Relationship between osteopenic syndrome and severity of coronary artery disease detected with coronary angiography and Gensini score in men

T-cell Immunoglobulin and Mucin Domain 3 in Circulating Monocytes as a Novel Biomarker for Coronary Artery Disease

The diagnostic role of T-cell immunoglobulin and mucin domain 3 (Tim-3) expression levels in circulating monocytes in coronary artery disease (CAD) remains to be determined. Here, we enrolled of 265 patients and isolated circulating monocytes from the blood of all participants. We found that the Tim-3 expression levels in monocytes were lower in CAD patients than in the control group. Spearman correlation analysis verified that the Tim-3 levels in monocytes were negatively correlated with the Gensini score and the number of coronary vessels. Multivariate logistic regression analysis showed that the Tim-3 levels in circulating monocytes were negatively correlated with CAD, severe CAD, and three-vessel CAD. The ROC curve showed that Tim-3 possessed high diagnostic value for CAD, severe CAD, and three-vessel CAD, with CAD prediction being the most significant of these values. In conclusion, Tim-3 in circulating monocytes is a novel biomarker for CAD.

Association between bone mineral density and coronary plaque burden in patients with coronary artery disease: a cross-sectional study using quantitative computed tomography

PURPOSE

To evaluate the association between osteoporosis and coronary calcification and coronary plaque burden in patients with atherosclerosis and coronary artery disease (CAD).

METHODS

This study included 290 men and 177 postmenopausal women with angiography-confirmed atherosclerosis or CAD who underwent chest multidetector row computed tomography covering L1-L2 between September 2020 and October 2021. Quantitative computed tomography was used to measure the lumbar vertebra's bone mineral density (BMD). The coronary artery calcium score (CACS) and total coronary plaque burden were quantified using the Agatston and modified Gensini scores, respectively. Associations between BMD and CACS and modified Gensini scores were assessed using multivariate regression analysis. Lasso regression was used in model selection.

RESULTS

In men, BMD was inversely associated with CACS [ β  = -0.24; 95% confidence interval (CI), -0.35 to -0.13; P  < 0.001) and coronary artery calcification (CAC) presence [odds ratio (OR) = 0.71; 95% CI, 0.52-0.96; P  = 0.03) in the unadjusted model. After adjusting for age, modified Gensini score, prior percutaneous coronary intervention and hypertension, BMD was inversely associated with CACS ( β  = -0.11; 95% CI, -0.22 to -0.01; P  = 0.04). In postmenopausal women, BMD was inversely associated with CACS ( β  = -0.24; 95% CI, -0.39 to 0.10; P  < 0.001) and CAC presence (OR = 0.66; 95% CI, 0.47-0.92; P  = 0.01) in the unadjusted model but no other models ( P  > 0.05). In both sexes, BMD did not correlate with the modified Gensini score or CAD prevalence (all P  > 0.05).

CONCLUSION

In patients with coronary atherosclerosis and CAD, BMD of the lumbar vertebra correlated inversely with CACS in men but not postmenopausal women. Additionally, BMD did not correlate with the modified Gensini score in both sexes.

The value of D-dimer to lymphocyte ratio in predicting clinical outcomes after percutaneous coronary intervention in ST-segment elevation myocardial infarction patients: A retrospective study

BACKGROUND

D-dimer to lymphocyte ratio (DLR) is a novel composite metric. This study investigated the association between DLR and major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention.

MATERIALS AND METHODS

This retrospective study included 683 STEMI cases treated between January 2018 and June 2021 at a single center. DLR was calculated for each patient. Receiver operating characteristic curves assessed the predictive value of in-hospital and long-term MACEs, with calculated AUC. Based on the optimal DLR cutoff value, the population was categorized into groups for clinical characteristic analysis. Multivariate logistic and COX regression analyses determined factors independently associated with MACEs. Kaplan-Meier estimation method and log-rank tests assessed event-free survival among different DLR groups. Spearman's test explored the correlation between DLR and Gensini score.

RESULTS

DLR demonstrated an AUC of 0.792 for predicting in-hospital MACEs and 0.708 for long-term MACEs in patients with STEMI. Multivariate logistic regression analysis revealed that a high DLR (cutoff value, 0.47) independently increased the risk of MACEs during hospitalization in patients with STEMI (P = 0.003; odds ratio: 3.015; 95 % CI: 1.438-6.321). Multivariate COX regression showed that a high DLR (cutoff value, 0.34) independently predicted MACEs during long-term follow-up in patients with STEMI (P = 0.011; hazard ratio: 1.724; 95 % CI: 1.135-2.619). Furthermore, DLR exhibited a positive correlation with the Gensini score (P < 0.001).

CONCLUSIONS

DLR is a valuable predictor for MACEs occurrence in patients with STEMI during hospitalization and long-term follow-up after PCI.

Impact of Low Bone Mineral Content Index on Cardiovascular Outcomes in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

The prognostic value of bone mineral content (BMC) for the clinical outcomes of patients with coronary artery disease (CAD) remains unknown. The present study evaluated the association between BMC index (BMCI) and cardiovascular events between January 2020 to June 2021, in consecutive patients (n = 257) with CAD undergoing percutaneous coronary intervention (PCI) at the Nagano Municipal Hospital. BMCI was measured using bioelectrical impedance analysis and calculated as the BMC divided by height squared. Patients were classified as low (<0.918) or high BMCI (≥0.918) groups according to the receiver operating characteristics curve analysis for the primary endpoint, major adverse cardiovascular events (MACE), including cardiovascular death, spontaneous myocardial infarction, stroke, and any revascularization. During a median follow-up of 744 days, the low BMCI group (n = 152) had an increased risk of MACE compared with the high group (n = 105) (19.7 vs 6.7%, P = .004). A low BMCI was significantly associated with MACE in the multivariable Cox and the Inverse Probability of Treatment Weighting analyses (hazard ratio: 3.16, 95% confidence interval: 1.15-8.67, P = .025). In conclusion, among patients with CAD undergoing PCI, BMCI was a predictor for cardiovascular events. Further research is required to determine whether medical interventions for BMC can improve patient prognosis.

White blood cell count combined with LDL cholesterol as a valuable biomarker for coronary artery disease

OBJECTIVE

Inflammation and dyslipidemia are important pathophysiological bases for the occurrence and development of coronary artery disease (CAD); however, combination of these two entities is rarely used to diagnose CAD and its severity. Our aim was to determine whether the combination of white blood cell count (WBCC) and LDL cholesterol (LDL-C) can serve as a biomarker for CAD.

METHODS

We enrolled 518 registered patients and measured serum WBCC and LDL-C on admission. The clinical data were collected, and the Gensini score was used to assess the severity of coronary atherosclerosis.

RESULTS

WBCC and LDL-C levels in the CAD group were higher than in the control group ( P  < 0.01). Spearman correlation analysis showed that WBCC combined with LDL-C was positively correlated with the Gensini score ( r  = 0.708, P  < 0.01) and the number of coronary artery lesions ( r  = 0.721, P  < 0.01). Receiver operating characteristic curve analysis revealed that WBCC combined with LDL-C had a higher predictive value for CAD, severe CAD, and three-vessel CAD [area under the curve (AUC) values were 0.909, 0.867, and 0.811, respectively] than WBCC (AUC values were 0.814, 0.753, 0.716, respectively) and LDL-C (AUC values were 0.779, 0.806, 0.715, respectively) alone (all P  < 0.05).

CONCLUSION

WBCC combined with LDL-C is correlated with the degree of coronary artery lesion. It had high sensitivity and specificity in the diagnosis of CAD, severe CAD, and three-vessel CAD.

Relationship of Gensini score with retinal vessel diameter and arteriovenous ratio in senile CHD

Background

This study aimed to find the correlation of Gensini score with retinal vessel diameter and arteriovenous ratio in elderly patients with coronary heart disease (CHD).

Methods

This study included 120 senile CHD patients as the CHD group and 100 healthy individuals as the normal group (NG). Gensini score was used to evaluate the severity of coronary artery lesions. Central retinal artery equivalents (CRAE), central retinal venular equivalents (CRVE), and arteriovenous ratio (AVR) were measured.

Results

CHD group has lower CRAE and AVR than NG, while higher CRVE was observed in NG. CRAE and AVR in UAP (unstable angina pectoris) and AMI (acute myocardial infarction) groups showed reduction (stable angina pectoris); however, enhanced CRVE and Gensini scores in UA and AMI groups were observed as compared to the SAP group. CRAE and AVR in moderate and severe groups were reduced to a greater extent compared to the mild groups, while enhanced CRVE and Gensini scores were observed more often in the severe group than the mild group. CRAE and AVR were negatively correlated with the Gensini score; however, CRVE was positively correlated with the Gensini score.

Conclusion

AVR is expected to be a noninvasive index to diagnose and predict senile CHD, which has a certain evaluation value. Diabetes, smoking history, and TC are independent risk factors of senile CHD.

Calcification of lower extremity arteries is related to the presence of osteoporosis in postmenopausal women with type 2 diabetes mellitus: a cross-sectional observational study

It is unknown whether there is any relationship between extremity arterial macroangiopathy and osteoporosis in type 2 diabetic mellitus (T2DM) patients. We provide evidence to show the association between lower extremity arterial calcification and the presence of osteoporosis in postmenopausal T2DM women, but not in T2DM men of similar age.

PURPOSE

To investigate the relationship between lower extremity arterial calcification and the presence of osteoporosis in type 2 diabetic mellitus (T2DM) patients.

METHODS

We performed a retrospective cross-sectional study in patients with T2DM. They were assigned into two groups (patients with or without vascular calcification) in both sexes. Clinical characteristics, presence of osteoporosis, and bone metabolic markers were compared. Arterial calcification was determined by ultrasonography examination. Osteoporosis was defined based on the measurements from dual-energy X-ray absorptiometry. The relationship between the lower extremity arterial calcification and the presence of osteoporosis was analyzed. Statistical analysis was performed in SPSS 26.0.

RESULTS

A total of 933 T2DM patients (535 men ≥ 50 years old, and 398 postmenopausal women) were identified and analyzed. A significant association between arterial calcification and osteoporosis was only observed in women, with a higher prevalence of osteoporosis observed in women with calcification (40.8%) than in women without calcification (26.9%) (P = 0.004). Compared to women without calcification, women with calcification had lower bone mineral densities in the hip (P < 0.001) and femoral neck (P < 0.001). Ordinal logistic regression analysis showed that women with calcification had a nearly 2-fold increased risk for osteoporosis, even after adjusting for age, duration of T2DM, body mass index, pulse pressure, clearance of creatinine, glycosylated hemoglobin, and fasting C-peptide. Similar differences were not identified between men with and without calcification.

CONCLUSION

Calcification of lower extremity arteries is related with the presence of osteoporosis in postmenopausal T2DM women.

The relationship between atherosclerosis and bone mineral density in patients with type 2 diabetes depends on vascular calcifications and sex

It is unknown whether a relationship exists between bone mineral density (BMD) and atherosclerosis with or without vascular calcification. In our study, a negative correlation between carotid atherosclerosis and BMD was found in female T2DM patients with vascular calcification, but not in those without calcification and males.

INTRODUCTION

Atherosclerosis is considered associated with low bone mineral density (BMD). However, most previous studies focus on patients with arterial atherosclerosis with vascular calcification. It is still unknown whether a relationship exists between atherosclerosis and BMD in patients without calcification. It is also unknown if sex plays a role in this relationship.

METHODS

We performed a retrospective cross-sectional study, which included 1459 type 2 diabetes mellitus (T2DM) patients (648 males ≥ 50 years old, and 811 postmenopausal females). They were assigned to three groups: group 1 (patients without carotid plaques and without carotid calcification), group 2 (patients with carotid plaques but without carotid calcification), and group 3 (patients with carotid plaques and with carotid calcification). Clinical characteristics and BMD were compared. The relationship between atherosclerosis and BMD was determined by binary logistic regression analysis. Statistical analysis was performed using SPSS 25.0.

RESULTS

Significant differences were only observed in women. The percentage of osteoporosis was higher in group 3 (43.64%) than in groups 1 (34.82%) and 2 (32.14%) (P = 0.016). Low BMD was found in the lumbar (P = 0.032), hip (P < 0.001), and femoral neck (P < 0.001). The odds ratio for osteoporosis increased significantly in a score-dependent manner in postmenopausal female patients with calcified atherosclerosis, but not in uncalcified patients. In men, no differences or relationships were identified.

CONCLUSION

A negative correlation between carotid atherosclerosis and BMD was found in female T2DM patients with vascular calcification, but not in those without calcification. A similar relationship was not observed in male patients with or without calcification. Thus, the relationship between atherosclerosis and bone mineral density in patients with type 2 diabetes depends on vascular calcifications and sex.

Associations between bone mineral density and coronary artery disease: a meta-analysis of cross-sectional studies

A meta-analysis was performed to explore the association of coronary artery disease (CAD) with bone mineral density (BMD). Low BMD was not found to be associated with prevalence of CAD. Though the BMD of CADs is significantly lower than that of non-CADs, the confounding effect of aging could not be excluded as CADs might be more prevalent in older patients.

PURPOSE/INTRODUCTION

The clinical association of coronary artery disease (CAD) with bone mineral density (BMD) has been increasingly reported, but findings on the relationship between the two age-related processes are conflicting. The aim of our study was to conduct a meta-analysis to evaluate the associations between CAD and BMD.

METHODS

We searched PubMed, Embase, and Cochrane Library. Odds ratio (OR) and 95% confidence interval (CI) were pooled to assess the association between low BMD and the prevalence of CAD. For continuous data, standardized mean difference (SMD) with its 95% CI was pooled. Correlation coefficients of BMD and Gensini score were pooled after being transformed by Fischer z-transformation. Subgroup and meta-regression analyses were performed to explore the sources of heterogeneity.

RESULTS

The meta-analysis involved 4170 participants from 11 studies. Pooled ORs for the incidence of CAD in patients with low BMD versus patients with normal BMD was 1.58 (95% CI 0.99-2.52, P = 0.06), and no statistical difference was found in men and women subgroups. After confounding age, the combined OR was 1.60 (95% OR 0.69-3.72, P = 0.27). Pooling data for comparing BMD of CADs and non-CADs were - 0.28 (95% CI - 0.47 to - 0.09, P = 0.004) in femoral neck and calcaneus, - 0.42 (95% CI - 0.89-0.05, P = 0.08) in lumbar spine, and - 0.25 (95% CI - 0.40 to - 0.11, P = 0.000) in the overall. A significance was detected in pooled correlation analysis between CAG Gensini score and BMD (COR = - 0.4435 [- 0.6647; - 0.1508], P = 0.004). No sources of heterogeneity were acquired, and no publication bias was identified.

CONCLUSIONS

Low BMD was not associated with the prevalence of CAD. Without age adjustment, the BMD of CADs is significantly lower than that of non-CADs, and the patients with lower BMD are inclined to more severe coronary artery lesions.

Low bone mineral density is associated with global coronary atherosclerotic plaque burden in stable angina patients

Background

Accelerated atherosclerosis is considered to be the linking factor between low bone mineral density (BMD) and increased cardiovascular events and mortality, while some coronary angiographic studies do not support this point. In this study, we attempt to provide a distinct comprehensive view of the relationship between BMD and the angiographically determined coronary atherosclerotic burden.

Methods

A total of 459 consecutive patients with stable chest pain suspected of coronary artery disease (CAD) underwent both dual-energy X-ray absorptiometry scan and selective coronary angiography. The association between BMD and global coronary atherosclerotic plaque burden as represented by the multivessel involvement and the modified Gensini score was analyzed.

Results

Multivariable analysis revealed that the low BMD at femoral neck and total hip was an independent correlate of multivessel CAD. The T-scores measured at femoral neck and total hip were both negatively and independently associated to the modified Gensini score. These inversely correlated relationships between BMD and CAD were not observed at lumbar spine 1–4.

Conclusion

This cross-sectional study elucidated an inverse relationship between hip BMD and the modified Gensini score, and low hip BMD values (T-scores) were significantly and independently associated with increased risk of multivessel coronary disease in patients hospitalized for stable chest pain.

Association of Severity of Coronary Lesions with Bone Mineral Density in Postmenopausal Women

Background

Coronary artery disease (CAD) and osteoporosis (OP) are common diseases in postmenopausal women. In both cross-sectional and longitudinal epidemiologic studies, low bone mass has been related to increased frequency of CAD. However, available data on the relationship between bone mineral density (BMD) and severity of coronary lesions is limited.

Objective

To investigate association between the BMD and severity of coronary lesions assessed by Gensini score in postmenopausal women.

Methods

This study included 122 postmenopausal women who were diagnosed with CAD. These patients were divided into two groups according to the severity of coronary lesions assessed by the Gensini score - patients with mild coronary lesions (Gensini score < 25) and patients with severe coronary lesions (Gensini score ≥ 25). Femoral neck mineral density was measured with dual energy X-ray absorptiometry (DXA).

Results

The study included postmenopausal women aged 64.31 ± 4.71 years, 85 of whom (69.7%) exhibited severe coronary lesions. Participants with severe coronary lesions had a significantly higher T score than did those with mild coronary lesions at the femoral neck (p < 0.05). The mean T-score was −0.84 ± 1.01 in mild coronary lesions group, −1.42 ± 1.39 in severe coronary lesions group (p < 0.05). Multivariable logistic regression analysis showed that osteopenia-osteoporosis at the Femoral neck (odds ratio 2.73; 95% confidence interval 1.06 to 6.13) was associated with an increased risk of developing severe coronary lesions. The multiple regression model showed that T-scores (b = −0.407, SE = 0.151, p=0.007) were the independent predictors of Gensini score.

Conclusion

The relationship between severity of coronary lesions and BMD was significant in postmenopausal women. BMD, a low-cost technique involving minimal radiation exposure, widely used for osteoporosis screening, is a promising marker of severity of coronary lesions.