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Kong G, Cao G, Koh J, Chan SP, Zhang A, Wong E, Chong B, Jauhari SM, Wang JW, Mehta A, Figtree GA, Mamas MA, Ng G, Chan KH, Chai P, Low AF, Lee CH, Yeo TC, Yip J, Foo R, Tan HC, Huang DQ, Muthiah M, Chan MYY, Loh PH, Chew NWS. The prognostic value of metabolic dysfunction-associated steatotic liver disease in acute myocardial infarction: A propensity score-matched analysis. Diabetes Obes Metab 2024; 26:3328-3338. [PMID: 38779875 DOI: 10.1111/dom.15660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/22/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
AIM Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) are at increased risk of incident cardiovascular disease. However, the clinical characteristics and prognostic importance of MASLD in patients presenting with acute myocardial infarction (AMI) have yet to be examined. METHODS This study compared the characteristics and outcomes of patients with and without MASLD presenting with AMI at a tertiary centre in Singapore. MASLD was defined as hepatic steatosis, with at least one of five metabolic criteria. Hepatic steatosis was determined using the Hepatic Steatosis Index. Propensity score matching was performed to adjust for age and sex. The Kaplan-Meier curve was constructed for long-term all-cause mortality. Cox regression analysis was used to investigate independent predictors of long-term all-cause mortality. RESULTS In this study of 4446 patients with AMI, 2223 patients with MASLD were matched with patients without MASLD using propensity scores. The mean follow-up duration was 3.4 ± 2.4 years. The MASLD group had higher rates of obesity, diabetes and chronic kidney disease than their counterparts. Patients with MASLD had early excess all-cause mortality (6.8% vs. 3.6%, p < .001) at 30 days, with unfavourable mortality rates sustained in the long-term (18.3% vs. 14.5%, p = .001) compared with those without MASLD. After adjustment, MASLD remained independently associated with higher long-term all-cause mortality (hazard ratio 1.330, 95% confidence interval 1.106-1.598, p = .002). CONCLUSION MASLD embodies a higher burden of metabolic dysfunction and is an independent predictor of long-term mortality in the AMI population. Its early identification may be beneficial for risk stratification and provide therapeutic targets for secondary preventive strategies in AMI.
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Affiliation(s)
- Gwyneth Kong
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Grace Cao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jaycie Koh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Siew Pang Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cardiovascular Research Institute, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Audrey Zhang
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Esther Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Silingga Metta Jauhari
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Jiong-Wei Wang
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Nanomedicine Translational Research Programme, Centre for NanoMedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anurag Mehta
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Gemma A Figtree
- Northern Clinical School, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Mamas A Mamas
- Institute of Population Health, University of Manchester, Manchester, UK
- Keele Cardiac Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Gavin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Koo Hui Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Ping Chai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Adrian F Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Chi Hang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Tiong Cheng Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - James Yip
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Huay Cheem Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Daniel Q Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mark Muthiah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mark Yan-Yee Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Poay-Huan Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
- Division of Cardiology, Department of Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
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2
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Tuzimek A, Dziedzic EA, Beck J, Kochman W. Correlations Between Acute Coronary Syndrome and Novel Inflammatory Markers (Systemic Immune-Inflammation Index, Systemic Inflammation Response Index, and Aggregate Index of Systemic Inflammation) in Patients with and without Diabetes or Prediabetes. J Inflamm Res 2024; 17:2623-2632. [PMID: 38707954 PMCID: PMC11067916 DOI: 10.2147/jir.s454117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/20/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose Type 2 diabetes mellitus (DM) is a recognized independent risk factor for both chronic coronary syndrome (CCS) and its complication, acute coronary syndrome (ACS). Patients with DM and prediabetes (preDM) face an increased ACS risk. Inflammation plays a significant role in the pathogenesis of both CCS and ACS. This study delves into novel inflammatory markers, such as the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI, also known as SIIRI or PIV), to explore their relationship with ACS and CCS in patients that have been or have not been diagnosed with DM or preDM. Patients and Methods This study included data of 493 patients with chest pain undergoing coronary angiography. They were categorized into four groups: 1) without DM/preDM and with CCS; 2) with both DM/preDM and CCS; 3) without DM/preDM and with ACS, 4) with both DM/preDM and ACS. Standard methods of statistical analysis were used to reveal possible differences between groups and to find the most influential ACS risk factors in groups with DM/preDM and without DM/preDM. Results The analysis showed no significant differences in SII, SIRI, or AISI between the respective patient groups. A logistic regression analysis generated a model incorporating SII, high-density lipoprotein, and low-density lipoprotein levels as the influential ACS risk factors for patients with DM/preDM. The model demonstrated 71.0% accuracy, 37.0% sensitivity, and 89.4% specificity. Conclusion The findings suggest that the aforementioned inflammatory markers may have potential for distinguishing DM/preDM patients at higher risk of ACS at a low financial cost. However, further comprehensive and well-designed research is required to validate their clinical utility.
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Affiliation(s)
- Agnieszka Tuzimek
- Cardiovascular Clinic, Centre of Postgraduate Medical Education, Warsaw, 01-813, Poland
| | - Ewelina A Dziedzic
- Cardiovascular Clinic, Centre of Postgraduate Medical Education, Warsaw, 01-813, Poland
| | - Joanna Beck
- Bioimaging Research Center, Institute of Physiology and Pathology of Hearing, Warsaw, 02-042, Poland
- Medical Faculty, Lazarski University, Warsaw, 02-662, Poland
| | - Wacław Kochman
- Cardiovascular Clinic, Centre of Postgraduate Medical Education, Warsaw, 01-813, Poland
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3
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Ding L, Fu B, Zhang H, Dai C, Zhang A, Yu F, Mi L, Hua W, Tang M. The impact of triglyceride glucose-body mass index on all-cause and cardiovascular mortality in elderly patients with diabetes mellitus: evidence from NHANES 2007-2016. BMC Geriatr 2024; 24:356. [PMID: 38649828 PMCID: PMC11034154 DOI: 10.1186/s12877-024-04992-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The relationship between triglyceride glucose-body mass index (TyG-BMI) index and mortality in elderly patients with diabetes mellitus (DM) are still unclear. This study aimed to investigate the association between TyG-BMI with all-cause and cardiovascular mortality among elderly DM patients in the United States (US). METHODS Patients aged over 60 years with DM from the National Health and Nutrition Examination Survey (2007-2016) were included in this study. The study endpoints were all-cause and cardiovascular mortality and the morality data were extracted from the National Death Index (NDI) which records up to December 31, 2019. Multivariate Cox proportional hazards regression model was used to explore the association between TyG-BMI index with mortality. Restricted cubic spline was used to model nonlinear relationships. RESULTS A total of 1363 elderly diabetic patients were included, and were categorized into four quartiles. The mean age was 70.0 ± 6.8 years, and 48.6% of them were female. Overall, there were 429 all-cause deaths and 123 cardiovascular deaths were recorded during a median follow-up of 77.3 months. Multivariate Cox regression analyses indicated that compared to the 1st quartile (used as the reference), the 3rd quartile demonstrated a significant association with all-cause mortality (model 2: HR = 0.64, 95% CI 0.46-0.89, P = 0.009; model 3: HR = 0.65, 95% CI 0.43-0.96, P = 0.030). Additionally, the 4th quartile was significantly associated with cardiovascular mortality (model 2: HR = 1.83, 95% CI 1.01-3.30, P = 0.047; model 3: HR = 2.45, 95% CI 1.07-5.57, P = 0.033). The restricted cubic spline revealed a U-shaped association between TyG-BMI index with all-cause mortality and a linear association with cardiovascular mortality, after adjustment for possible confounding factors. CONCLUSIONS A U-shaped association was observed between the TyG-BMI index with all-cause mortality and a linear association was observed between the TyG-BMI index with cardiovascular mortality in elderly patients with DM in the US population.
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Affiliation(s)
- Lei Ding
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Cardiovascular Institute, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, 100037, China
| | - Bingqi Fu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Cardiovascular Institute, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, 100037, China
| | - Hongda Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Cardiovascular Institute, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, 100037, China
| | - Cong Dai
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Aikai Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Cardiovascular Institute, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, 100037, China
| | - Fengyuan Yu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Cardiovascular Institute, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, 100037, China
| | - Lijie Mi
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Cardiovascular Institute, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, 100037, China
| | - Wei Hua
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Cardiovascular Institute, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, 100037, China
| | - Min Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Cardiovascular Institute, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, 100037, China.
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4
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Yildiz M, Miedema MD, Murthy A, Henry TD, Bergstedt S, Okeson BK, Schmidt CW, Volpenhein L, Garcia S, Sharkey SW, Aguirre FV. Association of triglyceride levels with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction. Heliyon 2023; 9:e17308. [PMID: 37484361 PMCID: PMC10361356 DOI: 10.1016/j.heliyon.2023.e17308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
Although there is an established association between elevated triglyceride (eTG, ≥175 mg/dl) levels and adverse cardiovascular events, some studies have suggested that eTG levels may be linked to neutral or even improved clinical outcomes, particularly among patients with acute myocardial infarction. However, these studies had certain limitations, including small sample sizes, heterogeneous study populations, and inadequate statistical adjustments. To address these limitations, we conducted an analysis of 5347 patients with ST-segment elevation myocardial infarction (STEMI) between March 2003 and December 2020, using a prospective registry-based cohort from two large, regional STEMI centers. We used a triglyceride level of 175 mg/dl as the cutoff point for eTG levels. Of the study participants, 24.5% (n = 1312) had eTG levels. These patients were more likely to be younger, male, and have a higher number of cardiovascular risk factors compared to those with low TG levels. Despite these unfavorable cardiovascular risk profiles, patients with eTG levels had lower unadjusted risks of 1-year major adverse cardiac events (MACE) -a composite of myocardial infarction, stroke, and death- than those with low TG levels (8.8% vs. 11%, p = 0.034). However, after adjusting for certain clinical factors and lipid profile, eTG levels were not associated with a lower 1-year MACE (aHR: 1.10 (0.71-1.70), p = 0.7). In conclusion, a quarter of STEMI patients had eTG levels and these patients had comparable long-term cardiovascular outcomes compared to those with low TG levels after controlling for clinical factors and lipid profile.
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Affiliation(s)
- Mehmet Yildiz
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, USA
| | | | - Avinash Murthy
- Prairie Heart Institute at St John's Hospital, Springfield, IL, USA
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, USA
| | - Seth Bergstedt
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Brynn K. Okeson
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | | | - Lucas Volpenhein
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, USA
| | - Santiago Garcia
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | | | - Frank V. Aguirre
- Prairie Heart Institute at St John's Hospital, Springfield, IL, USA
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5
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Zhao H, Sheng Z, Tan Y, Chen R, Zhou J, Li J, Zhao Q, Wang Y, Zhao X, Chen Y, Zhou P, Liu C, Song L, Yan H. High Human Antimicrobial Peptide LL-37 Level Predicts Lower Major Adverse Cardiovascular Events after an Acute ST-Segment Elevation Myocardial Infarction. J Atheroscler Thromb 2021; 29:1499-1510. [PMID: 34853213 PMCID: PMC9529390 DOI: 10.5551/jat.63221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims: We previously associated acute ST-elevation myocardial infarction (STEMI) with decreased plasma LL-37 levels. Therefore, this study investigated whether plasma LL-37 levels could predict ischemic cardiovascular events in patients after STEMI.
Methods: We prospectively collected peripheral plasma samples and clinical and laboratory data from consecutive patients who presented with STEMI and underwent primary percutaneous coronary intervention at Fuwai Hospital between April and November 2017. Enzyme-linked immunosorbent assay measured plasma LL-37 levels, and we followed the patients for 3 years. Major adverse cardiovascular events (MACEs) were a composite of all-cause mortality, reinfarction, unscheduled revascularization, or ischemic stroke.
Results: The study included 302 patients divided into high (≥ median) and low LL-37 level (<median) groups.
The cumulative incidence of MACE (29.1% vs. 12.6%, p=0.0003), all-cause death (12.6% vs. 3.3%, p=0.003),
reinfarction (7.1% vs. 2.0%, p=0.04), and unscheduled revascularization (13.0% vs. 5.4%, p=0.04) were higher in the low than those in the high LL-37 level group.
Multivariable Cox regression analysis showed that higher LL-37 level independently predicted lower risks of MACE (hazard ratio [HR] 0.390; 95% confidence interval [CI] 0.227–0.669; p<0.001),
all-cause death (HR 0.324; 95%CI 0.119–0.879; p=0.027), and unscheduled revascularization (HR 0.391; 95%CI 0.171–0.907; p=0.027).
Conclusions: High basal plasma level of human LL-37 may predict lower 3-year risks of ischemic cardiovascular events in patients after STEMI.
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Affiliation(s)
- Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.,Department of Cardiology, China-Japan Friendship Hospital
| | - Yu Tan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | | | - Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Hongbing Yan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.,Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences
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6
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Koo BK, Park S, Han KD, Moon MK. Hypertriglyceridemia Is an Independent Risk Factor for Cardiovascular Diseases in Korean Adults Aged 30-49 Years: a Nationwide Population-Based Study. J Lipid Atheroscler 2021; 10:88-98. [PMID: 33537256 PMCID: PMC7838513 DOI: 10.12997/jla.2021.10.1.88] [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: 10/27/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022] Open
Abstract
Objective This study was conducted to estimate the incidence of cardiovascular disease (CVD) independently from low-density lipoprotein (LDL) cholesterol according to triglyceride (TG) levels in young adults. Methods Subjects aged 30–49 years with data from routine health check-ups provided by the National Health Insurance Service during 2009 were selected. The primary outcome was incident CVD, defined as a composite of ischemic heart disease and ischemic stroke during the follow-up period from 2009 to 2018. Results The mean age of study subjects (n=1,823,537) was 40.1±5.7 years, and the median follow-up period was 8.3 years. The quartiles of serum TG levels at the baseline were calculated: Q1, <74 mg/dL; Q2, 74–108 mg/dL; Q3, 109–166 mg/dL; and Q4: >166 mg/dL. The highest quartile of TG levels (Q4) had a significantly higher risk of the primary outcome than Q1 (hazard ratio [HR], 2.40 [95% confidence interval; CI, 2.33–2.47]). Q2 and Q3 also experienced the primary outcome more frequently than Q1 (HR, 1.37 [95% CI, 1.33–1.42] and HR, 1.80 [95% CI, 1.75–1.86], respectively). Even after adjustment for age, sex, obesity, alcohol drinking amount, smoking, LDL cholesterol, diabetes mellitus, hypertension, lipid-lowering medication use, and family history of CVD, there was a significant dose-response relationship between TG quartiles and the risk of the primary outcome (HR per quartile, 1.13 [95% CI, 1.12–1.14]). Conclusion In conclusion, in the Korean population aged 30–49 years, high TG levels independently increased future CVD risk in both men and women.
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Affiliation(s)
- Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Endocrinology, Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea
| | - SangHyun Park
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Do Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Endocrinology, Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea
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7
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Chen HC, Lee WC, Fang HY, Fang CY, Chen CJ, Yang CH, Wu CJ. Impact of high triglyceride/high-density lipoprotein cholesterol ratio (insulin resistance) in ST-segment elevation myocardial infarction. Medicine (Baltimore) 2020; 99:e22848. [PMID: 33120817 PMCID: PMC7581178 DOI: 10.1097/md.0000000000022848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) has been proposed as an easily obtainable atherogenic marker and high TG/HDL-C ratio is associated with insulin resistance. This study investigated the associated between a high TG/HDL-C ratio and cardiovascular mortality in patients with ST-segment elevation myocardial infarction (STEMI), with or without diabetes mellitus (DM).Between January 2005 and December 2014, 1661 patients with STEMI underwent primary percutaneous coronary intervention in our hospital. Of these, 289 were classified into group 1 (with both DM and a high TG/HDL-C ratio), 295 into group 2 (with DM, but without a high TG/HDL-C ratio), 501 into group 3 (without DM, but a high TG/HDL-C ratio), and 576 into group 4 (without DM or a high TG/HDL-C ratio).Older age, longer chest pain to reperfusion time, poor hemodynamic condition, and higher prevalence of multiple vessel coronary artery disease were noted in those with DM. Poor outcomes including higher 30-day and 1-year cardiovascular mortality and all-cause mortality rates were noted in those with DM but without a high TG/HDL-C ratio. Patients with DM but without a high TG/HDL-C ratio had a Hazard ratio of 3.637 for cardiovascular mortality relative to those without DM, but without a high TG/HDL-C ratio.Even though a high TG/HDL-C ratio is associated with insulin resistance, patients with or without DM, but with a high TG/HDL-C ratio had better 30-day and 1-year outcomes.
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Affiliation(s)
- Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
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8
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Sia CH, Zheng H, Ho AFW, Bulluck H, Chong J, Foo D, Foo LL, Lim PZY, Liew BW, Tan HC, Yeo TC, Chua TSJ, Chan MYY, Hausenloy DJ. The Lipid Paradox is present in ST-elevation but not in non-ST-elevation myocardial infarction patients: Insights from the Singapore Myocardial Infarction Registry. Sci Rep 2020; 10:6799. [PMID: 32321961 PMCID: PMC7176706 DOI: 10.1038/s41598-020-63825-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/06/2020] [Indexed: 12/12/2022] Open
Abstract
Lowering low-density lipoprotein (LDL-C) and triglyceride (TG) levels form the cornerstone approach of cardiovascular risk reduction, and a higher high-density lipoprotein (HDL-C) is thought to be protective. However, in acute myocardial infarction (AMI) patients, higher admission LDL-C and TG levels have been shown to be associated with better clinical outcomes - termed the 'lipid paradox'. We studied the relationship between lipid profile obtained within 72 hours of presentation, and all-cause mortality (during hospitalization, at 30-days and 12-months), and rehospitalization for heart failure and non-fatal AMI at 12-months in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients treated by percutaneous coronary intervention (PCI). We included 11543 STEMI and 8470 NSTEMI patients who underwent PCI in the Singapore Myocardial Infarction Registry between 2008-2015. NSTEMI patients were older (60.3 years vs 57.7 years, p < 0.001) and more likely to be female (22.4% vs 15.0%, p < 0.001). In NSTEMI, a lower LDL-C was paradoxically associated with worse outcomes for death during hospitalization, within 30-days and within 12-months (all p < 0.001), but adjustment eliminated this paradox. In contrast, the paradox for LDL-C persisted for all primary outcomes after adjustment in STEMI. For NSTEMI patients, a lower HDL-C was associated with a higher risk of death during hospitalization but in STEMI patients a lower HDL-C was paradoxically associated with a lower risk of death during hospitalization. For this endpoint, the interaction term for HDL-C and type of MI was significant even after adjustment. An elevated TG level was not protective after adjustment. These observations may be due to differing characteristics and underlying pathophysiological mechanisms in NSTEMI and STEMI.
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Affiliation(s)
- Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Huili Zheng
- Health Promotion Board, National Registry of Diseases Office, Singapore, Singapore
| | - Andrew Fu-Wah Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore, Singapore
- Cardiovascular & Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
| | | | - Jun Chong
- Cardiovascular & Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
| | - David Foo
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Ling-Li Foo
- Health Promotion Board, National Registry of Diseases Office, Singapore, Singapore
| | | | | | - Huay-Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Derek J Hausenloy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Cardiovascular & Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore.
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore.
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom.
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung City, Taiwan.
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9
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Poudel I, Tejpal C, Rashid H, Jahan N. Major Adverse Cardiovascular Events: An Inevitable Outcome of ST-elevation myocardial infarction? A Literature Review. Cureus 2019; 11:e5280. [PMID: 31423405 PMCID: PMC6695291 DOI: 10.7759/cureus.5280] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/30/2019] [Indexed: 02/06/2023] Open
Abstract
Major adverse cardiovascular events (MACE) remain the major cause of mortality and morbidity in patients with STEMI (ST-elevation myocardial infarction). The current literature is aimed to analyze the occurrence of MACE following STEMI irrespective of treatment provided, and follow up after the first diagnosis of STEMI. A PubMed search for Studies of STEMI identified 24,244 articles. After applying our inclusion/exclusion criteria, we found out 75 articles of relevance wherein MACE and its components were considered to be the primary endpoint. These 75 articles included eight Cohort Studies, 13 clinical trials including five randomized controlled trials (RCT), one case-control Study, one cross-sectional study, one review article, and 51 other observational studies. Our analysis shows that MACE remains one of the strongest adverse outcomes among STEMI patients. The current literature review found out the incidence of MACE was 4.2 % to 51% irrespective of the mode of treatment, and follow-ups lasting up to 10 years from the time of STEMI diagnosis.
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Affiliation(s)
- Ishan Poudel
- Internal Medicine, Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Chavi Tejpal
- Family Medicine, Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Hamza Rashid
- Internal Medicine: Critical Care, Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Nusrat Jahan
- Internal Medicine, Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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10
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Xia TL, Li YM, Huang FY, Chai H, Huang BT, Li Q, Zhao ZG, Liao YB, Zuo ZL, Peng Y, Chen M, Huang DJ. The triglyceride paradox in the mortality of coronary artery disease. Lipids Health Dis 2019; 18:21. [PMID: 30670053 PMCID: PMC6343235 DOI: 10.1186/s12944-019-0972-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/08/2019] [Indexed: 02/05/2023] Open
Abstract
Background The role of triglyceride (TG) in secondary prevention of patients with coronary artery disease (CAD) was debated. In the present study, we assessed the association between admission TG levels and long-term mortality risk in CAD patients. Methods A retrospective analysis was conducted from a single registered database. 3061 consecutive patients with CAD confirmed by coronary angiography were enrolled and were grouped into 3 categories by the tertiles of admission serum TG levels. The primary end point in this study was all-cause mortality and the secondary end point was cardiovascular mortality. Results The mean follow-up time was 26.9 ± 13.6 months and death events occurred in 258 cases and cardiovascular death events occurred in 146 cases. Cumulative survival curves indicated that the risk of all-cause death decreased with increasing TG level (Tertile 1 vs. Tertile 2 vs. Tertile 3 = 10.3% vs. 8.6% vs. 6.3%, log rank test for overall p = 0.001). Cox regression analysis showed an independent correlation between TG level and risk of all-cause mortality [hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.58–0.86] and cardiovascular mortality (HR 0.67, 95% CI 0.51–0.89) in total patients with CAD. Subgroup analysis found the similar results in patients with acute coronary syndrome and acute myocardial infarction. Conclusions This study found an inverse association between TG levels and mortality risk in CAD patients, which suggests that the “TG paradox” may exist in CAD patients. Trial registration ChiCTR, ChiCTR-OOC-17010433. Registered 17 February 2017 - Retrospectively registered.
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Affiliation(s)
- Tian-Li Xia
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Yi-Ming Li
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Fang-Yang Huang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Hua Chai
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Bao-Tao Huang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Qiao Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Zhen-Gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Zhi-Liang Zuo
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China.
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China.
| | - De-Jia Huang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
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11
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Eppinga RN, Kofink D, Dullaart RP, Dalmeijer GW, Lipsic E, van Veldhuisen DJ, van der Horst IC, Asselbergs FW, van der Harst P. Effect of Metformin on Metabolites and Relation With Myocardial Infarct Size and Left Ventricular Ejection Fraction After Myocardial Infarction. ACTA ACUST UNITED AC 2017; 10:CIRCGENETICS.116.001564. [DOI: 10.1161/circgenetics.116.001564] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/12/2016] [Indexed: 12/15/2022]
Abstract
Background—
Left ventricular ejection fraction (LVEF) and infarct size (ISZ) are key predictors of long-term survival after myocardial infarction (MI). However, little is known about the biochemical pathways driving LV dysfunction after MI. To identify novel biomarkers predicting post-MI LVEF and ISZ, we performed metabolic profiling in the GIPS-III randomized clinical trial (Glycometabolic Intervention as Adjunct to Primary Percutaneous Intervention in ST Elevation Myocardial Infarction). We also investigated the metabolic footprint of metformin, a drug associated with improved post-MI LV function in experimental studies.
Methods and Results—
Participants were patients with ST-segment–elevated MI who were randomly assigned to receive metformin or placebo for 4 months. Blood samples were obtained on admission, 24 hours post-MI, and 4 months post-MI. A total of 233 metabolite measures were quantified using nuclear magnetic resonance spectrometry. LVEF and ISZ were assessed 4 months post-MI. Twenty-four hours post-MI measurements of high-density lipoprotein (HDL) triglycerides (HDL-TG) predicted LVEF (β=1.90 [95% confidence interval (CI), 0.82 to 2.98];
P
=6.4×10
−4
) and ISZ (β=−0.41 [95% CI, −0.60 to −0.21];
P
=3.2×10
−5
). In addition, 24 hours post-MI measurements of medium HDL-TG (β=−0.40 [95% CI, −0.60 to −0.20];
P
=6.4×2×10
−5
), small HDL-TG (β=−0.34 [95% CI, −0.53 to −0.14];
P
=7.3×10
−4
), and the triglyceride content of very large HDL (β=−0.38 [95% CI, −0.58 to −0.18];
P
=2.7×10
−4
) were associated with ISZ. After the 4-month treatment, the phospholipid content of very large HDL was lower in metformin than in placebo-treated patients (28.89% versus 38.79%;
P
=7.5×10
−5
); alanine levels were higher in the metformin group (0.46 versus 0.44 mmol/L;
P
=2.4×10
−4
).
Conclusions—
HDL triglyceride concentrations predict post-MI LVEF and ISZ. Metformin increases alanine levels and reduces the phospholipid content in very large HDL particles.
Clinical Trial Registration—
URL:
https://clinicaltrials.gov/ct2/show/NCT01217307
. Unique Identifier: NCT01217307.
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Affiliation(s)
- Ruben N. Eppinga
- From the Department of Cardiology (R.N.E., E.L., D.J.v.V., P.v.d.H.), Department of Endocrinology (R.P.F.D.), Department of Critical Care (I.C.C.v.d.H.), University of Groningen, University Medical Center Groningen, The Netherlands; Division of Heart and Lungs, Department of Cardiology (D.K., F.W.A.), Julius Center for Health Sciences and Primary Care (G.W.D.), University Medical Center Utrecht, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (F.W
| | - Daniel Kofink
- From the Department of Cardiology (R.N.E., E.L., D.J.v.V., P.v.d.H.), Department of Endocrinology (R.P.F.D.), Department of Critical Care (I.C.C.v.d.H.), University of Groningen, University Medical Center Groningen, The Netherlands; Division of Heart and Lungs, Department of Cardiology (D.K., F.W.A.), Julius Center for Health Sciences and Primary Care (G.W.D.), University Medical Center Utrecht, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (F.W
| | - Robin P.F. Dullaart
- From the Department of Cardiology (R.N.E., E.L., D.J.v.V., P.v.d.H.), Department of Endocrinology (R.P.F.D.), Department of Critical Care (I.C.C.v.d.H.), University of Groningen, University Medical Center Groningen, The Netherlands; Division of Heart and Lungs, Department of Cardiology (D.K., F.W.A.), Julius Center for Health Sciences and Primary Care (G.W.D.), University Medical Center Utrecht, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (F.W
| | - Geertje W. Dalmeijer
- From the Department of Cardiology (R.N.E., E.L., D.J.v.V., P.v.d.H.), Department of Endocrinology (R.P.F.D.), Department of Critical Care (I.C.C.v.d.H.), University of Groningen, University Medical Center Groningen, The Netherlands; Division of Heart and Lungs, Department of Cardiology (D.K., F.W.A.), Julius Center for Health Sciences and Primary Care (G.W.D.), University Medical Center Utrecht, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (F.W
| | - Erik Lipsic
- From the Department of Cardiology (R.N.E., E.L., D.J.v.V., P.v.d.H.), Department of Endocrinology (R.P.F.D.), Department of Critical Care (I.C.C.v.d.H.), University of Groningen, University Medical Center Groningen, The Netherlands; Division of Heart and Lungs, Department of Cardiology (D.K., F.W.A.), Julius Center for Health Sciences and Primary Care (G.W.D.), University Medical Center Utrecht, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (F.W
| | - Dirk J. van Veldhuisen
- From the Department of Cardiology (R.N.E., E.L., D.J.v.V., P.v.d.H.), Department of Endocrinology (R.P.F.D.), Department of Critical Care (I.C.C.v.d.H.), University of Groningen, University Medical Center Groningen, The Netherlands; Division of Heart and Lungs, Department of Cardiology (D.K., F.W.A.), Julius Center for Health Sciences and Primary Care (G.W.D.), University Medical Center Utrecht, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (F.W
| | - Iwan C.C. van der Horst
- From the Department of Cardiology (R.N.E., E.L., D.J.v.V., P.v.d.H.), Department of Endocrinology (R.P.F.D.), Department of Critical Care (I.C.C.v.d.H.), University of Groningen, University Medical Center Groningen, The Netherlands; Division of Heart and Lungs, Department of Cardiology (D.K., F.W.A.), Julius Center for Health Sciences and Primary Care (G.W.D.), University Medical Center Utrecht, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (F.W
| | - Folkert W. Asselbergs
- From the Department of Cardiology (R.N.E., E.L., D.J.v.V., P.v.d.H.), Department of Endocrinology (R.P.F.D.), Department of Critical Care (I.C.C.v.d.H.), University of Groningen, University Medical Center Groningen, The Netherlands; Division of Heart and Lungs, Department of Cardiology (D.K., F.W.A.), Julius Center for Health Sciences and Primary Care (G.W.D.), University Medical Center Utrecht, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (F.W
| | - Pim van der Harst
- From the Department of Cardiology (R.N.E., E.L., D.J.v.V., P.v.d.H.), Department of Endocrinology (R.P.F.D.), Department of Critical Care (I.C.C.v.d.H.), University of Groningen, University Medical Center Groningen, The Netherlands; Division of Heart and Lungs, Department of Cardiology (D.K., F.W.A.), Julius Center for Health Sciences and Primary Care (G.W.D.), University Medical Center Utrecht, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (F.W
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12
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Liu X, Su X, Zeng H. Impact of admission serum total cholesterol level on in-hospital mortality in patients with acute aortic dissection. Pak J Med Sci 2016; 32:939-43. [PMID: 27648044 PMCID: PMC5017107 DOI: 10.12669/pjms.324.10124] [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] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To find out the association between serum total cholesterol (TC) on admission and in-hospital mortality in patients with acute aortic dissection (AAD). METHODS From January 2007 to January 2014, we enrolled 1492 consecutive AAD patients with serum TC measured immediately on admission. Baseline characteristics and in-hospital mortality were compared between the patients with serum TC above and below the median (4.00 mmol/L). Propensity score matching (PSM) was used to account for known confounders in the study. Cox proportional hazard model was performed to calculate the hazard ratio (HR) and 95% confidence interval (CI) for admission serum TC levels. RESULTS With the use of PSM, 521 matched pairs of patients with AAD were yielded in this analysis due to their similar propensity scores. Patients with admission serum TC < 4.00 mmol/L, as compared with those with admission serum TC ≥ 4.00 mmol/L, had higher in-hospital mortality (11.7% vs. 5.8%; HR, 2.06; 95% CI, 1.33-3.19, P = 0.001). Stratified analysis according to Stanford classification showed that the inverse association between admission serum TC and in-hospital mortality was observed in patients with Type-A AAD (24.0% vs. 11.3%; HR, 2.18; 95% CI, 1.33 - 3.57, P = 0.002) but not in those with Type-B AAD (3.8% vs. 2.2%; HR, 1.71; 95% CI, 0.67 - 4.34, P = 0.261). CONCLUSIONS Lower serum TC level on admission was strongly associated with higher in-hospital mortality in patients with Type-A AAD.
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Affiliation(s)
- Xintian Liu
- Xintian Liu, Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Su
- Xi Su, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Hesong Zeng
- Hesong Zeng, Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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13
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Klempfner R, Erez A, Sagit BZ, Goldenberg I, Fisman E, Kopel E, Shlomo N, Israel A, Tenenbaum A. Elevated Triglyceride Level Is Independently Associated With Increased All-Cause Mortality in Patients With Established Coronary Heart Disease: Twenty-Two-Year Follow-Up of the Bezafibrate Infarction Prevention Study and Registry. Circ Cardiovasc Qual Outcomes 2016; 9:100-8. [PMID: 26957517 DOI: 10.1161/circoutcomes.115.002104] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 12/17/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The independent association between elevated triglycerides and all-cause mortality among patients with established coronary heart disease is controversial. The aim of this study was to investigate this association in a large cohort of patients with proven coronary heart disease. METHODS AND RESULTS The study cohort comprised 15 355 patients who were screened for the Bezafibrate Infarction Prevention (BIP) trial. Twenty-two-year mortality data were obtained from the national registry. Patients were divided into 5 groups according to strata of fasting serum triglycerides: (1) low-normal triglycerides (<100 mg/dL); (2) high-normal triglycerides (100-149 mg/dL); (3) borderline hypertriglyceridemia triglycerides (150-199 mg/dL); (4) moderate hypertriglyceridemia triglycerides (200-499 mg/dL); (5) severe hypertriglyceridemia triglycerides (≥500 mg/dL). Age- and sex-adjusted survival was 41% in the low-normal triglycerides group than 37%, 36%, 35%, and 25% in groups with progressively higher triglycerides (P<0.001). In an adjusted Cox-regression for various covariates including high-density lipoprotein cholesterol, each 1 unit of natural logarithm (Ln) triglycerides elevation was associated with a corresponding 6% (P=0.016) increased risk of 22-year all-cause mortality. The 22-year mortality risk for patients with severe hypertriglyceridemia was increased by 68% when compared with patients with low-normal triglycerides (P<0.001). CONCLUSIONS In patients with established coronary heart disease, higher triglycerides levels are independently associated with increased 22-year mortality. Even in patients with triglycerides of 100 to 149 mg/dL, the elevated risk for death could be detected than in patients with lower triglycerides levels, whereas severe hypertriglyceridemia denotes a population with particularly increased mortality risk.
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Affiliation(s)
- Robert Klempfner
- From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.)
| | - Aharon Erez
- From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.).
| | - Ben-Zekry Sagit
- From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.)
| | - Ilan Goldenberg
- From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.)
| | - Enrique Fisman
- From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.)
| | - Eran Kopel
- From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.)
| | - Nir Shlomo
- From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.)
| | - Ariel Israel
- From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.)
| | - Alexander Tenenbaum
- From The Heart Center, Sheba Medical Center, Tel-Hashomer, Israel (R.K., A.E., B.-Z.S., I.G., E.F., A.T.); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (B.-Z.S., I.G., E.F., A.T.); Heart Research Follow-up Program, University of Rochester Medical Center, NY (I.G.); Public Health Department, Ministry of Health, Jerusalem, Israel (E.K.); and The Israeli Association for Cardiovascular Trials, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel (N.S., A.I.)
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14
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Yeh YT, Liu CW, Li AH, Ke SR, Liu YH, Chen KC, Liao PC, Wu YW. Rapid Early Triage by Leukocytosis and the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: An Observational Study. Medicine (Baltimore) 2016; 95:e2857. [PMID: 26886652 PMCID: PMC4998652 DOI: 10.1097/md.0000000000002857] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The clinical utility of leukocytosis in risk assessment for ST-elevation myocardial infarction (STEMI) is still unclear. We aim to demonstrate the prognostic value of leukocyte counts independent from traditional risk factors and the TIMI risk score (TRS) for STEMI and to propose a practical model comprising leukocyte count for early triage in STEMI undergoing primary angioplasty. A prospective database (n = 796) of consecutive STEMI cases receiving primary angioplasty at a tertiary medical center was retrospectively analyzed in the period from February 1, 2007 through December 31, 2012. Primary endpoints were 30-day and 1-year mortality. Propensity score-adjusted Cox regression models and subdivision analysis were performed. Leukocytosis group (n = 306) had higher 30-day mortality (5.9% vs 3.1%, P = 0.048) and 1-year mortality (9.2% vs 5.1%, P = 0.022). After adjustment by propensity score and TRS, leukocyte count (per 10/μL) was an independent predictor of 1-year mortality (HR: 1.086, 95% CI: 1.034-1.140, P = 0.001). Subdivision analysis demonstrated the correlation between leukocytosis and higher 1-year mortality within both high and low TRS strata (divided by 4, the median of TRS). Additionally, 24% (191 out of 796) of patients were characterized by nonleukocytosis and TRS < 4, having 0% of mortality rate at 1-year follow-up. In conclusion, leukocyte count is an independent prognostic factor adding incremental value to TRS for STEMI. Nonleukocytosis in conjunction with TRS < 4 identifies a large patient group at extremely low risk and thus provides rapid early triage for STEMI patients undergoing primary PCI. This finding is worth validation in the future.
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Affiliation(s)
- Yen-Ting Yeh
- From the Cardiology Division of Cardiovascular Medical Center (Y-TY, C-WL, A-HL, S-RK, Y-WL, K-CC, P-CL, Y-WW), Department of Nuclear Medicine (Y-WW), Far Eastern Memorial Hospital, New Taipei City, National Yang-Ming University School of Medicine, Taipei, Taiwan (Y-WW), National Defense Medical Center (C-WL), Department of Nuclear Medicine and Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine (Y-WW), Taipei, Taiwan
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