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Amiri M, Raeisi-Dehkordi H, Verkaar AJCF, Wu Y, van Westing AC, Berk KA, Bramer WM, Aune D, Voortman T. Circulating lipoprotein (a) and all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis. Eur J Epidemiol 2023; 38:485-499. [PMID: 36708412 PMCID: PMC10164031 DOI: 10.1007/s10654-022-00956-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/16/2022] [Indexed: 01/29/2023]
Abstract
AIMS To investigate the association between circulating lipoprotein(a) (Lp(a)) and risk of all-cause and cause-specific mortality in the general population and in patients with chronic diseases, and to elucidate the dose-response relations. METHODS AND RESULTS We searched literature to find prospective studies reporting adjusted risk estimates on the association of Lp(a) and mortality outcomes. Forty-three publications, reporting on 75 studies (957,253 participants), were included. The hazard ratios (HRs) and 95% confidence intervals (95%CI ) for the top versus bottom tertile of Lp(a) levels and risk of all-cause mortality were 1.09 (95%CI: 1.01-1.18, I2: 75.34%, n = 19) in the general population and 1.18 (95%CI: 1.04-1.34, I2: 52.5%, n = 12) in patients with cardiovascular diseases (CVD). The HRs for CVD mortality were 1.33 (95%CI: 1.11-1.58, I2: 82.8%, n = 31) in the general population, 1.25 (95%CI: 1.10-1.43, I2: 54.3%, n = 17) in patients with CVD and 2.53 (95%CI: 1.13-5.64, I2: 66%, n = 4) in patients with diabetes mellitus. Linear dose-response analyses revealed that each 50 mg/dL increase in Lp(a) levels was associated with 31% and 15% greater risk of CVD death in the general population and in patients with CVD. No non-linear dose-response association was observed between Lp(a) levels and risk of all-cause or CVD mortality in the general population or in patients with CVD (Pnonlinearity > 0.05). CONCLUSION This study provides further evidence that higher Lp(a) levels are associated with higher risk of all-cause mortality and CVD-death in the general population and in patients with CVD. These findings support the ESC/EAS Guidelines that recommend Lp(a) should be measured at least once in each adult person's lifetime, since our study suggests those with higher Lp(a) might also have higher risk of mortality.
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Affiliation(s)
- Mojgan Amiri
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hamidreza Raeisi-Dehkordi
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Auke J C F Verkaar
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Yahong Wu
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anniek C van Westing
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Kirsten A Berk
- Department of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Dietetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.
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Lv Q, Jiao X, Yu H, Sun Q, Li F, Wang Y, Sun H, Du Z, Li L, Hu C, Zhang M, Nie S, Qin Y. ANGPTL3 and Cardiovascular Outcomes in Patients With Acute Coronary Syndrome and Obstructive Sleep Apnea. J Am Heart Assoc 2022; 11:e025955. [PMID: 36073641 DOI: 10.1161/jaha.122.025955] [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] [Indexed: 11/16/2022]
Abstract
Background The aim of this prospective study was to determine the impact of elevated ANGPTL3 (angiopoietin-like protein 3) on cardiovascular events (CVEs) following acute coronary syndrome (ACS) in patients with or without obstructive sleep apnea (OSA). Methods and Results A total of 1174 patients with ACS underwent successful percutaneous coronary intervention were included in this prospective cohort study (NCT03362385). Patients were categorized according to the apnea-hypopnea index (≥15 events/h, OSA) and further classified by ANGPTL3 levels. We analyzed the incidence of CVEs in patients with ACS according to the status of OSA and ANGPTL3. During a median of 3.1 years of follow-up, 217 (18.48%) CVEs occurred. The patients with ACS with OSA had higher ANGPTL3 levels than those without OSA (30.4 [20.9-43.2] versus 27.80 [19.1-41.5] ng/mL; P<0.001). In all patients with ACS, 29≤ANGPTL3<42 mg/dL and ANGPTL3≥42 mg/dL were associated with an increased risk of CVEs with hazard ratios (HRs) of 1.555 (95% CI, 1.010-2.498) and 2.489 (95% CI 1.613-3.840), respectively. When the status of OSA or not was incorporated in stratifying factors, 29≤ANGPTL3<42 mg/dL and ANGPTL3≥42 mg/dL were associated with a significantly higher risk of CVEs in patients with ACS with OSA (HR, 1.916 [95% CI, 1.019-3.601] and HR, 2.692 [95% CI, 1.379-4.503]) but not without OSA. Moreover, adding ANGPTL3 to the Cox model increased C-statistic values by 0.035 and 0.029 in the OSA group and all patients with ACS, respectively, but was not statistically improved in patients with ACS without OSA. Conclusions In conclusion, our study demonstrates a predictive impact of plasma ANGPTL3 on cardiovascular risk in patients with ACS, especially in patients with ACS with OSA. It might be of clinical value in refining risk stratification and tailoring treatment of patients with ACS and OSA. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03362385.
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Affiliation(s)
- Qianwen Lv
- Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases Beijing China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases Beijing China
| | - Xiaolu Jiao
- Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases Beijing China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases Beijing China
| | - Huahui Yu
- Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases Beijing China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases Beijing China
| | - Qiuju Sun
- Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases Beijing China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases Beijing China
| | - Fan Li
- Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases Beijing China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases Beijing China
| | - Yu Wang
- Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases Beijing China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases Beijing China
| | - Haili Sun
- Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases Beijing China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases Beijing China
| | - Zhiyong Du
- Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases Beijing China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases Beijing China
| | - Linyi Li
- Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases Beijing China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases Beijing China
| | - Chaowei Hu
- Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases Beijing China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases Beijing China
| | - Ming Zhang
- Cardiology Department Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases Beijing China
| | - Shaoping Nie
- Emergency & Critical Care Center Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases Beijing China
| | - Yanwen Qin
- Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases Beijing China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases Beijing China
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Guo J, Gao Y, Ahmed M, Dong P, Gao Y, Gong Z, Liu J, Mao Y, Yue Z, Zheng Q, Li J, Rong J, Zhou Y, An M, Gu L, Zhang J. Serum Homocysteine Level Predictive Capability for Severity of Restenosis Post Percutaneous Coronary Intervention. Front Pharmacol 2022; 13:816059. [PMID: 35685647 PMCID: PMC9171111 DOI: 10.3389/fphar.2022.816059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background: In stent restenosis (ISR) is one of the major complications after stent implantation. Thus, there is a growing interest in identifying a biomarker for the onset of ISR. High levels of serum homocysteine (Hcy) have been associated with the progression of cardiovascular disease. Therefore, the study was carried out to quantify the correlation between serum Hcy and ISR severity. Compared with coronary angiography (CAG), Hcy levels provided a significantly better clinical detection of ISR severity after PCI. Methods: A total of 155 patients were recruited from Shanxi Bethune hospital, from 6 months to 2 years post PCI. Serum Hcy levels and postoperative angiography results were used to differentiate the patients into two experimental groups: ISR (>50% diametrical stenosis), and non-ISR. The non-ISR included two subgroups: intimal hyperplasia (10–50% diametrical stenosis), and recovery (<10% diametrical stenosis). In addition, a group of 80 healthy individuals was used as a negative control. The correlation between homocysteine level and ISR severity t was analyzed for all groups. In addition, the correlation between serum Hcy level and the severity of ISR in the experimental group was analyzed by the Pearson correlation test. Results: The serum Hcy level in the experimental group and control group was determined to be (20.21 ± 11.42) μmol/L and (15.11 ± 10.25) μmol/L respectively. The level of serum Hcy in the experimental group was significantly higher than in the control group (t-value of 2.385; p-value of 0.019). The serum Hcy level in the restenosis and the intimal hyperplasia group was (25.72 ± 13.71) μmol/L and (17.35 ± 7.70) μmol/L respectively. The serum Hcy level in the restenosis group was significantly higher than in the intimal hyperplasia group (t-value of 2.215; p-value of 0.033). The level of serum Hcy in the group without a plaque in the stent was (16.30 ± 6.08) μmol/L, whereas in the control group was (15.11 ± 10.25) μmol/L. The no plaque group had a slightly higher serum Hcy level than the control group (t-value of 0.634; p-value of 0.528). All included patients were divided into four quartiles based on the serum Hcy concentration: quartile 1 (8.90–13.20 μmol/L), quartile 2 (13.30–16.45 μmol/L), quartile 3 (16.60–24.25 μmol/L) and quartile 4 (24.30-65.30 μ mol/L). The incidence of ISR was 5, 6.25, 7.5 and 15%, in the 1,2,3 and four quartiles respectively. The serum Hcy level in the experimental group was (20.21 ± 11.42) μmol/L, the severity of in-stent restenosis was (0.25 ± 0.31), (R-value was 0.234; p-value was 0.037), indicating a correlation between serum Hcy and the severity of restenosis (p < 0.05). Taking coronary angiography as the gold standard, a ROC curve analysis was performed on the serum Hcy levels for the experimental group. The area under the curve (AUC) was 0.718 (95% CI 0.585-0.854, p < 0.001), indicating that the serum Hcy concentration could predict ISR. On the ROC curve, the best critical value of serum Hcy concentration for predicting ISR was 20.05 μmol/L, with a sensitivity of 45% and specificity of 88.1%. Conclusion: A positive correlation was observed between homocysteine and the severity of restenosis after PCI, The level of Hcy could serve as a predictive biomarker for the severity of ISR.
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Affiliation(s)
- Jiqiang Guo
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, China
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Gao
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, China
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mohammad Ahmed
- Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, FL, United States
| | - Pengfei Dong
- Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, FL, United States
| | - Yuping Gao
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhihua Gong
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinwen Liu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yajie Mao
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhijie Yue
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingli Zheng
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, China
| | - Jiansheng Li
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianrong Rong
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yongnian Zhou
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meiwen An
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, China
- *Correspondence: Meiwen An, ; Linxia Gu, ; Jin Zhang,
| | - Linxia Gu
- Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, FL, United States
- *Correspondence: Meiwen An, ; Linxia Gu, ; Jin Zhang,
| | - Jin Zhang
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Meiwen An, ; Linxia Gu, ; Jin Zhang,
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Kimura T, Akahori H, Tanaka T, Yanaka K, Yoshihara N, Miki K, Imanaka T, Asakura M, Ishihara M. Impact of lipoprotein (a) on long-term outcome after percutaneous coronary intervention in the era of new generation drug-eluting stents. J Cardiol 2022; 80:179-183. [DOI: 10.1016/j.jjcc.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/18/2022] [Accepted: 02/26/2022] [Indexed: 11/26/2022]
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Li M, Hou J, Gu X, Weng R, Zhong Z, Liu S. Incidence and risk factors of in-stent restenosis after percutaneous coronary intervention in patients from southern China. Eur J Med Res 2022; 27:12. [PMID: 35065663 PMCID: PMC8783476 DOI: 10.1186/s40001-022-00640-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/11/2022] [Indexed: 12/29/2022] Open
Abstract
Background In-stent restenosis (ISR) remains a challenge for coronary artery disease (CAD) patients who undergo percutaneous coronary intervention (PCI) with stents, and risk factors for ISR are controversial. This study aimed to investigate the incidence and risk factors of ISR in patients from southern China. Methods In this retrospective study, patients diagnosed as acute coronary syndromes (ACS) and underwent successful PCI with drug-eluting stent (DES) and conducted a follow-up coronary angiography in Center for Cardiovascular Diseases of Meizhou People’s Hospital at the period of January 1st, 2016 to January 1st, 2021 were included for analysis. The clinical and angiographic factors were compared between patients in ISR ( +) and ISR (−) groups. The association between variables and ISR was evaluated by multivariate logistic regression model. Result A total of 341 ACS patients who had been installed at least 1 stent were included in this study. The follow-up time was 34.2 ± 17.2 months. During the follow-up period, 62 (18.2%) patients experienced ISR, and the average time for ISR was 32.8 months; the incidence of ISR for left main coronary artery, left anterior descending coronary artery, left circumflex artery coronary artery and right coronary artery were 6.7%, 20.9%, 19.4% and 14.4%, respectively; left ventricular ejection fraction (LVEF), stent number, stent type, statin therapy, antiplatelet therapy were significantly different between patients in ISR ( +) and ISR (−) group. Multivariate logistic analysis suggested that LVEF and stent number were significantly correlated with ISR. Conclusion Our study revealed the incidence and risk factors of ISR in patients from southern China. Our data suggested that LVEF and stent number were independent risk factors associated with ISR.
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Ugovšek S, Šebeštjen M. Lipoprotein(a)—The Crossroads of Atherosclerosis, Atherothrombosis and Inflammation. Biomolecules 2021; 12:biom12010026. [PMID: 35053174 PMCID: PMC8773759 DOI: 10.3390/biom12010026] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022] Open
Abstract
Increased lipoprotein(a) (Lp(a)) levels are an independent predictor of coronary artery disease (CAD), degenerative aortic stenosis (DAS), and heart failure independent of CAD and DAS. Lp(a) levels are genetically determinated in an autosomal dominant mode, with great intra- and inter-ethnic diversity. Most variations in Lp(a) levels arise from genetic variations of the gene that encodes the apolipoprotein(a) component of Lp(a), the LPA gene. LPA is located on the long arm of chromosome 6, within region 6q2.6–2.7. Lp(a) levels increase cardiovascular risk through several unrelated mechanisms. Lp(a) quantitatively carries all of the atherogenic risk of low-density lipoprotein cholesterol, although it is even more prone to oxidation and penetration through endothelia to promote the production of foam cells. The thrombogenic properties of Lp(a) result from the homology between apolipoprotein(a) and plasminogen, which compete for the same binding sites on endothelial cells to inhibit fibrinolysis and promote intravascular thrombosis. LPA has up to 70% homology with the human plasminogen gene. Oxidized phospholipids promote differentiation of pro-inflammatory macrophages that secrete pro-inflammatory cytokines (e. g., interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor-α). The aim of this review is to define which of these mechanisms of Lp(a) is predominant in different groups of patients.
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Affiliation(s)
- Sabina Ugovšek
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Miran Šebeštjen
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Department of Cardiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
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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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Gogu AE, Motoc AG, Stroe AZ, Docu Axelerad A, Docu Axelerad D, Petrica L, Jianu DC. Plasminogen Activator Inhibitor-1 ( PAI-1) Gene Polymorphisms Associated with Cardiovascular Risk Factors Involved in Cerebral Venous Sinus Thrombosis. Metabolites 2021; 11:266. [PMID: 33922851 PMCID: PMC8146064 DOI: 10.3390/metabo11050266] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/17/2021] [Accepted: 04/21/2021] [Indexed: 12/21/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST), accounting for less than 1% of stroke cases, is characterized by various causes, heterogeneous clinical presentation and different outcome. The plasminogen activator inhibitor-1 (PAI-1) gene polymorphisms has been found to be associated with CVST. The aim of this retrospective study was to determine the potential association of PAI-1 675 4G/5G polymorphisms and homocysteine levels with cardiovascular risk factors in a group of young patients with CVST. Eighty patients with CVST and an equal number of age and sex matched controls were enrolled. The protocol included demographic and clinical baseline characteristics, neuroimagistic aspects, genetic testing (PAI-1 675 4G/5G polymorphisms), biochemical evaluation (homocysteine-tHcy, the lipid profile, blood glucose, glycohemoglobin-HbA1c, high-sensitive C-reactive protein-hsCRP) data, therapy and prognosis. The PAI-1 675 4G/5G gene polymorphisms were significantly correlated with increased homocysteine level (tHcy) (p < 0.05), higher total cholesterol (TC) (p < 0.05), low- density lipoprotein cholesterol (LDLc) (p = 0.05) and high- sensitive C- reactive protein (hsCRP) (p < 0.05) in patients with CVST when compared with controls. From the PAI-1 gene polymorphisms, the PAI-1 675 4G/5G genotype presented statistically significant values regarding the comparisons of the blood lipids values between the CVST group and control group. The homocysteine (tHcy) was increased in both groups, patients versus controls, in cases with the homozygous variant 4G/4G but the level was much higher in the group with CVST (50.56 µmol/L vs. 20.22 µmol/L; p = 0.03). The most common clinical presentation was headache (91.25%), followed by seizures (43.75%) and focal motor deficits (37.5%). The superior sagittal sinus (SSS) was the most commonly involved dural sinus (56.25%), followed by the lateral sinus (LS) (28.75%). Intima-media thickness (IMT) values were higher in the patients' group with CVST (0.95 mm vs. 0.88 mm; p < 0.05). The fatal outcome occurred 2.5% of the time. PAI-1 675 4G/5G gene polymorphisms and higher homocysteine concentrations were found to be significantly associated with CVST in young patients.
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Affiliation(s)
- Anca Elena Gogu
- Department of Neurology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.E.G.); (D.C.J.)
| | - Andrei Gheorghe Motoc
- Department of Anatomy, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Alina Zorina Stroe
- Department of Neurology, General Medicine Faculty, Ovidius University, 900470 Constanta, Romania;
| | - Any Docu Axelerad
- Department of Neurology, General Medicine Faculty, Ovidius University, 900470 Constanta, Romania;
| | | | - Ligia Petrica
- Department of Internal Medicine II, Division of Nephrology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Dragos Catalin Jianu
- Department of Neurology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.E.G.); (D.C.J.)
- Centre for Cognitive Research in Neuropsychiatric Pathology (Neuropsy-Cog), Faculty of Medicine, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania
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High-Serum Angiopoietin-Like Protein 3 Levels Associated with Cardiovascular Outcome in Patients with Coronary Artery Disease. Int J Hypertens 2020; 2020:2980954. [PMID: 32280540 PMCID: PMC7140125 DOI: 10.1155/2020/2980954] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/02/2020] [Accepted: 03/09/2020] [Indexed: 11/25/2022] Open
Abstract
Background Angiopoietin-like protein 3 (ANGPTL3) plays a pivotal role in lipid metabolism and angiogenesis, and there is growing interest regarding the association between ANGPTL3 and coronary artery disease (CAD). This study aims to investigate whether ANGPTL3 levels can be used to predict the future occurrence of major adverse cardiovascular events (MACEs) in patients with CAD. Methods Overall, 90 patients with CAD were enrolled between January and December 2012. The study's primary endpoint was incidence of MACEs. Patient follow-up was completed on June 30, 2017. Results Following a median follow-up period of 54 months, 33 MACEs had occurred. Patients reporting MACEs had lower statin use (P=0.022) and higher serum C-reactive protein (P < 0.001) and serum ANGPTL3 (P < 0.001) levels than those without MACEs. Kaplan–Meier analysis revealed higher cumulative incidence of CV events in the high ANGPTL3 group (median ANGPTL3 level ≥ 222.37 ng/mL) than in the low ANGPTL3 group (log-rank P=0.046). Multivariable Cox regression analysis demonstrated that ANGPTL3 levels were independently associated with MACEs in patients with CAD (hazard ratio: 1.003; 95% confidence interval: 1.000–1.005; P=0.026) after adjusted for age, gender, and body mass index, classical risk factors, and potential confounders. Conclusions Serum ANGPTL3 levels could serve as a biomarker for future occurrence of MACEs in patients with CAD.
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Zhang Z, Xiao S, Yang C, Ye R, Hu X, Chen X. Association of Elevated Plasma Homocysteine Level with Restenosis and Clinical Outcomes After Percutaneous Coronary Interventions: a Systemic Review and Meta-analysis. Cardiovasc Drugs Ther 2020; 33:353-361. [PMID: 30778807 DOI: 10.1007/s10557-019-06866-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE We conducted this systemic review and meta-analysis to investigate the association between elevated plasma homocysteine (Hcy) levels and recurrent restenosis and clinical outcomes after percutaneous coronary intervention (PCI). METHODS PubMed, EMBASE, and Web of Science were systematically searched prior to May 2018. Studies evaluating the association between plasma Hcy levels and the occurrence of restenosis, major adverse cardiac events (MACE), all-cause mortality, cardiac death, non-fatal myocardial infarction (MI), and target lesion revascularization were identified. RESULTS A total of 19 articles with 4340 participants were identified. Higher Hcy levels were not associated with an increased risk of restenosis (relative risk (RR) = 1.10, 95% CI 0.90-1.33). Hcy levels in the restenosis group were not significantly higher than in the non-restenosis group (weighted mean difference = 0.70, 95% CI - 0.23-1.63). Subgroup analysis revealed that higher Hcy levels were not associated with restenosis after stenting but appeared to increase the risk of restenosis after angioplasty. Elevated Hcy levels increased the risk of all-cause mortality by an average of 3.19-fold (RR = 3.19, 95% CI 1.90-5.34, P = 0.000), the risk of MACE by 1.51-fold (RR = 1.51, 95% CI 1.23-1.85, P = 0.000), and the risk of cardiac death by 2.76-fold (RR = 2.76, 95% CI 1.44-5.32, P = 0.000) but appeared not to increase the risk of non-fatal MI (RR = 1.36, 95% CI 0.89-2.09). CONCLUSIONS Our meta-analysis suggests that although there is no clear association between higher Hcy levels and restenosis following stent implantation, higher Hcy levels appeared to increase the risk of restenosis after coronary angioplasty and also increased the risk of all-cause mortality, MACE, and cardiac death after PCI. REGISTRATION DETAILS The protocol of this meta-analysis was registered on PROSPERO (CRD42018096466). ( http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018096466 ).
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Affiliation(s)
- Zhipeng Zhang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Shan Xiao
- Department of Day Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Changqiang Yang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Runyu Ye
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Xianjin Hu
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
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11
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Homocysteine is an independent predictor of long-term cardiac mortality in patients with stable coronary artery disease in the era of statins. Coron Artery Dis 2020; 31:152-156. [DOI: 10.1097/mca.0000000000000800] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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12
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Impact of serum lipoprotein(a) on endothelium-dependent coronary vasomotor response assessed by intracoronary acetylcholine provocation. Coron Artery Dis 2019; 29:516-525. [PMID: 29912783 DOI: 10.1097/mca.0000000000000642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic vascular disease. However, there are limited data regarding the impact of Lp(a) levels on the incidence and severity of endothelium-dependent coronary vasomotor response. PATIENTS AND METHODS A total of 2416 patients without significant coronary artery lesion (<50% stenosis) by coronary angiography and underwent acetylcholine (ACh) provocation test were enrolled and categorized according to their serum Lp(a) level into four quartile groups: less than 6.70, 6.70-13.30, 13.30-26.27, and more than 26.27 mg/dl. The aim of this study is to estimate the incidence and severity of endothelium-dependent positive ACh provocation test in each group; moreover, to access the incidence of major adverse cardiovascular events, the composite of total death, myocardial infarction, and de novo percutaneous coronary intervention were compared between the four groups up to 5 years. RESULTS The group with higher Lp(a) had a higher incidence of coronary heart disease, myocardial infarction, and peripheral arterial disease history. However, there was no difference among the four groups as regards the incidence of positive ACh provocation test, spasm severity, spasm extent, and location. However, at up to 5 years of clinical follow-up, the higher-Lp(a) group showed higher total death, de novo percutaneous coronary intervention, recurrent angina, and total major adverse cardiovascular events compared with the lower-Lp(a) groups. CONCLUSION In our study, there was no relationship between the elevated Lp(a) level and the vasospastic response to the intracoronary ACh provocation test; however, higher Lp(a) levels were associated with poor clinical outcomes up to 5 years.
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Abstract
Lipoprotein(a) (Lp(a)) is an independent cardiovascular risk factor playing a causal role for atherosclerotic cardiovascular disease (ASCVD). Early or progressive ASCVD or a familial predisposition are key findings which can be associated with Lp(a)-hyperlipoproteinemia (Lp(a)-HLP). The German guideline for the indication of lipoprotein apheresis in patients with Lp(a)-HLP has proved to be of value to identify patients at highest risk, using the composite of a Lp(a) threshold >60 mg/dl (>120 nmol/l) and clinical ASCVD progression despite effective LDL-C lowering therapy. In particular for such patients it appears to be plausible that Lp(a)-associated risk would increase cardiovascular mortality as the most important part of total mortality in Western populations. By the majority of existing investigations an association of Lp(a) concentration on total or cardiovascular mortality was demonstrated. However, inconsistency in the findings between studies exists without a clear trend for any study feature to explain this. Genetic homogeneity of the population, long-term follow-up, and clinically guided selection of patients might be important to further clarify the impact of Lp(a) concentration on progression of ASCVD, and finally total or cardiovascular mortality. LDL and Lp(a) particles exhibit a mutual effect modification on related ASCVD risk. Therefore, LDL-C levels and concomitant LDL-C lowering treatment must be considered in this context. Prospective evaluation is needed to document that specific Lp(a)-lowering additional to targeted LDL-C lowering will in fact reduce cardiovascular or total mortality.
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Affiliation(s)
- Reinhard Klingel
- Apheresis Research Institute, Stadtwaldguertel 77, 50935, Cologne, Germany.
- 1st Department of Internal Medicine, University of Mainz, Mainz, Germany.
| | - Andreas Heibges
- Apheresis Research Institute, Stadtwaldguertel 77, 50935, Cologne, Germany
| | - Cordula Fassbender
- Apheresis Research Institute, Stadtwaldguertel 77, 50935, Cologne, Germany
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14
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Enas EA, Varkey B, Dharmarajan TS, Pare G, Bahl VK. Lipoprotein(a): An independent, genetic, and causal factor for cardiovascular disease and acute myocardial infarction. Indian Heart J 2019; 71:99-112. [PMID: 31280836 PMCID: PMC6620428 DOI: 10.1016/j.ihj.2019.03.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/10/2019] [Accepted: 03/13/2019] [Indexed: 12/24/2022] Open
Abstract
Lipoprotein(a) [Lp(a)] is a circulating lipoprotein, and its level is largely determined by variation in the Lp(a) gene (LPA) locus encoding apo(a). Genetic variation in the LPA gene that increases Lp(a) level also increases coronary artery disease (CAD) risk, suggesting that Lp(a) is a causal factor for CAD risk. Lp(a) is the preferential lipoprotein carrier for oxidized phospholipids (OxPL), a proatherogenic and proinflammatory biomarker. Lp(a) adversely affects endothelial function, inflammation, oxidative stress, fibrinolysis, and plaque stability, leading to accelerated atherothrombosis and premature CAD. The INTER-HEART Study has established the usefulness of Lp(a) in assessing the risk of acute myocardial infarction in ethnically diverse populations with South Asians having the highest risk and population attributable risk. The 2018 Cholesterol Clinical Practice Guideline have recognized elevated Lp(a) as an atherosclerotic cardiovascular disease risk enhancer for initiating or intensifying statin therapy.
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Affiliation(s)
- Enas A Enas
- Coronary Artery Disease in Indians (CADI) Research Foundation, Lisle, IL USA.
| | - Basil Varkey
- Emeritus of Medicine, Medical College of Wisconsin, USA
| | - T S Dharmarajan
- Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Medicine, Montefiore Medical Center (Wakefield Campus), Bronx, NY, USA
| | | | - Vinay K Bahl
- Department of Cardiology, All India Institute of Medical Sciences New Delhi, India
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15
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Chen MC, Wang JH, Lee CJ, Hsu BG. Association between hyperleptinemia and cardiovascular outcomes in patients with coronary artery disease. Ther Clin Risk Manag 2018; 14:1855-1862. [PMID: 30319266 PMCID: PMC6171750 DOI: 10.2147/tcrm.s172231] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose Hyperleptinemia has been independently associated with human cardiovascular (CV) diseases. Accordingly, we evaluate the association between serum leptin and future CV events in patients with coronary artery disease (CAD). Patients and methods This study enrolled 98 patients with CAD from January to December 2012. The primary endpoint included incidences of major adverse CV events and hospitalization. Patients follow-up had been completed on June 30, 2017. Results After a median follow-up of 52 months, 43 CV events had occurred. Patients with CV events had higher systolic blood pressure (P = 0.030), total cholesterol (P = 0.034), C-reactive protein (P = 0.018), and serum leptin levels (P = 0.001) than those without CV events. Kaplan–Meier analysis showed greater cumulative incidences of CV events in the high leptin group (median leptin concentration >6.03 ng/mL) than in the low leptin group (log-rank P = 0.012). Multivariate Cox regression analysis showed that triglyceride (HR: 1.010; 95% CI: 1.001–1.018; P = 0.022) and leptin levels (HR: 1.054; 95% CI: 1.026–1.082; P < 0.001) were independently associated with CV events in patients with CAD. Conclusion Serum leptin levels could serve as a biomarker for future CV events in patients with CAD.
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Affiliation(s)
| | - Ji-Hung Wang
- Division of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan,
| | - Chung-Jen Lee
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Bang-Gee Hsu
- School of Medicine, Tzu Chi University, Hualien, Taiwan, .,Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan,
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Zhu X, Chen Y, Xiang L, You T, Jiao Y, Xu W, Chen J. The long-term prognostic significance of high-sensitive C-reactive protein to in-stent restenosis. Medicine (Baltimore) 2018; 97:e10679. [PMID: 29979375 PMCID: PMC6076028 DOI: 10.1097/md.0000000000010679] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In the current meta-analysis, we aim to assess the effect of high-sensitive C-reactive protein (hs-CRP) on in-stent restenosis (ISR) outcome in patients receiving stent implantation. METHODS Embase, PubMed, and Cochrane databases were searched through October 2016 using the keywords "high-sensitive C-reactive protein," "in-stent restenosis." An odds ratio (OR) of on ISR endpoints among patients receiving stent implantation was calculated using random-effects models. RESULTS In the meta-analysis of 6 prospective observational studies, there are 1156 coronary heart disease (CHD) patients, a total of 885 stents were implanted and 194 ISR events had been followed up for 6 to 12 months; high-sensitive C-reactive protein levels are associated with the prediction of in-stent restenosis among patients receiving stent implantation. The OR of hs-CRP for ISR was 1.16 [95% confidence interval (CI), 1.01-1.30, P < .05]. CONCLUSIONS This meta-analysis shows that higher levels of hs-CRP are associated with an increased risk of ISR and indicate a poorer prognosis in CHD patients after stent implantation.
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17
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Avan A, Tavakoly Sany SB, Ghayour‐Mobarhan M, Rahimi HR, Tajfard M, Ferns G. Serum C‐reactive protein in the prediction of cardiovascular diseases: Overview of the latest clinical studies and public health practice. J Cell Physiol 2018; 233:8508-8525. [DOI: 10.1002/jcp.26791] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/30/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Amir Avan
- Department of Modern Sciences and Technologies School of Medicine, Mashhad University of Medical Sciences Mashhad Iran
| | - Seyedeh Belin Tavakoly Sany
- Social Determinants of Health Research Center Mashhad University of Medical Sciences Mashhad Iran
- Department of Health Education and Health Promotion Faculty of Health, Mashhad University of Medical Sciences Mashhad Iran
| | - Majid Ghayour‐Mobarhan
- Department of Modern Sciences and Technologies School of Medicine, Mashhad University of Medical Sciences Mashhad Iran
| | - Hamid Reza Rahimi
- Department of Modern Sciences and Technologies School of Medicine, Mashhad University of Medical Sciences Mashhad Iran
| | - Mohammad Tajfard
- Social Determinants of Health Research Center Mashhad University of Medical Sciences Mashhad Iran
- Department of Health Education and Health Promotion Faculty of Health, Mashhad University of Medical Sciences Mashhad Iran
| | - Gordon Ferns
- Medical Education and Metabolic Medicine Head, Department of Medical Education, Brighton and Sussex Medical School University of Brighton Falmer Campus, Brighton UK
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Yeh JK, Chen CC, Hsieh MJ, Tsai ML, Yang CH, Chen DY, Chang SH, Wang CY, Lee CH, Hsieh IC. Impact of Homocysteine Level on Long-term Cardiovascular Outcomes in Patients after Coronary Artery Stenting. J Atheroscler Thromb 2016; 24:696-705. [PMID: 27803490 PMCID: PMC5517543 DOI: 10.5551/jat.36434] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim: The prognostic value of homocysteine (HCY) in patients with coronary artery diseases (CAD) is still controversial. The objective of this study was to investigate whether elevated HCY level at admission predict long-term outcomes in patients after percutaneous coronary interventions (PCI) with coronary artery stenting. Methods: From the institutional registry of Cardiovascular Atherosclerosis and Percutaneous TrAnsluminal INterventions (CAPTAIN), we enrolled a total of 1,307 patients with documented CAD undergone PCI with bare metal stents from July 2003 to December 2014. They were divided into two groups according to the fasting plasma HCY levels before catheterization: group I (883 patients, < 12 µmol/L) and group II (424 patients, ≥ 12 µmol/L). The primary endpoint was occurrence of major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, stroke, target lesion revascularization, new lesion stenting, and requiring bypass surgery. Results: After a mean follow-up period of 58 ± 41 months, the group II patients had a higher MACE rate (33.3% vs. 25.6%, p = 0.005). The main differences between two groups were cardiac death (8.0% vs. 3.4%, p = 0.001) and new lesion stenting (13.6% vs. 9.5%, p = 0.034). The risks of long-term MACE remained significantly higher in patients with elevated HCY level (≥ 12 µmol/L) after adjusting for clinical variables, with a hazard ratio of 1.29 (95% CI, 1.02–1.64, p = 0.036). Conclusions: Elevated HCY level (≥ 12 µmol/L) was independently associated with increased risk of long-term cardiovascular events in patients after coronary artery bare metal stents implantations. Thus, hyperhomocysteinemia may remain a useful prognostic marker for the risk assessment in clinical care of CAD patients.
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Affiliation(s)
- Jih-Kai Yeh
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital
| | - Chun-Chi Chen
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital
| | - Ming-Jer Hsieh
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital
| | - Ming-Lung Tsai
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital
| | - Chia-Hung Yang
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital
| | - Dong-Yi Chen
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital
| | - Shang-Hung Chang
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital
| | - Chao-Yung Wang
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital
| | - Cheng-Hung Lee
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital
| | - I-Chang Hsieh
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital
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Forbes CA, Quek RGW, Deshpande S, Worthy G, Wolff R, Stirk L, Kleijnen J, Gandra SR, Djedjos S, Wong ND. The relationship between Lp(a) and CVD outcomes: a systematic review. Lipids Health Dis 2016; 15:95. [PMID: 27184891 PMCID: PMC4869344 DOI: 10.1186/s12944-016-0258-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/02/2016] [Indexed: 02/28/2023] Open
Abstract
Robust associations between lipoprotein(a) [Lp(a)] and CVD outcomes among general populations have been published in previous studies. However, associations in high risk primary prevention and secondary prevention populations are less well defined. In order to investigate this further, a systematic review was performed including prospective studies, which assessed the relationship between Lp(a) and CVD outcomes using multivariable analyses. Additional information was gathered on Lp(a) assays, multivariable modelling and population characteristics. Literature searches from inception up to December 2015 retrieved 2850 records. From these 60 studies were included. Across 39 primary prevention studies in the general population (hazard ratios ranged from 1.16 to 2.97) and seven high risk primary prevention studies (hazard ratios ranged from 1.01 to 3.7), there was evidence of a statistically significant relationship between increased Lp(a) and an increased risk of future CVD. Results in 14 studies of secondary prevention populations were also suggestive of a modest statistically significant relationship (hazard ratios ranged from 0.75 to 3.7).Therefore current evidence would suggest that increased Lp(a) levels are associated with modest increases in the risk of future CVD events in both general and higher risk populations. However, further studies are required to confirm these findings.
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Affiliation(s)
- Carol A Forbes
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK.
| | - Ruben G W Quek
- Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, 91320-1799, USA
| | - Sohan Deshpande
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Gill Worthy
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Robert Wolff
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Lisa Stirk
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Jos Kleijnen
- School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | | | - Stephen Djedjos
- Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, 91320-1799, USA
| | - Nathan D Wong
- University of California, Heart Disease Prevention Program, C240 Medical Sciences, University of California, Mail Code: 4079, Irvine, CA, 92697, USA
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Kwon SW, Kim JY, Suh YJ, Lee DH, Yoon YW, Lee BK, Jung YH, Choi EY, Hong BK, Rim SJ, Kwon HM. Prognostic Value of Elevated Homocysteine Levels in Korean Patients with Coronary Artery Disease: A Propensity Score Matched Analysis. Korean Circ J 2016; 46:154-60. [PMID: 27014345 PMCID: PMC4805559 DOI: 10.4070/kcj.2016.46.2.154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/01/2015] [Accepted: 12/17/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We sought to determine whether an elevated homocysteine (Hcy) level is associated with a worse prognosis in Korean patients with coronary artery disease (CAD). SUBJECTS AND METHODS A total of 5839 patients (60.4% male, mean age 61.3±11.2 years) with CAD were enrolled from 2000 to 2010 at Gangnam Severance Hospital. CAD was diagnosed by invasive coronary angiography. Laboratory values including Hcy level were obtained on the day of coronary angiography and analyses were performed shortly after sampling. Patients were divided into two groups according to their Hcy levels. Baseline risk factors, coronary angiographic findings, length of follow-up, and composite endpoints including cardiac death (CD) and non-fatal myocardial infarction (NFMI) were recorded. 1:1 propensity score matched analysis was also performed. RESULTS Over a mean follow-up period of 4.4±2.5 years, there were 132 composite endpoints (75 CD and 57 NFMI) with an event rate of 2.3%. Mean Hcy level was 9.9±4.3 µmol/L (normal Hcy 7.9±1.5 µmol/L and elevated Hcy 13.9±5.1 µmol/L). Kaplan-Meier survival analysis showed an association of elevated Hcy level with worse prognosis (p<0.0001). In addition, a multivariate Cox regression analysis showed an association of elevated Hcy level with worse prognosis for both the entire cohort (hazard ratio [HR] 2.077, 95% confidence interval [CI] 1.467-2.941, p<0.0001) and the propensity score matched cohort (HR 1.982, 95% CI 1.305-3.009, p=0.001). CONCLUSION Elevated Hcy level is associated with worse outcomes in Korean patients with CAD.
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Affiliation(s)
- Sung Woo Kwon
- Department of Cardiology, Inha University Hospital, Incheon, Korea.; Department of Medicine, Yonsei University Graduate School, Seoul, Korea
| | - Jong-Youn Kim
- Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ju Suh
- Clinical Research Institute, Inha University School of Medicine, Incheon, Korea
| | - Dae Hyung Lee
- Future Strategy, Inha University Hospital, Incheon, Korea
| | - Young Won Yoon
- Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Kwon Lee
- Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Hak Jung
- Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eui-Young Choi
- Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bum-Kee Hong
- Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se-Joong Rim
- Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuck Moon Kwon
- Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Park SH, Rha SW, Choi BG, Park JY, Jeon U, Seo HS, Kim EJ, Na JO, Choi CU, Kim JW, Lim HE, Park CG, Oh DJ. Impact of high lipoprotein(a) levels on in-stent restenosis and long-term clinical outcomes of angina pectoris patients undergoing percutaneous coronary intervention with drug-eluting stents in Asian population. Clin Exp Pharmacol Physiol 2016; 42:588-95. [PMID: 25865336 DOI: 10.1111/1440-1681.12396] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 02/22/2015] [Accepted: 03/28/2015] [Indexed: 11/29/2022]
Abstract
Lipoprotein(a) (Lp(a)) is known to be associated with cardiovascular complications and atherothrombotic properties in general populations. However, it has not been examined whether Lp(a) levels are able to predict adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). A total of 595 consecutive patients with angina pectoris who underwent elective PCI with DES were enrolled from 2004 to 2010. The patients were divided into two groups according to the levels of Lp(a): Lp(a) < 50 mg/dL (n = 485 patients), and Lp(a) ≥ 50 mg/dL (n = 111 patients). The 6-9-month angiographic outcomes and 3-year cumulative major clinical outcomes were compared between the two groups. Binary restenosis occurred in 26 of 133 lesions (19.8%) in the high Lp(a) group and 43 of 550 lesions (7.9%) in the low Lp(a) group (P = 0.001). In multivariate analysis, the reference vessel diameter, low density lipoprotein cholesterol, total lesion length, and Lp(a) ≥ 50 mg/dL were predictors of binary restenosis. In the Cox proportional hazards regression analysis, Lp(a) > 50 mg/dL was significantly associated with the 3-year adverse clinical outcomes including any myocardial infarction, revascularization (target lesion revascularization (TLR) and target vessel revascularization (TVR)), TLR-major adverse cardiac events (MACEs), TVR-MACE, and All-MACEs. In our study, high Lp(a) level ≥ 50 mg/dL in angina pectoris patients undergoing elective PCI with DES was significantly associated with binary restenosis and 3-year adverse clinical outcomes in an Asian population.
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Affiliation(s)
- Sang-Ho Park
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Byoung-Geol Choi
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Ji-Young Park
- Division of Cardiology, Department of Internal Medicine, Eulji Medical University, Seoul, Korea
| | - Ung Jeon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Korea
| | - Hong-Seog Seo
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Eung-Ju Kim
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Jin-Oh Na
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Cheol-Ung Choi
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Jin-Won Kim
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Hong-Euy Lim
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Chang-Gyu Park
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Dong-Joo Oh
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
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Hsieh IC, Chen CC, Hsieh MJ, Yang CH, Chen DY, Chang SH, Wang CY, Lee CH, Tsai ML. Prognostic Impact of 9-Month High-Sensitivity C-Reactive Protein Levels on Long-Term Clinical Outcomes and In-Stent Restenosis in Patients at 9 Months after Drug-Eluting Stent Implantation. PLoS One 2015; 10:e0138512. [PMID: 26406989 PMCID: PMC4583430 DOI: 10.1371/journal.pone.0138512] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 08/30/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction The level of 9-month high-sensitivity C-reactive protein (hsCRP) in predicting cardiovascular outcomes is scanty in patients at 9 months after receiving drug-eluting stent (DES) implantations. This study aims to evaluate the relationship between 9-month follow-up hsCRP levels and long-term clinical outcomes in patients at 9 months after receiving DES. Methods A total of 1,763 patients who received 9-month follow-up angiography were enrolled and grouped according to hsCRP level 9 months after the DES implantation: group I (718 patients, hsCRP<1.0 mg/L), group II (639 patients, 1.0≦hsCRP≦3.0 mg/L), and group III (406 patients, hsCRP>3.0 mg/L). Results Group III patients had a lower cardiovascular event-free survival rate than group I or II patients during a follow-up of 64±45 months (64.5% vs. 71.6% vs. 72.8%, respectively, p = 0.012). Multivariate analysis showed that a follow-up hsCRP level <3.0 mg/L was an independent predictor of a major adverse cardiovascular event (cardiac death, reinfarction, target lesion revascularization, stenting in a new lesion, or coronary bypass surgery). Group III patients had a higher restenosis rate (11.3% vs. 5.8% vs. 6.6%, respectively, p = 0.002) and loss index (0.21±0.32 vs. 0.16±0.24 vs. 0.18±0.28, respectively, p = 0.001) than group I or II patients in 9-month follow-up angiography. Conclusions A high 9-month follow-up hsCRP level is an independent predictor of long-term clinical cardiovascular outcomes in patients at 9 months after DES implantation. It is also associated with a higher restenosis rate, larger late loss and loss index at 9 months after DES implantation.
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Affiliation(s)
- I-Chang Hsieh
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan
- * E-mail:
| | - Chun-Chi Chen
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan
| | - Ming-Jer Hsieh
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan
| | - Chia-Hung Yang
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan
| | - Dong-Yi Chen
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan
| | - Shang-Hung Chang
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan
| | - Chao-Yung Wang
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan
| | - Cheng-Hung Lee
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan
| | - Ming-Lung Tsai
- Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan, Taiwan
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Nagata I, Ike A, Nishikawa H, Zhang B, Sugihara M, Mori K, Iwata A, Kawamura A, Shirai K, Uehara Y, Ogawa M, Miura SI, Saku K. Associations between lipid profiles and MACE in hemodialysis patients with percutaneous coronary intervention: From the FU-Registry. J Cardiol 2015; 65:105-11. [DOI: 10.1016/j.jjcc.2014.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 03/07/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
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Ogita M, Miyauchi K, Kasai T, Doi S, Wada H, Naito R, Konishi H, Tsuboi S, Dohi T, Tamura H, Okazaki S, Daida H. Impact of preprocedural high-sensitive C-reactive protein levels on long-term clinical outcomes of patients with stable coronary artery disease and chronic kidney disease who were treated with drug-eluting stents. J Cardiol 2015; 66:15-21. [PMID: 25572020 DOI: 10.1016/j.jjcc.2014.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/03/2014] [Accepted: 10/14/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND To evaluate the prognostic impact of preprocedural high-sensitivity C-reactive protein (hsCRP) levels on the long-term clinical outcomes after first-generation drug-eluting stent (DES) implantation in chronic kidney disease (CKD) patients with stable coronary artery disease (CAD). METHODS AND RESULTS We found significant interaction between CKD and hsCRP levels (p=0.0138) in 1176 consecutive patients with stable CAD who were treated with first-generation DES implantation between 2004 and 2009 at our institution. Therefore, we separately analyzed data from patients with and without CKD who were assigned to tertiles based on preprocedural hsCRP levels. We evaluated the incidence of major adverse cardiovascular events (MACE) comprising all-cause death, nonfatal myocardial infarction, and target vessel revascularization after percutaneous coronary intervention during a median follow-up period of 1266 days. The rate of MACE significantly differed among the tertiles (log-rank p=0.0074) in the group with CKD. Multivariate Cox regression analysis significantly associated a higher hsCRP tertile with MACE in the CKD group (hazard ratio 2.39, 95% confidence interval 1.27-4.75, p=0.0062). CONCLUSION Elevated preprocedural serum hsCRP levels might be associated with the long-term clinical outcomes of patients with stable CAD and CKD who were implanted with first-generation DES.
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Affiliation(s)
- Manabu Ogita
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Katsumi Miyauchi
- Juntendo University, Department of Cardiovascular Medicine, Japan.
| | - Takatoshi Kasai
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Shinichiro Doi
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Hideki Wada
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Ryo Naito
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Hirokazu Konishi
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Shuta Tsuboi
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Tomotaka Dohi
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Hiroshi Tamura
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Shinya Okazaki
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Hiroyuki Daida
- Juntendo University, Department of Cardiovascular Medicine, Japan
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O'Donoghue ML, Morrow DA, Tsimikas S, Sloan S, Ren AF, Hoffman EB, Desai NR, Solomon SD, Domanski M, Arai K, Chiuve SE, Cannon CP, Sacks FM, Sabatine MS. Lipoprotein(a) for risk assessment in patients with established coronary artery disease. J Am Coll Cardiol 2013; 63:520-7. [PMID: 24161323 DOI: 10.1016/j.jacc.2013.09.042] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 09/13/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the prognostic utility of lipoprotein(a) [Lp(a)] in individuals with coronary artery disease (CAD). BACKGROUND Data regarding an association between Lp(a) and cardiovascular (CV) risk in secondary prevention populations are sparse. METHODS Plasma Lp(a) was measured in 6,708 subjects with CAD from 3 studies; data were then combined with 8 previously published studies for a total of 18,978 subjects. RESULTS Across the 3 studies, increasing levels of Lp(a) were not associated with the risk of CV events when modeled as a continuous variable (odds ratio [OR]: 1.03 per log-transformed SD, 95% confidence interval [CI]: 0.96 to 1.11) or by quintile (Q5:Q1 OR: 1.05, 95% CI: 0.83 to 1.34). When data were combined with previously published studies of Lp(a) in secondary prevention, subjects with Lp(a) levels in the highest quantile were at increased risk of CV events (OR: 1.40, 95% CI: 1.15 to 1.71), but with significant between-study heterogeneity (p = 0.001). When stratified on the basis of low-density lipoprotein (LDL) cholesterol, the association between Lp(a) and CV events was significant in studies in which average LDL cholesterol was ≥130 mg/dl (OR: 1.46, 95% CI: 1.23 to 1.73, p < 0.001), whereas this relationship did not achieve statistical significance for studies with an average LDL cholesterol <130 mg/dl (OR: 1.20, 95% CI: 0.90 to 1.60, p = 0.21). CONCLUSIONS Lp(a) is significantly associated with the risk of CV events in patients with established CAD; however, there exists marked heterogeneity across trials. In particular, the prognostic value of Lp(a) in patients with low cholesterol levels remains unclear.
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Affiliation(s)
- Michelle L O'Donoghue
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
| | - David A Morrow
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sotirios Tsimikas
- Division of Cardiovascular Diseases, University of California San Diego, La Jolla, California
| | - Sarah Sloan
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Angela F Ren
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elaine B Hoffman
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine; Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, Connecticut
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Domanski
- Mount Sinai School of Medicine, Cardiovascular Division, New York, New York
| | - Kiyohito Arai
- Division of Cardiovascular Diseases, University of California San Diego, La Jolla, California; Division of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Stephanie E Chiuve
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Christopher P Cannon
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Frank M Sacks
- Channing Laboratory and Cardiology Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marc S Sabatine
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
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Patel D, Jhamnani S, Ahmad S, Silverman A, Lindsay J. Discordant association of C-reactive protein with clinical events and coronary luminal narrowing in postmenopausal women: data from the Women's Angiographic Vitamin and Estrogen (WAVE) study. Clin Cardiol 2013; 36:535-41. [PMID: 23754758 DOI: 10.1002/clc.22155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 05/06/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The incidence of cardiovascular events had been shown to be associated with C-reactive protein (CRP). However, it is unclear that the cardiovascular risk associated with CRP is due to progressive coronary narrowing or to other factors such as formation of unstable plaque. This study was designed to determine the effect of baseline CRP on cardiovascular events and on the progression of atherosclerotic narrowing among 423 postmenopausal women with angiographic stenosis between 15% and 75%. HYPOTHESIS Baseline CRP levels may affect cardiovascular events and progression of atherosclerotic coronary artery narrowing among postmenopausal women. METHODS Baseline and follow-up (2.8 years) angiographic data were analyzed among 320 women. Women were stratified into 4 quartiles according to baseline CRP levels. The changes in lumen diameter and clinical events in each quartile were compared. RESULTS The annualized changes in minimal and average lumen diameter in diseased and nondiseased coronary segments were not significantly associated with baseline CRP levels. The composite end point of all-cause mortality and myocardial infarction (MI) increased from 3% (3/107) in the first CRP quartile to 14% (14/98) in fourth CRP quartile (P < 0.001). Similar results were found for cardiovascular death and MI (increased from 1% (2/107) in the first quartile to 11% (11/98) in fourth quartile). The difference remained significant even after adjustment for baseline differences and cardiovascular risk factors. CONCLUSIONS Higher baseline CRP was associated with increased risk of clinical events but was not associated with annualized change in luminal diameters. Thus, increased risk of adverse events among patients with higher baseline CRP events was independent of progression of atherosclerosis as measured by change in minimal or average luminal diameter.
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Affiliation(s)
- Dhavalkumar Patel
- Department of Internal Medicine, Washington Hospital Center, Washington, DC; Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University Hospital, Richmond, Virginia
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Association between baseline lipoprotein (a) levels and restenosis after coronary stenting: Meta-analysis of 9 cohort studies. Atherosclerosis 2013; 227:360-6. [DOI: 10.1016/j.atherosclerosis.2013.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 12/30/2012] [Accepted: 01/10/2013] [Indexed: 11/17/2022]
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Kishk YT, Youssef AA, Bafadhl TA. Prognostic significance of high sensitivity C-reactive protein in patients with angina pectoris underwent percutaneous coronary intervention. J Saudi Heart Assoc 2012. [DOI: 10.1016/j.jsha.2012.06.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Kardys I, Oemrawsingh RM, Kay IP, Jones GT, McCormick SPA, Daemen J, Van Geuns RJ, Boersma E, Van Domburg RT, Serruys PW. Lipoprotein(a), interleukin-10, C-reactive protein, and 8-year outcome after percutaneous coronary intervention. Clin Cardiol 2012; 35:482-9. [PMID: 22488248 DOI: 10.1002/clc.21988] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 02/28/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND This prospective study investigated the association between preprocedural biomarker levels and incident major adverse cardiac events (MACE) in complex patients undergoing percutaneous coronary intervention (PCI) with sirolimus-eluting stenting. HYPOTHESIS Lipoprotein(a) (Lp[a]), interleukin-10 (IL-10), and high-sensitivity C-reactive protein (CRP) have long-term prognostic value in patients undergoing PCI. METHODS Between April 2002 and February 2003, 161 patients were included in the study. Blood was drawn before the procedure, and biomarkers were measured. Patients were followed-up for MACE (death, nonfatal myocardial infarction, and repeat revascularization). Cox proportional hazard models were used to determine risk of MACE for tertiles of biomarkers. Both 1-year and long-term follow-up (median, 6 years; maximum, 8 years) were evaluated. RESULTS Mean age was 59 years, and 68% were men. During long-term follow-up, 72 MACE occurred (overall crude cumulative incidence: 45% [95% confidence interval (CI): 37%-52%]). Lp(a) was associated with a higher 1-year risk of MACE, with an adjusted hazard ratio (HR) of 3.1 (95% CI: 1.1-8.6) for the highest vs the lowest tertile. This association weakened and lost significance with long-term follow-up. IL-10 showed a tendency toward an association with MACE. The 1-year HR was 2.1 (95% CI: 0.92-5.0). Long-term follow-up rendered a similar result. The association of CRP with MACE did not reach statistical significance at 1-year follow-up. However, CRP was associated with long-term risk of MACE, with an HR of 1.9 (95% CI: 1.0-3.5). CONCLUSIONS In this prospective study, preprocedural Lp(a) level was associated with short-term prognosis after PCI. The preprocedural CRP level was associated with long-term prognosis after PCI.
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Affiliation(s)
- Isabella Kardys
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
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Ishii H, Toriyama T, Aoyama T, Takahashi H, Tanaka M, Yoshikawa D, Hayashi M, Yasuda Y, Maruyama S, Matsuo S, Matsubara T, Murohara T. Percutaneous coronary intervention with bare metal stent vs. drug-eluting stent in hemodialysis patients. Circ J 2012; 76:1609-15. [PMID: 22484980 DOI: 10.1253/circj.cj-12-0078] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) is widely performed in patients with coronary artery disease, but the high restenosis rate remains a major clinical problem after implantation of DES in patients on hemodialysis (HD). Until now, there are limited reports regarding the long-term clinical outcome after implantation of DES in this patient population. METHODS AND RESULTS We compared bare metal stent (BMS) and DES for long-term clinical outcomes, such as target lesion revascularization (TLR), in HD patients undergoing PCI. BMS and DES were implanted in 204 and 301 patients, respectively. Baseline and lesion characteristics were comparable between the 2 groups. By Kaplan-Meier analysis, event rates of major adverse cardiac events for 6 years were significantly lower in the DES group than in the BMS group (42.5% vs. 58.0%, P=0.036). Although there were no significant differences in TLR rates between patients treated with DES and those with BMS at 1 year after PCI (17.8% vs. 21.3%, P=0.32), patients treated with DES had significantly lower rates of TLR compared with those treated with BMS beyond the 1-year follow-up after PCI (16.4% vs. 30.9%, P=0.019). CONCLUSIONS In patients on HD, implantation of DES might be more effective for preventing TLR in the medium to long follow-up period than BMS, although restenosis after PCI with DES is common in the short term.
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Affiliation(s)
- Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Lim CCS, van Gaal WJ, Testa L, Cuculi F, Arnold JR, Karamitsos T, Francis JM, Petersen SE, Digby JE, Westaby S, Antoniades C, Kharbanda RK, Burrell LM, Neubauer S, Banning AP. With the "universal definition," measurement of creatine kinase-myocardial band rather than troponin allows more accurate diagnosis of periprocedural necrosis and infarction after coronary intervention. J Am Coll Cardiol 2011; 57:653-61. [PMID: 21292125 DOI: 10.1016/j.jacc.2010.07.058] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 06/22/2010] [Accepted: 07/06/2010] [Indexed: 01/27/2023]
Abstract
OBJECTIVES We aimed to assess the differential implications of creatine kinase-myocardial band (CK-MB) and troponin measurement with the universal definition of periprocedural injury after percutaneous coronary intervention. BACKGROUND Differentiation between definitions of periprocedural necrosis and periprocedural infarction has practical, sociological, and research implications. Troponin is the recommended biomarker, but there has been debate about the recommended diagnostic thresholds. METHODS Thirty-two patients undergoing multivessel percutaneous coronary intervention and late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging in a prospective study had cardiac troponin I, CK-MB, and inflammatory markers (C-reactive protein, serum amyloid A, myeloperoxidase, tumor necrosis factor alpha) measured at baseline, 1 h, 6 h, 12 h, and 24 h after the procedure. Three "periprocedural injury" groups were defined with the universal definition: G1: no injury (biomarker <99th percentile); G2: periprocedural necrosis (1 to 3 × 99th percentile); G3: myocardial infarction (MI) type 4a (>3 × 99th percentile). Differences in inflammatory profiles were analyzed. RESULTS With CK-MB there were 17, 10, and 5 patients in groups 1, 2, and 3, respectively. Patients with CK-MB-defined MI type 4a closely approximated patients with new CMR-LGE injury. Groups defined with CK-MB showed progressively increasing percentage change in C-reactive protein and serum amyloid A, reflecting increasing inflammatory response (p < 0.05). Using cardiac troponin I resulted in 26 patients defined as MI type 4a, but only a small minority had evidence of abnormality on CMR-LGE, and only 3 patients were defined as necrosis. No differences in inflammatory response were evident when groups were defined with troponin. CONCLUSIONS Measuring CK-MB is more clinically relevant for diagnosing MI type 4a, when applying the universal definition. Current troponin thresholds are oversensitive with the arbitrary limit of 3 × 99th percentile failing to discriminate between periprocedural necrosis and MI type 4a. (Myocardial Injury following Coronary Artery bypass Surgery versus Angioplasty: a randomised controlled trial using biochemical markers and cardiovascular magnetic resonance imaging; ISRCTN25699844).
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Affiliation(s)
- Chris C S Lim
- Oxford Heart Centre, John Radcliffe Hospital, United Kingdom
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Abstract
The pathophysiology of post-PCI restenosis involves neointimal formation that consists of three phases: thrombosis (within 24 h), recruitment (3-8 days), and proliferation, which starts on day 8 of PCI. Various factors suggested to be predictors/risks for restenosis include C-reactive protein (CRP), inflammatory mediators (cytokines and adhesion molecules), oxygen radicals, advanced glycation end products (AGEs) and their receptors (RAGE), and soluble RAGE (sRAGE). The earlier noted factors produce thrombogenesis, vascular smooth muscle cell proliferation, and extracellular matrix formation. Statins have pleiotropic effects. Besides lowering serum cholesterol, they have various other biological effects including antiinflammatory, antithrombotic, CRP-lowering, antioxidant, antimitotic, and inhibition of smooth muscle cell proliferation. They inhibit matrix metalloproteinase and cyclooxygenase-2, lower AGEs, decrease expression of RAGE and increase levels of serum sRAGE. They also increase the synthesis of nitric oxide (NO) by increasing endothelial NO synthase expression and activity. Preprocedural statin therapy is known to reduce peri- and post-PCI myonecrosis and reduce the need for repeat revascularization. There is evidence that statin-eluting stents inhibit in-stent restenosis in animal models. It is concluded that because of the above attributes of statins, they are suitable candidates for reduction of post-PCI restenosis and post-PCI myonecrosis. The future directions for the use of statins in reduction of post-PCI restenosis and myonecrosis have been discussed.
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Affiliation(s)
- Kailash Prasad
- Department of Physiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
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Iakovou I, Foin N, Andreou A, Viceconte N, Di Mario C. New strategies in the treatment of coronary bifurcations. Herz 2011; 36:198-212. [PMID: 21541738 DOI: 10.1007/s00059-011-3459-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite major improvements in stent technology (i.e., drug-eluting stents, DES), treatment of coronary bifurcations is an ever occurring problem of the interventional cardiology. While stenting the main branch with provisional side branch stenting seems to be the prevailing approach, in the era of DES various two-stent techniques emerged (crush) or were re-introduced (V or simultaneous kissing stents, crush, T, culottes, etc.) to allow stenting in the side branch when needed. New techniques in imaging like optical coherence tomography help in better understanding bifurcation anatomy and, thus, have the potential to help us better treat this challenging subset of lesions. In addition, new dedicated bifurcation stents have been proposed in an attempt to overcome limitations associated with current approaches, and they showed promising results in early studies; however, the safety and the efficacy of these devices remain to be seen in the ongoing and upcoming trials. This review focuses on the current approaches and the development of new techniques employed for the treatment of bifurcation disease.
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Affiliation(s)
- I Iakovou
- Onassis Cardiac Surgery Center, Athens, Greece
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Siegel G, Ermilov E. Hs-CRP may be associated with white blood cell count in metabolic syndrome patients treated with Ginkgo biloba. Atherosclerosis 2011; 218:250-2. [DOI: 10.1016/j.atherosclerosis.2011.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 05/04/2011] [Accepted: 05/07/2011] [Indexed: 10/18/2022]
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Momiyama Y, Ohmori R, Uto-Kondo H, Tanaka N, Kato R, Taniguchi H, Arakawa K, Nakamura H, Ohsuzu F. Serum resistin levels and cardiovascular events in patients undergoing percutaneous coronary intervention. J Atheroscler Thromb 2010; 18:108-14. [PMID: 21071880 DOI: 10.5551/jat.6023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Resistin is an adipocytokine that may link inflammation and atherosclerosis.We studied the associations of resistin levels with cardiovascular events and restenosis. METHODS We measured pre-procedural serum resistin levels in 140 patients with coronary artery disease undergoing elective percutaneous coronary intervention (PCI), of whom 97 had a stent. Restenosis was defined as > 50% stenosis at follow-up angiography. Patients were followed for 3 years for major adverse cardiovascular events (MACE). RESULTS At 8±6 months after PCI, reangiography was performed in 94 (67%) patients, of whom 42 had restenosis. Between 42 patients with restenosis and 52 without restenosis, resistin (4.5±2.6 vs. 4.5±2.5 ng/mL) and Creactive protein (CRP) (median 0.70 vs. 0.70 mg/L) levels did not differ. During 3-year follow-up, MACE occurred in 24 patients (1 death, 21 unstable angina, 2 stroke). Compared with 116 patients without MACE, 24 with MACE had higher resistin (5.4±2.4 vs. 4.3±2.5 ng/mL) and CRP (1.30 vs. 0.60 mg/L) levels (p< 0.05). Patients with MACE more often had resistin >4.0 ng/mL than without MACE (75% vs. 35%, p< 0.001). Resistin correlated with CRP levels (r= 0.31). To clarify the association between MACE and resistin, patients were divided into 2 groups by resistin levels. Kaplan-Meier analysis showed a lower event-free survival rate in patients with resistin > 4.0 ng/mL than without it (p< 0.001). On multivariate analysis, resistin, but not CRP, was an independent predictor of MACE. The hazard ratio for MACE was 3.6 (95%CI=1.4-9.2) for resistin > 4.0 ng/mL. CONCLUSION Serum resistin levels were found to be associated with further cardiovascular events in patients undergoing PCI.
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Affiliation(s)
- Yukihiko Momiyama
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan.
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Müller K, Aichele S, Herkommer M, Bigalke B, Stellos K, Htun P, Fateh-Moghadam S, May AE, Flather M, Gawaz M, Geisler T. Impact of inflammatory markers on platelet inhibition and cardiovascular outcome including stent thrombosis in patients with symptomatic coronary artery disease. Atherosclerosis 2010; 213:256-62. [PMID: 20728084 DOI: 10.1016/j.atherosclerosis.2010.07.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 07/02/2010] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
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Zheng JL, Lu L, Hu J, Zhang RY, Zhang Q, Chen QJ, Shen WF. Increased serum YKL-40 and C-reactive protein levels are associated with angiographic lesion progression in patients with coronary artery disease. Atherosclerosis 2010; 210:590-5. [DOI: 10.1016/j.atherosclerosis.2009.12.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 12/10/2009] [Accepted: 12/11/2009] [Indexed: 10/20/2022]
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Delhaye C, Maluenda G, Wakabayashi K, Ben-Dor I, Lemesle G, Collins SD, Syed AI, Torguson R, Kaneshige K, Xue Z, Suddath WO, Satler LF, Kent KM, Lindsay J, Pichard AD, Waksman R. Long-term prognostic value of preprocedural C-reactive protein after drug-eluting stent implantation. Am J Cardiol 2010; 105:826-32. [PMID: 20211326 DOI: 10.1016/j.amjcard.2009.10.064] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 10/28/2009] [Accepted: 10/28/2009] [Indexed: 10/19/2022]
Abstract
C-reactive protein (CRP) elevation is associated with an adverse cardiovascular prognosis after bare metal stent implantation. Data have suggested a similar association between preprocedural CRP and adverse events after drug-eluting stent (DES) implantation. The present study was designed to address whether such a relation exists after DES placement. After excluding patients presenting with an acute coronary syndrome with troponin I elevation, we analyzed the data from 936 consecutive patients who had undergone DES implantation from 2003 to 2007 and had a preprocedural CRP measurement. The patients were divided into 3 groups according to the preprocedural CRP level (<1.31, 1.31-3.76, and >3.76 mg/L). The primary end point was the composite of death and Q-wave myocardial infarction (QWMI) at 2 years of follow-up. Target vessel revascularization was also assessed. The rate of death/QWMI was not significantly different statistically among the CRP tertiles during the in-hospital period (0.6% vs 0.0% vs 0.6%, p = 0.5) or at 1 year of follow-up (1.9% vs 2.9% vs 4.5%, p = 0.2). At 2 years, death/QWMI had occurred in 2.9% of patients in the lowest, 5.2% in the middle, and 8.8% in the highest tertile (p = 0.006). The incidence of target vessel revascularization was similar in the 3 groups at 2 years of follow-up (13.2% vs 14.9% vs 16.9%, p = 0.5). On multivariate analysis, the upper tertile of CRP was an independent predictor of death/QWMI at 2 years (hazard ratio 2.5, 95% confidence interval 1.1 to 5.4, tertile 3 vs tertile 1, p = 0.006). In conclusion, high preprocedural CRP levels are associated with an increased risk of death and QWMI after DES implantation at long-term follow-up but not acutely. The CRP levels were not related to target vessel revascularization. Thus, an elevated CRP level in this population appears to be more of a marker of global cardiovascular risk than a predictor of post-DES-related complications.
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A novel predictor of restenosis and adverse cardiac events: asymmetric dimethylarginine. Heart Vessels 2010; 25:19-26. [PMID: 20091394 DOI: 10.1007/s00380-009-1158-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 03/09/2009] [Indexed: 02/07/2023]
Abstract
The aim of this study is to investigate if serum asymmetric dimethylarginine (ADMA) levels can predict restenosis and major adverse cardiac events (MACE) in patients who undergo percutaneous coronary interventions. The most important cause of restenosis following percutaneous coronary intervention is neointimal hyperplasia. Nitric oxide (NO) prevents the neointimal hyperplasia growing. Asymmetric dimethylarginine is a competitive inhibitor of NO synthesis. The effect of ADMA on the restenosis has not yet been investigated. A total of 105 (80 male and 25 female) patients were included in our study. All patients underwent elective percutaneous transluminal coronary angioplasty (PTCA) with bare metal stent implantation or direct stenting for one coronary artery between September 2004 and January 2006. All patients were clinically followed for a period of 6 months, and a control angiography was performed at the end of this period. The probrain natriuretic peptide (pro-BNP), high-sensitivity Creactive protein (hs-CRP), and ADMA levels of the patients were evaluated before the procedure and 6 months afterwards. Biochemical parameters and angiographic features were evaluated in order to determine if they could predict the development of restenosis and MACE by using univariate and multivariate Cox regression analysis. The 65 (61.9%) patients (50 males and 15 females) who had not developed restenosis were designated as Group 1. The 27 (25.7%) patients (21 males and 6 females) who had developed restenosis were designated as Group 2. In terms of predicting the development of restenosis, the presence of diabetes mellitus (hazard ratio [HR]: 2.78; confidence interval [CI]: 1.25-6.20; P = 0.01), type of lesion (HR: 1.89; CI: 1.01-3.55; P = 0.04), form of procedure (HR: 0.30; CI: 0.11-0.81; P = 0.01), and ADMA (HR: 4.08; CI: 1.73-9.62; P = 0.001) were found to be significant in univariate Cox regression analysis. In contrast, only the levels of ADMA were found to be a significant predictor of restenosis in the multivariate Cox regression analysis (HR: 3.02; CI: 1.16-7.84; P = 0.02). The restenosis prediction of ADMA levels continued after excluding the patients with diabetes mellitus in the univariate and multivariate Cox regression analysis (HR: 5.23; CI: 1.99-13.76; P = 0.001 and HR: 5.61; CI: 1.79-17.62; P = 0.003, respectively). Regarding the development of cardiac events, hs-CRP (HR: 1.03; CI: 1.00-1.06; P = 0.01) and ADMA (HR: 17.1; CI: 3.06-95.8; P = 0.001) were found to be significantly correlated with adverse cardiac events in univariate Cox regression analysis, whereas only ADMA levels were significant in the multivariate Cox regression analysis (HR: 2.83; CI: 1.27-6.31; P = 0.01). The levels of ADMA obtained before the procedure predict the development of restenosis and MACE in patients who underwent elective PTCA and bare metal stent procedures.
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Momiyama Y, Kawaguchi A, Kajiwara I, Ohmori R, Okada K, Saito I, Konishi M, Nakamura M, Sato S, Kokubo Y, Mannami T, Adachi H, Kario K, Iso H, Ohsuzu F, Tsushima M. Prognostic value of plasma high-sensitivity C-reactive protein levels in Japanese patients with stable coronary artery disease: The Japan NCVC-Collaborative Inflammation Cohort (JNIC) Study. Atherosclerosis 2009; 207:272-6. [DOI: 10.1016/j.atherosclerosis.2009.04.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 04/03/2009] [Accepted: 04/08/2009] [Indexed: 10/20/2022]
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Ishii H, Toriyama T, Aoyama T, Takahashi H, Amano T, Hayashi M, Tanaka M, Kawamura Y, Yasuda Y, Yuzawa Y, Maruyama S, Matsuo S, Matsubara T, Murohara T. Prognostic values of C-reactive protein levels on clinical outcome after implantation of sirolimus-eluting stents in patients on hemodialysis. Circ Cardiovasc Interv 2009; 2:513-8. [PMID: 20031768 DOI: 10.1161/circinterventions.109.889915] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) using drug-eluting stents significantly reduces the risk of restenosis in the general population. However, in patients on hemodialysis, adverse cardiac events are frequently seen even if treated with drug-eluting stents. Recent studies suggest that C-reactive protein (CRP) reflects vascular wall inflammation and can predict adverse cardiac events. We evaluated possible prognostic values of CRP on outcomes in patients on hemodialysis undergoing PCI with drug-eluting stents. METHODS AND RESULTS A total of 167 patients undergoing PCI with sirolimus-eluting stents for stable angina (322 lesions) were enrolled. They were divided into tertiles according to serum CRP levels. We analyzed the incidence of major adverse cardiovascular events including cardiovascular death, nonfatal myocardial infarction, and target lesion revascularization after PCI as well as quantitative coronary angiographic data. The mean follow-up was 31 months (SD, 14). Major adverse cardiac events occurred in 11 patients (19.6%) of the lowest tertile, in 22 patients (39.3%) of the middle tertile, and in 28 patients (50.9%) of the highest tertile during follow-up period (P=0.0009). There was a progressive increase in neointimal growth after sirolimus-eluting stent implantation during follow-up because preprocedural CRP levels were higher, despite similar angiographic data just after PCI. Angiographic restenosis at 6 to 8 months after PCI was seen in 10.6% in the lowest tertile, 17.9% in the middle tertile, and 32.0% in the highest tertile (P=0.0007). CONCLUSIONS Increased preprocedural serum CRP levels would predict higher major adverse cardiac events and restenosis rates after sirolimus-eluting stents implantation in patients on hemodialysis.
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Affiliation(s)
- Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
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Park MW, Seung KB, Kim PJ, Park HJ, Yoon SG, Baek JY, Koh YS, Jung HO, Chang K, Kim HY, Baek SH. Long-term percutaneous coronary intervention rates and associated independent predictors for progression of nonintervened nonculprit coronary lesions. Am J Cardiol 2009; 104:648-52. [PMID: 19699339 DOI: 10.1016/j.amjcard.2009.04.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Revised: 04/14/2009] [Accepted: 04/14/2009] [Indexed: 10/20/2022]
Abstract
After successful percutaneous coronary intervention (PCI), unpredictable coronary events occur that are caused by in-stent restenosis and the progression of preexisting nonculprit coronary lesions. However, little is known about the long-term clinically driven PCI rates for the progression of nonculprit coronary lesions discovered during culprit-lesion PCI or its independent predictors, including several biomarkers. In this study, the clinical and angiographic data of 1,395 PCI patients treated from January 2004 to May 2007 were retrospectively analyzed. Of these patients, 507 were eligible for this study. After baseline PCI (i.e., culprit-lesion PCI), 81 patients (16%) underwent additional clinically driven PCI to treat preexisting nonculprit coronary lesions during the study period. The cumulative rates of clinically driven PCI for nonculprit coronary lesions were 7.7% (n = 39) at 1 year, 14% (n = 70) at 2 years, and 16% (n = 81) at 3 years. The independent predictors of clinically driven PCI included a larger number of significant coronary lesions (odds ratio [OR] 2.29, 95% confidence interval [CI] 1.5 to 3.5, p <0.001), low high-density lipoprotein (<40 mg/dl; OR 2.01, 95% CI 1.01 to 3.98, p = 0.046), hypercholesterolemia (total cholesterol >200 mg/dl; OR 1.46, 95% CI 1.22 to 1.97, p = 0.04), history of PCI (OR 1.24, 95% CI 1.09 to 1.60, p = 0.003), and increased triglyceride levels (OR 1.003, 95% CI 1.001 to 1.007, p = 0.038) at the time of baseline PCI. In conclusion, PCI patients with nonculprit coronary lesions underwent additional clinically driven PCI at rates of 7.7% at 1 year, 14% at 2 years, and 16% at 3 years because of the progression of preexisting nonculprit coronary lesions. Overall coronary artery disease burden and poor lipid profiles at baseline PCI confer significant risks for clinically driven PCI.
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Aronson D. Inflammatory markers: linking unstable plaques to coronary event, an interventional perspective. ACTA ACUST UNITED AC 2009; 6:110-8. [PMID: 16146903 DOI: 10.1080/14628840410030522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Abundant data links inflammatory mechanisms to atheromatous plaque destabilization leading to plaque rupture and coronary events. The discovery of inflammatory cells and inflammatory mediators within atherosclerotic plaques prone to rupture led to a series of studies demonstrating an association between various markers of inflammation and future coronary events. Inflammatory markers have also been used in patients undergoing coronary angioplasty in an attempt to predict restenosis and risk for post-procedural coronary events. This review article provides an overview on the potential use of inflammatory markers in the context of coronary interventions.
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Affiliation(s)
- Doron Aronson
- Department of Cardiology, Rambam Medical Center, Haifa, Israel.
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Frazier L, Vaughn WK, Willerson JT, Ballantyne CM, Boerwinkle E. Inflammatory protein levels and depression screening after coronary stenting predict major adverse coronary events. Biol Res Nurs 2009; 11:163-73. [PMID: 19251718 DOI: 10.1177/1099800409332801] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traditional risk factors cannot account for the majority of future major adverse coronary events (MACE) in patients diagnosed with heart disease. We examined levels of inflammatory proteins to be possible predictors of future MACE and physiological and psychological factors that initiate temporal increases in inflammatory protein levels. METHODS Peripheral blood samples and depression data were collected 4 to 12 hr after elective coronary stent insertion in 490 patients. Depression screening was assessed by a single-question screening tool. Predictive modeling for future MACE was performed by using survival analysis, with time from the index event (placement of the stent) to future MACE as the dependent variable. RESULTS Patients with high-sensitivity c-reactive protein (hsCRP) in the second and third quartiles were 3 and 2.5 times more likely to have a MACE than patients with hsCRP in the first quartile, respectively. As levels of vascular cell adhesion molecule and monocyte chemoattractant protein-1 increased, so did the risk of future MACE. Patients who screened positive for depression were approximately 2 times more likely to have a MACE within 24 months after stent placement than were patients who did not screen positive. CONCLUSIONS Our results suggest that hsCRP, vascular cell adhesion molecule, and monocyte chemoattractant protein-1 levels, measured after coronary stent insertion in patients with coronary heart disease, are prognostic of future MACE. Furthermore, positive depression screening is an independent predictor of future MACE.
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Affiliation(s)
- Lorraine Frazier
- School of Nursing, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
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Kato R, Momiyama Y, Ohmori R, Tanaka N, Taniguchi H, Arakawa K, Nakamura H, Ohsuzu F. Prognostic Significance of Plasma Osteopontin Levels in Patients Undergoing Percutaneous Coronary Intervention. Circ J 2009; 73:152-7. [DOI: 10.1253/circj.cj-08-0687] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ryuichi Kato
- First Department of Internal Medicine, National Defense Medical College
| | - Yukihiko Momiyama
- Division of Cardiology, National Hospital Organization Tokyo Medical Center
| | | | - Nobukiyo Tanaka
- First Department of Internal Medicine, National Defense Medical College
| | - Hiroaki Taniguchi
- First Department of Internal Medicine, National Defense Medical College
| | - Koh Arakawa
- First Department of Internal Medicine, National Defense Medical College
| | - Haruo Nakamura
- First Department of Internal Medicine, National Defense Medical College
| | - Fumitaka Ohsuzu
- First Department of Internal Medicine, National Defense Medical College
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Dai DF, Hwang JJ, Lin JL, Lin JW, Hsu CN, Lin CM, Chiang FT, Lai LP, Hsu KL, Tseng CD, Tseng YZ. Joint effects of N-terminal pro-B-type-natriuretic peptide and C-reactive protein vs angiographic severity in predicting major adverse cardiovascular events and clinical restenosis after coronary angioplasty in patients with stable coronary artery disease. Circ J 2008; 72:1316-23. [PMID: 18654020 DOI: 10.1253/circj.72.1316] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study was designed to evaluate the joint effects of plasma C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) vs coronary angiographic severity on cardiovascular risk stratification. METHODS AND RESULTS A total of 345 patients with stable coronary artery disease (CAD) were recruited after successful percutaneous coronary intervention (PCI). Endpoints were major adverse cardiovascular events (MACE) and cumulative clinical restenosis rate after 18-36-month follow-up. Plasma NT-proBNP and CRP levels were among the strongest predictors of MACE. Adjusted hazard ratios of MACE according to combined biomarkers were 2.4 (p=0.05) for elevated CRP only, 5.22 (p<0.001) for elevated NT-proBNP only, and 7.04 (p<0.001) for elevation of both. The differential capacity using both plasma CRP and NT-proBNP in a receiver-operating-characteristics curve analysis (area under curve, AUC: 0.82) was significantly higher than using either biomarker alone or conventional risk factors (AUC: 0.67). Significant predictors of clinical restenosis were plasma NT-proBNP and the Gensini score. The combination of NT-proBNP and the Gensini score was the strongest predictor (AUC: 0.77) for clinical restenosis. CONCLUSIONS Plasma NT-proBNP, CRP, and the Gensini score are complementary in risk stratification. Combined use of these biomarkers has provided substantial extra information to conventional risk factors in stable CAD patients.
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Affiliation(s)
- Dao-Fu Dai
- Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Kim JS, Kim MH, Lee BK, Rim SJ, Min PK, Yoon SJ, Kim JH, Rhee JH, Yoon YW, Hong BK, Kwon HM, Kim C. Effects of increasing particle size of low-density lipoprotein on restenosis after coronary stent implantation. Circ J 2008; 72:1059-64. [PMID: 18577812 DOI: 10.1253/circj.72.1059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Small dense low-density lipoprotein (LDL) has emerged as an important risk factor in coronary atherosclerosis and vascular inflammation, which is related to neointimal hyperplasia. Therefore, the aim of the present study was to investigate whether changes in LDL particle size are related to in-stent restenosis (ISR). METHODS AND RESULTS The LDL subfraction and lipid profiles were measured in 274 patients (412 stents) at both baseline and follow-up coronary angiography (CAG). The incidence of ISR (80 lesions, 19.4%) was lower in the patients with increased LDL particle size than in those with no change or decrease (14.2% vs 25.8%, p=0.004). Logistic multivariate analysis revealed that stent length (>or=24 mm) (odds ratio (OR) =1.913, p=0.027), post minimal luminal diameter (>3 mm) (OR =0.528, p=0.028), acute coronary syndrome (OR =2.294, p=0.005), decrease in high-density lipoprotein-cholesterol (OR =1.028, p=0.047) and increase in LDL particle size (OR =0.528, p=0.031) were independent predictors for ISR. CONCLUSIONS In the present study, an increase in the LDL particle size between baseline and follow-up CAG was associated with reduced incidence of ISR. Therefore, modification of LDL particle size may have a beneficial effect on the risk of ISR.
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Affiliation(s)
- Jung-Sun Kim
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
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Association between C-reactive protein and angiographic restenosis after bare metal stents: an updated and comprehensive meta-analysis of 2747 patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2008; 9:156-65. [DOI: 10.1016/j.carrev.2008.01.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 01/04/2008] [Accepted: 01/18/2008] [Indexed: 11/23/2022]
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Lasave LI, Abizaid AAC, Paiva e Maia J, de Ribamar Costa J, Feres F, Mattos LA, Abizaid AS, Siqueira DA, Tanajura LF, Staico R, Beraldo de Andrade P, Braga SN, Sousa AGMR, Sousa JE. [Relationship between plasma C-reactive protein level and neointimal hyperplasia volume in patients with zotarolimus-eluting stents. Volumetric analysis by three-dimensional intracoronary ultrasound]. Rev Esp Cardiol 2007; 60:923-31. [PMID: 17915148 DOI: 10.1157/13109645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES C-reactive protein (CRP) is an inflammatory marker that predicts cardiac events in patients with coronary syndromes. However, data on the relationship between the CRP level and in-stent restenosis are contradictory. The objective of this study was to investigate the relationship between the basal CRP level and the neointimal hyperplasia volume measured by intracoronary ultrasound 4 months after implantation of a zotarolimus-eluting stent. METHODS The study included 40 consecutive patients who underwent zotarolimus-eluting stent implantation. Patients were divided into quartiles according to their preprocedural CRP level. Intracoronary ultrasound was performed after stent implantation and at 4 months, and the neointimal hyperplasia volume was determined using Simpson's rule. Correlation and linear regression analyses were used to evaluate the relationships between variables. Multivariate analysis was used to identify variables that were independently related to neointimal hyperplasia volume. RESULTS The patients' mean age was 58 (8) years, 55% were male, and 40% had diabetes mellitus. There was no difference in baseline characteristics between the quartiles. The hyperplasia volumes were 4.8 (4.2) microl and 15.8 (10.0) microl in the first and fourth quartiles, respectively (P< .001). There was a significant positive correlation between the CRP level and neointimal hyperplasia volume (r = 0.64, P=.0001). The CRP level, the postimplantation lumen volume, and the final deployment pressure were all independent predictors of neointimal hyperplasia. CONCLUSIONS In this study, an independent correlation was observed between the CRP level before zotarolimus-eluting stent implantation and the neointimal hyperplasia volume at 4-month follow-up.
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Affiliation(s)
- Leandro I Lasave
- Servicio de Hemodinámica y Cardiología Intervencionista, Instituto Dante Pazzanese de Cardiología, São Paulo, Brasil
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Lucreziotti S, Conforti S, Carletti F, Santaguida G, Meda S, Raveglia F, Tundo F, Panigalli T, Biondi ML, Mezzetti M, Fiorentini C. Elevaciones de la troponina I cardiaca tras la cirugía torácica. Incidencia y correlaciones con las características clínicas basales, la proteína C reactiva y los parámetros perioperatorios. Rev Esp Cardiol 2007. [DOI: 10.1157/13111788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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