed Rep 2014; 3:110-114. [PMID: 25469258 DOI: 10.3892/br.2014.384] [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: 09/02/2014] [Accepted: 10/29/2014] [Indexed: 11/05/2022] Open
Abstract
Coronary artery disease (CAD) is mainly caused by atherosclerosis, which is closely associated with the C-reactive protein (CRP), a systemic inflammatory mediator. The aim of the present study was to examine whether the CRP rs2794520 polymorphism played a role in the risk of CAD. A total of 459 CAD patients and 432 non-CAD controls were recruited in the case-control study. Genotyping was performed on the SEQUENOM® Mass-ARRAY iPLEX® platform according to the manufacturer's instructions. The results showed that CRP rs2794520 was not associated with CAD. A further breakdown analysis by age or gender also indicated a lack of association between rs2794520 and CAD. In addition, the CRP rs2794520 polymorphism was not associated with the severity of CAD, which was represented by the number of coronary arteries with stenosis. In conclusion, there was no contribution of the CRP rs2794520 polymorphism to the risk of CAD.
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Affiliation(s)
- Jiangfang Lian
- Ningbo Medical Center, Lihuili Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Junxing Li
- Ningbo Medical Center, Lihuili Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, P.R. China ; Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Dongjun Dai
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Peiliang Fang
- Ningbo Medical Center, Lihuili Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, P.R. China ; Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Jianqing Zhou
- Ningbo Medical Center, Lihuili Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Shiwei Duan
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
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Duan J, Lou J, Zhang Q, Ke J, Qi Y, Shen N, Zhu B, Zhong R, Wang Z, Liu L, Wu J, Wang W, Gong F, Miao X. A genetic variant rs1801274 in FCGR2A as a potential risk marker for Kawasaki disease: a case-control study and meta-analysis. PLoS One 2014; 9:e103329. [PMID: 25093412 PMCID: PMC4122468 DOI: 10.1371/journal.pone.0103329] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 06/28/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Recent genome-wide association study found rs1801274, a functional single nucleotide polymorphism (SNP) in IgG receptor gene FCGR2A, was associated with increased risk of Kawasaki disease (KD). However, subsequent studies on the role of this SNP were limited and controversial. METHODS A case-control study was conducted in a Chinese Han population including 428 KD patients and 493 controls to examine the association between rs1801274 and KD susceptibility. A meta-analysis was performed in combination with the relevant published studies to further clarify such an association. RESULTS Our case-control study found that rs1801274 was significantly associated with increased risk of KD in the Chinese Han population, with an odds ratio (OR) of 1.58 (95% CI = 0.96-2.62) for the GA genotype and 1.93 (95% CI = 1.16-3.19) for the AA genotype compared with the GG genotype. The result of meta-analysis further demonstrated that the A allele of rs1801274 was significantly correlated with KD risk under the allelic model (OR = 1.35, 95% CI = 1.27-1.44) without heterogeneity by fixed-effects model analysis (Q = 17.30, p = 0.139). Moreover, sensitivity analysis supported the robustness of this meta-analysis. CONCLUSION These results further confirm that rs1801274 in the FCGR2A gene is significantly associated with increased risk of KD.
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Affiliation(s)
- Jiayu Duan
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, Ministry of Education Key Laboratory of Environment and Health, Ministry of Environmental Protection Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiao Lou
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, Ministry of Education Key Laboratory of Environment and Health, Ministry of Environmental Protection Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qing Zhang
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Juntao Ke
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, Ministry of Education Key Laboratory of Environment and Health, Ministry of Environmental Protection Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanqi Qi
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Na Shen
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, Ministry of Education Key Laboratory of Environment and Health, Ministry of Environmental Protection Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Beibei Zhu
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, Ministry of Education Key Laboratory of Environment and Health, Ministry of Environmental Protection Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Rong Zhong
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, Ministry of Education Key Laboratory of Environment and Health, Ministry of Environmental Protection Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhenling Wang
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, Ministry of Education Key Laboratory of Environment and Health, Ministry of Environmental Protection Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lifeng Liu
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, Ministry of Education Key Laboratory of Environment and Health, Ministry of Environmental Protection Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Wu
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, Ministry of Education Key Laboratory of Environment and Health, Ministry of Environmental Protection Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wei Wang
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fangqi Gong
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoping Miao
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, Ministry of Education Key Laboratory of Environment and Health, Ministry of Environmental Protection Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Relation of C-reactive protein levels to instability of untreated vulnerable coronary plaques (from the PROSPECT Study). Am J Cardiol 2014; 114:376-83. [PMID: 24931291 DOI: 10.1016/j.amjcard.2014.04.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 04/30/2014] [Accepted: 04/30/2014] [Indexed: 11/21/2022]
Abstract
C-reactive protein (CRP) levels predict adverse coronary events, but it is uncertain if they predict the burden or stability of vulnerable coronary plaques. In the Providing Regional Observations to Study Predictors of Events in the Coronary Tree study, 697 patients with acute coronary syndromes underwent percutaneous coronary intervention followed by 3-vessel angiography, gray-scale intravascular ultrasound (IVUS), and radiofrequency IVUS. Major adverse cardiac events (MACE) during 3 years of follow-up were adjudicated to initially treated culprit lesions or to untreated nonculprit lesions (NCLs). NCLs at greatest risk of causing subsequent MACE had plaque burden ≥70%, minimal luminal area ≤4.0 mm(2), and/or thin-cap fibroatheroma morphology. Here, we examine the interaction of high-risk NCLs with CRP levels, which were measured at presentation, 1 month, and 6 months, then categorized at each time as normal (<3 mg/L), elevated (3 to 10 mg/L), or very elevated (>10 mg/L). We found that patients with elevated CRP levels at any time did not have more high-risk NCLs; however, untreated high-risk NCLs were more likely to cause subsequent MACE in patients with very elevated compared with normal 6-month CRP levels (for thin-cap fibroatheromas, 13.8% vs 1.9%, p = 0.0003; for lesions with minimal luminal area ≤4.0 mm(2), 15.6% vs 2.2%, p <0.0001). As expected, patients with very elevated 6-month CRP levels had higher rates of subsequent NCL-related MACE (19.0% vs 7.2%, p = 0.039). In conclusion, the higher rates of NCL-related MACE in post-acute coronary syndrome patients with very elevated CRP levels may reflect greater instability of high-risk NCLs, rather than a larger burden of such lesions.
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Lewek J, Kaczmarek K, Cygankiewicz I, Wranicz JK, Ptaszynski P. Inflammation and arrhythmias: potential mechanisms and clinical implications. Expert Rev Cardiovasc Ther 2014; 12:1077-85. [DOI: 10.1586/14779072.2014.942286] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nakamura A, Miura SI, Shiga Y, Norimatsu K, Miyase Y, Suematsu Y, Mitsutake R, Saku K. Is pentraxin 3 a biomarker, a player, or both in the context of coronary atherosclerosis and metabolic factors? Heart Vessels 2014; 30:752-61. [DOI: 10.1007/s00380-014-0553-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 07/04/2014] [Indexed: 11/24/2022]
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Wickramatilake CM, Mohideen MR, Withanawasam BPS, Pathirana C. Testosterone and high-sensitive C-reactive protein in coronary artery disease patients awaiting coronary artery bypass graft. Andrologia 2014; 47:493-8. [PMID: 24811768 DOI: 10.1111/and.12290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2014] [Indexed: 11/29/2022] Open
Abstract
Natural androgens inhibit atherosclerosis in men. This study aimed to examine whether testosterone and high-sensitive C-reactive protein differ between patients with coronary artery disease and those without coronary artery disease and to determine the association with the severity of coronary artery disease. Two hundred and six male subjects were recruited. Serum total testosterone and high-sensitive C-reactive protein were estimated. Severity of coronary artery disease was assessed by angiographic scores. Total testosterone level in patients was significantly different from controls (11.4 ± 2.7 vs. 18.1 ± 7.2 nmP = 0.001) and high-sensitive protein level in cases was significantly higher compared to controls (3.37 ± 1.62 mg l(-1) vs. 1.71 ± 0.60 mg l(-1) , P = 0.001). Testosterone levels were not significantly different with vessel (P = 0.592), Leaman (P = 0.694) and Gensini (P = 0.329) score groups, but high-sensitive C-reactive protein showed significant positive correlation among the respective groups (P = 0.005, P = 0.028, P = 0.015). Testosterone was lower, while high-sensitive C-reactive protein was higher in patients compared to controls. Testosterone showed no correlation with the severity of atherosclerosis, but high-sensitive C-reactive protein showed significant positive correlation.
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Affiliation(s)
- C M Wickramatilake
- Department of Biochemistry, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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Sung JW, Lee SH, Byrne CD, Chung PW, Won YS, Sung KC. High-sensitivity C-reactive Protein Is Associated with the Presence of Coronary Artery Calcium in Subjects with Normal Blood Pressure but Not in Subjects with Hypertension. Arch Med Res 2014; 45:170-6. [DOI: 10.1016/j.arcmed.2014.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 01/15/2014] [Indexed: 11/29/2022]
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van der Meer MG, Cramer MJ, van der Graaf Y, Appelman Y, Doevendans PA, Nathoe HM. The impact of polyvascular disease on long-term outcome in percutaneous coronary intervention patients. Eur J Clin Invest 2014; 44:231-9. [PMID: 24372467 DOI: 10.1111/eci.12222] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/25/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous studies demonstrated the prognostic importance of concomitant polyvascular disease in patients with coronary artery disease (CAD). However, the significance of the number of diseased vascular territories and subclinical disease is unknown. MATERIALS AND METHODS The number of diseased vascular territories was evaluated in 2299 percutaneous coronary intervention (PCI) patients. Vascular disease was defined by documented atherosclerotic disease, either diagnosed in the medical history (clinical) or at the standardized cardiovascular screening (subclinical). The following territories were evaluated: cerebrovascular disease, peripheral arterial disease, abdominal aortic aneurysm and vascular renal disease. The outcome measures were all-cause mortality, cardiovascular mortality and a composite cardiovascular endpoint (myocardial infarction, stroke, cardiovascular mortality). Patients with monovascular disease (CAD) served as the reference category. Hazard ratios (HRs) were adjusted for baseline characteristics. RESULTS Mean follow-up was 7.3 years. The HRs (95% confidence interval) for patients with two diseased territories compared to monovascular disease were for all-cause mortality 1.60 (1.14-2.25), cardiovascular mortality 2.13 (1.29-3.50) and the combined cardiovascular endpoint 1.66 (1.20-2.31). Moreover, the HRs (95% confidence intervals) for patients with more than two diseased territories compared to monovascular disease were for all-cause mortality 3.81 (2.45-5.92), cardiovascular mortality 4.40 (2.32-8.35) and the combined cardiovascular endpoint 2.75 (1.69-4.47). The HRs of patients with subclinical disease were comparable to the HRs of patients with clinical disease. CONCLUSIONS In patients undergoing PCI, the presence of subclinical and clinical polyvascular disease is associated with an increased long-term mortality and morbidity. Moreover, the outcome is highly influenced by the number of diseased territories.
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Affiliation(s)
- Manon G van der Meer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Lian XQ, Zhao D, Zhu M, Wang ZM, Gao W, Zhao H, Zhang DG, Yang ZJ, Wang LS. The influence of regular walking at different times of day on blood lipids and inflammatory markers in sedentary patients with coronary artery disease. Prev Med 2014; 58:64-9. [PMID: 24201089 DOI: 10.1016/j.ypmed.2013.10.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 10/25/2013] [Accepted: 10/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the influence of walking at different times of day on lipids and inflammatory markers in sedentary patients with coronary artery disease (CAD). METHODS A total of 330 patients recruited from Nanjing between September 2011 and November 2012 were randomly assigned to a control group (n=110), morning (n=110) or evening walking group (n=110). Both the walking groups were asked to walk 30 min/day or more on at least 5 days/week either in the morning or evening for 12 weeks. Lipids and inflammatory markers were measured before and after exercise intervention. RESULTS Compared with baseline, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were improved in all groups. Significances were shown in the changes of fibrinogen, high sensitivity C-reactive protein (hsCRP), white blood cell (WBC) count, TC, triglycerides, LDL-C, lipoprotein(a) between groups. The evening walking group had a larger decrease in fibrinogen (0.16 ± 0.19 g/L, P<0.001), hsCRP (1.16 ± 1.07 mg/L, P<0.001), WBC count (0.76 ± 1.53·10(9)/L, P=0.004) and LDL-C (0.34 ± 0.31 mmol/L, P<0.001) than the other two groups. CONCLUSIONS Our walking program successfully resulted in a favorable change in lipids and inflammatory markers. Patients in the evening walking group gained more benefits than those walking in the morning walking group. NCT01887093.
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Affiliation(s)
- Xiao-Qing Lian
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Di Zhao
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Meng Zhu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ze-Mu Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wei Gao
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Huan Zhao
- Department of Cardiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 211100, China
| | - Ding-Guo Zhang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhi-Jian Yang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Lian-Sheng Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
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Kim KH, Kim W, Kang WY, Hwang SH, Cho SC, Kim W, Jeong MH. The Impact of Ischemic Time on the Predictive Value of High-Sensitivity C-Reactive Protein in ST-Segment Elevation Myocardial Infarction Patients Treated by Primary Percutaneous Coronary Intervention. Korean Circ J 2013; 43:664-73. [PMID: 24255650 PMCID: PMC3831012 DOI: 10.4070/kcj.2013.43.10.664] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/01/2013] [Accepted: 08/29/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The high-sensitivity C-reactive protein (hs-CRP), a marker of inflammation, has been known to be elevated in patients with coronary artery disease. However, there is controversy about the predictive value of hs-CRP after acute myocardial infarction (MI). Therefore, we evaluated the impact of ischemic time on the predictive value of hs-CRP in ST-segment elevation myocardial infarction (STEMI) patients who were treated by primary percutaneous coronary intervention (PCI). SUBJECTS AND METHODS We enrolled 5123 STEMI patients treated by primary PCI from the Korean Working Group in Myocardial Infarction and divided enrolled patients into four groups by symptom-to-balloon time (SBT) and level of hs-CRP (Group I: SBT <6 hours and hs-CRP <3 mg/L, Group II: SBT <6 hours and hs-CRP ≥3 mg/L, Group III: SBT ≥6 hours and hs-CRP <3 mg/L, and Group IV: SBT ≥6 hours and hs-CRP ≥3 mg/L). To evaluate the impact of ischemic time on the predictive value of hs-CRP in STEMI patients, we compared the cumulative cardiac event-free survival rate between these four groups. RESULTS The sum of the cumulative incidence of all-cause mortality and recurrence of MI was higher in Group IV than in the other groups. However, there was no significant difference among Group I, Group II, and Group III. The Cox-regression analyses showed that an elevated level of hs-CRP (≥3 mg/L) was an independent predictor of long-term cardiovascular outcomes only among late-presenting STEMI patients (p=0.017, hazard ratio=2.462). CONCLUSION For STEMI patients with a long ischemic time (≥6 hours), an elevated level of hs-CRP is a poor prognostic factor of long-term cardiovascular outcomes.
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Affiliation(s)
- Kyung Hwan Kim
- Division of Cardiology, Department of Internal Medicine, Gwangju Veterans Hospital, Gwangju, Korea
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Abd El-Aziz TA, Mohamed RH. Human C-reactive protein gene polymorphism and metabolic syndrome are associated with premature coronary artery disease. Gene 2013; 532:216-21. [PMID: 24055729 DOI: 10.1016/j.gene.2013.09.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 09/08/2013] [Accepted: 09/11/2013] [Indexed: 01/19/2023]
Abstract
The aim of this study was to investigate the association between C-reactive protein (CRP) gene polymorphism and metabolic syndrome (MetS) with premature coronary artery disease (PCAD). 116 patients with PCAD (58 with MetS and 58 without MetS) and 119 controls were included in the study. CRP gene +1059 G>C polymorphism was analyzed by polymerase chain reaction. Serum hs-CRP was measured using high-sensitivity enzyme-linked immunosorbent assay. Carriers of C allele of the CRP +1059 G>C polymorphism had 3.37 fold increased risk to develop MetS in patients with PCAD. In addition CRP gene and hs-CRP levels were independent risk factors for PCAD and MetS. The present study provides new evidence that the presence of CRP +1059 G>C polymorphism and hs-CRP levels are independent determinants of PCAD and MetS in Egyptians. The results of our study suggest a synergistic effect of CRP C allele with classical risk factors such as hypertension, obesity, dyslipidemia and MetS.
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Affiliation(s)
- Tarek A Abd El-Aziz
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Lodh M, Goswami B, Parida A, Patra S, Saxena A. Assessment of serum leptin, pregnancy-associated plasma protein A and CRP levels as indicators of plaque vulnerability in patients with acute coronary syndrome. Cardiovasc J Afr 2013. [PMID: 22836155 DOI: 10.5830/cvja-2012-008.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION A multifactorial aetiology of coronary artery disease (CAD) has been established in the recent past. Extensive research is now underway to understand the mechanisms responsible for plaque vulnerability. The identification of a novel biomarker that will help in the assessment of plaque status is urgently needed for the purpose of patient stratification and prognostication. The aim of the present study was to evaluate leptin, pregnancy-associated plasma protein A (PAPP-A) and C-reactive protein (CRP) levels in patients with acute coronary syndrome and to assess their diagnostic efficacy in the identification of vulnerable plaques. METHODS The study group comprised 105 patients who had chest pain along with ECG changes (ST elevation, ST depression, T inversion) and raised cardiac enzyme levels. Sixty-two patients with chest pain and ECG changes but with normal cardiac enzyme profiles were included in the control group. Lipid profiles, and leptin, PAPP-A and CRP levels were assessed in these two groups. Receiver operating characteristics (ROC) curves were plotted to determine the utility of the parameters under study as markers of plaque vulnerability. RESULTS Significantly higher levels of serum lipoprotein (a), leptin, PAPP-A and high-sensitivity CRP (hs-CRP) were observed in the cases than in the controls. A positive correlation was observed between CRP and PAPP-A levels as well as CRP and leptin concentrations. ROC curve analysis revealed similar efficacies of CRP and PAPP-A levels in their ability to detect unstable plaques with areas under the curve of 0.762 and 0.732, respectively. Multivariate analysis established the superiority of hs-CRP as a predictor of plaque instability. CONCLUSIONS Our study highlights the utility of both CRP and PAPP-A levels as determinants of plaque instability. Our findings necessitate population-based follow-up studies to establish the superiority of either of the two biomarkers in the field of preventive cardiology.
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Affiliation(s)
- Moushumi Lodh
- Department of Biochemistry, The Mission Hospital, Durgapur, West Bengal, India
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Kwon BJ, Kim DW, Her SH, Kim DB, Jang SW, Cho EJ, Ihm SH, Kim HY, Youn HJ, Seung KB, Kim JH, Rho TH. Metabolically obese status with normal weight is associated with both the prevalence and severity of angiographic coronary artery disease. Metabolism 2013; 62:952-60. [PMID: 23391273 DOI: 10.1016/j.metabol.2013.01.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 01/01/2013] [Accepted: 01/07/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We evaluated prevalence and severity of angiographic coronary artery disease (CAD) according to groups by metabolically obese (MO) and/or weight status. MATERIAL/METHODS Normal weight was defined as body mass index (BMI, kg/m²)<25 and obesity was defined as BMI≥25. The MO was determined using the National Cholesterol Education Program-Adult Treatment Panel III classification with Korean-specific cutoffs for abdominal obesity. Therefore, a total of 856 subjects were categorized as follows: (1) metabolically healthy and normal weight (MHNW); (2) metabolically obese but normal weight (MONW); (3) metabolically healthy but obese (MHO); and (4) metabolically abnormally obese (MAO). The presence of obstructive lesion≥50% of coronary artery was considered as an angiographic CAD and the Gensini scoring system was used for the severity. RESULTS MONW or MO showed a higher prevalence of CAD than MHNW or non-MO after adjustment for age and sex, respectively (MONW, odds ratio [OR]=1.69, 95% confidence interval [CI]: 1.13-2.51 and MO, OR=1.44, 95% CI: 1.09-1.91). In subjects without diabetes mellitus (DM), MONW or MO showed a marginally higher prevalence of CAD (MONW, OR=1.58, 95% CI: 0.96-2.61 and MO, OR=1.41, 95% CI: 0.96-2.08). MONW was independently associated with a higher severity of angiographic CAD than MHNW after age, sex, glomerular filtration rate, smoking status, high sensitive C-reactive protein, and use of anti-platelet and anti-angina drugs (β=0.118, P=0.005). And MO was associated with a higher severity of angiographic CAD than non-MO after adjustment for age and sex (β=0.077, P=0.024). The above associations were also consistent in subjects without DM (MONW, β=0.147, P=0.003 and MO, β=0.129, P=0.005). CONCLUSIONS MONW or MO is associated with both the prevalence and severity of angiographic CAD after adjustment for age and sex and MONW is independently associated with the severity of angiographic CAD irrespective of DM. Therefore, subjects with MO but normal weight (MONW) should be carefully examined for angiographic CAD.
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Affiliation(s)
- Beom-June Kwon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Lin CC, Chang CM, Liu CY, Huang TL. Increased high-sensitivity C-reactive protein levels in Taiwanese schizophrenic patients. Asia Pac Psychiatry 2013; 5:E58-63. [PMID: 23857813 DOI: 10.1111/appy.12078] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 03/12/2013] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Schizophrenia is associated with the activation of the immune/inflammatory system. C-reactive protein (CRP), a positive acute phase protein, may be associated with schizophrenia and antipsychotic treatment. METHODS The serum high-sensitivity CRP (hsCRP) levels of 36 schizophrenic patients undergoing clozapine, olanzapine or risperidone treatment and 36 sex-matched healthy subjects were collected. The difference in hsCRP levels between the schizophrenic and the control groups was estimated using ancova. anova was performed to examine the differences in the hsCRP levels between three antipsychotic groups (clozapine, olanzapine and risperidone). RESULTS ancova adjusted for age and body mass index (BMI) revealed a significant increase in the hsCRP levels in the schizophrenic group (1.4 mg/L, SD =1.5 mg/L) in comparison with the control group (0.9 mg/L, SD = 1.4 mg/L) (P = 0.013). anova revealed no statistical difference of age, BMI and hsCRP in three antipsychotic groups (P = 0.83, 0.90 and 0.71, respectively). DISCUSSION The elevation of CRP level is seen in chronic schizophrenia under antipsychotic treatment; however, studies with a larger sample size are required to confirm these results.
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Affiliation(s)
- Chin-Chuen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Tiong WN, Sim EUH, Fong AYY, Ong TK. Early detection of C-reactive protein and von Willebrand factor levels in Malaysian patients with acute coronary syndrome. J Cardiovasc Dis Res 2013; 4:3-6. [PMID: 24023462 PMCID: PMC3758105 DOI: 10.1016/j.jcdr.2012.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 08/28/2012] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Diagnosing acute coronary syndrome (ACS) remains a challenge in patients presenting at early phase of hospitalization. We hypothesized that inflammatory markers of plaque rupture could accurately identifying ACS patients from stable coronary artery diseases (CAD). MATERIALS AND METHODS The serum and peripheral blood gene expression levels of C-reactive protein (CRP) and von Willebrand factor (vWF) in multiethnic Malaysian patients (n = 7) admitted with early hospitalization of ACS was evaluated. Nine patients with stable coronary artery disease without previous history of ACS were enrolled as controls. RESULTS Serum and peripheral blood mRNA levels of CRP and vWF were significantly higher in ACS compared to control groups (P < 0.05). CONCLUSIONS Elevated levels of these markers in ACS may reflect an acute phase response due to endothelial dysfunction. Both CRP and vWF may add to the list of useful markers for early detection of ACS in hospitals of developing countries.
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Affiliation(s)
- Wen Ni Tiong
- Clinical Research Centre, Sarawak General Hospital, Malaysia
- Faculty of Resource Science and Technology, University Malaysia Sarawak, Kota Samarahan, Malaysia
| | - Edmund Ui Hang Sim
- Faculty of Resource Science and Technology, University Malaysia Sarawak, Kota Samarahan, Malaysia
| | - Alan Yean Yip Fong
- Clinical Research Centre, Sarawak General Hospital, Malaysia
- Department of Cardiology, Sarawak General Hospital, Kuching, Malaysia
| | - Tiong Kiam Ong
- Department of Cardiology, Sarawak General Hospital, Kuching, Malaysia
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Gundogdu BM, Cilingiroglu M. Chronic inflammatory muscle diseases and risk of coronary artery disease. Curr Atheroscler Rep 2013; 15:308. [PMID: 23341225 DOI: 10.1007/s11883-012-0308-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite recent advancements in the treatment of coronary artery disease (CAD), it remains the commonest cause of death in the world. Although traditional risk factors partially account for the development of CAD, other novel risk factors have recently been implicated. Specifically, chronic inflammation has been postulated to play a role in the development and propagation of this disease. The purpose of this review is to examine the available evidence to determine if patients with chronic inflammatory muscle diseases have higher rates of cardiovascular disease.
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Affiliation(s)
- Betul M Gundogdu
- Department of Neurology, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 500, Little Rock, AR 72205-7199, USA.
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Association of inflammatory markers with the morphology and extent of coronary plaque as evaluated by 64-slice multidetector computed tomography in patients with stable coronary artery disease. Int J Cardiovasc Imaging 2013; 29:1149-58. [PMID: 23358918 DOI: 10.1007/s10554-013-0181-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 01/04/2013] [Indexed: 01/06/2023]
Abstract
We evaluated the association between inflammatory markers and coronary artery plaque assessed by 64-slice multidetector computed tomography. Coronary computed tomography angiography was performed in patients with chest discomfort suggestive of coronary artery disease (CAD). Individuals with an acute coronary syndrome were excluded from the study. Coronary plaque morphology, the number of artery segments exhibiting plaque, and the number of vessels with >50% stenosis were evaluated. Plasma levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), plasminogen activator inhibitor-1, and vascular endothelial growth factor were measured. Among the 178 patients studied (age 65 ± 10 years; 70% men), 125 were diagnosed with CAD. Hs-CRP and IL-6 concentrations were significantly higher in patients with CAD than in patients without (2.73 ± 4.7 vs. 1.32 ± 2.6 mg/L, P = 0.018, and 3.06 ± 3.3 vs. 2.19 ± 2.4 pg/mL, P = 0.036). The IL-6 level was high in patients with predominantly calcified plaque, and was significantly higher in patients with 4-9 plaque segments than in those with no or 1-3 plaque segments (4.07 ± 5.3 vs. 2.19 ± 2.4 pg/mL and 2.43 ± 2.0 pg/mL, respectively, P = 0.025). The number of stenotic vessels was not significantly related to inflammatory markers. Multivariate logistic analysis revealed that plasma levels of hs-CRP but not IL-6 were associated with the presence of coronary plaque with calcification (OR 3.37, P = 0.026). This study supports the usefulness of inflammatory markers for the evaluation of coronary plaque in patients with stable CAD.
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Herrmann J, Lennon RJ, Barsness GW, Sandhu GS, Gulati R, Best PJ, Sorajja P, Bresnahan JF, Mathew V, Bell MR, Prasad A. High Sensitivity C-Reactive Protein and Outcomes Following Percutaneous Coronary Intervention in Contemporary Practice. Circ Cardiovasc Interv 2012; 5:783-90. [DOI: 10.1161/circinterventions.112.972182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Joerg Herrmann
- From the Division of Cardiovascular Diseases, Department of Medicine and the Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Ryan J. Lennon
- From the Division of Cardiovascular Diseases, Department of Medicine and the Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Gregory W. Barsness
- From the Division of Cardiovascular Diseases, Department of Medicine and the Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Gurpreet S. Sandhu
- From the Division of Cardiovascular Diseases, Department of Medicine and the Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Rajiv Gulati
- From the Division of Cardiovascular Diseases, Department of Medicine and the Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Patricia J.M. Best
- From the Division of Cardiovascular Diseases, Department of Medicine and the Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Paul Sorajja
- From the Division of Cardiovascular Diseases, Department of Medicine and the Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - John F. Bresnahan
- From the Division of Cardiovascular Diseases, Department of Medicine and the Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Verghese Mathew
- From the Division of Cardiovascular Diseases, Department of Medicine and the Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Malcolm R. Bell
- From the Division of Cardiovascular Diseases, Department of Medicine and the Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Abhiram Prasad
- From the Division of Cardiovascular Diseases, Department of Medicine and the Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Foundation, Rochester, MN
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Zhang Z, Yang Y, Hill MA, Wu J. Does C-reactive protein contribute to atherothrombosis via oxidant-mediated release of pro-thrombotic factors and activation of platelets? Front Physiol 2012; 3:433. [PMID: 23162475 PMCID: PMC3499691 DOI: 10.3389/fphys.2012.00433] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 10/24/2012] [Indexed: 01/08/2023] Open
Abstract
Inflammation and the generation of reactive oxygen species (ROS) have been implicated in the initiation and progression of atherosclerosis. Although C-reactive protein (CRP) has traditionally been considered to be a biomarker of inflammation, recent in vitro and in vivo studies have provided evidence that CRP, itself, exerts pro-thrombotic effects on vascular cells and may thus play a critical role in the development of atherothrombosis. Of particular importance is that CRP interacts with Fcγ receptors on cells of the vascular wall giving rise to the release of pro-thrombotic factors. The present review focuses on distinct sources of CRP-mediated ROS generation as well as the pivotal role of ROS in CRP-induced tissue factor expression. These studies provide considerable insight into the role of the oxidative mechanisms in CRP-mediated stimulation of pro-thrombotic factors and activation of platelets. Collectively, the available data provide strong support for ROS playing an important intermediary role in the relationship between CRP and atherothrombosis.
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Affiliation(s)
- Zhuo Zhang
- Drug Discovery Research Center, Luzhou Medical College Luzhou, China
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Zhong Y, Tang H, Zeng Q, Wang X, Yi G, Meng K, Mao Y, Mao X. Total cholesterol content of erythrocyte membranes is associated with the severity of coronary artery disease and the therapeutic effect of rosuvastatin. Ups J Med Sci 2012; 117:390-8. [PMID: 23009223 PMCID: PMC3497225 DOI: 10.3109/03009734.2012.672345] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Numerous studies suggest that total cholesterol content of erythrocyte membranes (CEM) might play a critical role in atherosclerotic plaque progression and instability. However, the exact role of CEM in atherosclerosis remains obscure. Our study was designed to investigate the association between CEM and the severity of coronary artery disease (CAD), and to assess the effect of rosuvastatin on CEM levels. METHODS CEM levels were assessed in 136 participants, including acute coronary syndrome (ACS) (non-ST-segment elevation ACS (NSTEACS) and ST-segment elevation myocardial infarction (STEMI)), stable angina pectoris (SAP), and controls. The Gensini score was used to estimate the severity of CAD. Additionally, 54 patients with CAD were medicated with rosuvastatin, 5 or 10 mg once daily, and then checked at 6 months. RESULTS The highest level of CEM was found in the STEMI group, followed by the NSTEACS, the SAP, and the control groups. Gensini score in group IV (CEM > 141.6 μg/mg) was markedly higher compared with group I (CEM ≤77.6 μg/mg). Gensini scores in group II (77.6 < CEM ≤111.1 μg/mg) and group III (111.1 < CEM ≤141.6 μg/mg) were also higher than in group I (all P < 0.001). Furthermore, a positive correlation was found between CEM levels and Gensini score (r = 0.714, P < 0.001). CEM levels were dose-dependently reduced by rosuvastatin therapy. CONCLUSIONS CEM levels are positively associated with the severity of CAD, meaning that CEM might contribute to the development of CAD. Importantly, rosuvastatin could decrease CEM levels in patients with CAD and might effectively help to attenuate the progression of CAD.
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Affiliation(s)
- Yucheng Zhong
- Department of Cardiology, Institute of Cardiovascular Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hongxia Tang
- Department of Pediatric Infectious and Immunological Diseases, Wuhan Children's Hospital, Wuhan, 430016, China
| | - Qiutang Zeng
- Department of Cardiology, Institute of Cardiovascular Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiang Wang
- Department of Cardiology, Institute of Cardiovascular Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Guiwen Yi
- Department of Cardiology, Institute of Cardiovascular Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Kai Meng
- Department of Cardiology, Institute of Cardiovascular Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yi Mao
- Department of Cardiology, Institute of Cardiovascular Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiaobo Mao
- Department of Cardiology, Institute of Cardiovascular Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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