Unique and Varied Contributions of Traditional CVD Risk Factors: A Systematic Literature Review of CAD Risk Factors in China

Classification models for assessing coronary artery disease instances using clinical and biometric data: an explainable man-in-the-loop approach

The main goal driving this work is to develop computer-aided classification models relying on clinical data to identify coronary artery disease (CAD) instances with high accuracy while incorporating the expert's opinion as input, making it a "man-in-the-loop" approach. CAD is traditionally diagnosed in a definite manner by Invasive Coronary Angiography (ICA). A dataset was created using biometric and clinical data from 571 patients (21 total features, 43% ICA-confirmed CAD instances) along with the expert's diagnostic yield. Five machine learning classification algorithms were applied to the dataset. For the selection of the best feature set for each algorithm, three different parameter selection algorithms were used. Each ML model's performance was evaluated using common metrics, and the best resulting feature set for each is presented. A stratified ten-fold validation was used for the performance evaluation. This procedure was run both using the assessments of experts/doctors as input and without them. The significance of this paper lies in its innovative approach of incorporating the expert's opinion as input in the classification process, making it a "man-in-the-loop" approach. This approach not only increases the accuracy of the models but also provides an added layer of explainability and transparency, allowing for greater trust and confidence in the results. Maximum achievable accuracy, sensitivity, and specificity are 83.02%, 90.32%, and 85.49% when using the expert's diagnosis as input, compared to 78.29%, 76.61%, and 86.07% without the expert's diagnosis. The results of this study demonstrate the potential for this approach to improve the diagnosis of CAD and highlight the importance of considering the role of human expertise in the development of computer-aided classification models.

Association of lipid metabolism-related gene promoter methylation with risk of coronary artery disease

BACKGROUND

Coronary artery disease (CAD) is a complex disease that is influenced by environmental and genetic factors. Lipid levels are regarded as a major risk factor for CAD, and epigenetic mechanisms might be involved in the regulation of CAD development. This study was designed to investigate the association between the DNA methylation status of 8 lipid metabolism-related genes and the risk of CAD in the Chinese Han population.

METHODS

A total of 260 individuals were sampled in this study, including 120 CAD cases and 140 normal healthy controls. DNA methylation status was tested via targeted bisulfite sequencing.

RESULTS

The results indicated a significant association between hypomethylation of the APOC3, CETP and APOC1 gene promoters and the risk of CAD. Individuals with higher methylation levels of the APOA5 and LIPC gene promoters had increased risks for CAD. In addition, ANGPTL4 methylation level was significantly associated with CAD in males but not females. There were no significant differences in the methylation levels of the APOB and PCSK9 gene promoters between CAD patients and controls.

CONCLUSIONS

The methylation status of the APOC3, APOA5, LIPC, CETP and APOC1 gene promoters may be associated with the development of CAD.

Plasma Metabolites Alert Patients With Chest Pain to Occurrence of Myocardial Infarction

Myocardial infarction (MI) is one of the leading causes of death worldwide, and knowing the early warning signs of MI is lifesaving. To expand our knowledge of MI, we analyzed plasma metabolites in MI and non-MI chest pain cases to identify markers for alerting about MI occurrence based on metabolomics. A total of 230 volunteers were recruited, consisting of 146 chest pain patients admitted with suspected MI (85 MIs and 61 non-MI chest pain cases) and 84 control individuals. Non-MI cardiac chest pain cases include unstable angina (UA), myocarditis, valvular heart diseases, etc. The blood samples of all suspected MI cases were collected not longer than 6 h since the onset of chest pain. Gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry were applied to identify and quantify the plasma metabolites. Multivariate statistical analysis was utilized to analyze the data, and principal component analysis showed MI could be clearly distinguished from non-MI chest pain cases (including UA and other cases) in the scores plot of metabolomic data, better than that based on the data constructed with medical history and clinical biochemical parameters. Pathway analysis highlighted an upregulated methionine metabolism and downregulated arginine biosynthesis in MI cases. Receiver operating characteristic curve (ROC) and adjusted odds ratio (OR) were calculated to evaluate potential markers for the diagnosis and prediction ability of MI (MI vs. non-MI cases). Finally, gene expression profiles from the Gene Expression Omnibus (GEO) database were briefly discussed to study differential metabolites' connection with plasma transcriptomics. Deoxyuridine (dU), homoserine, and methionine scored highly in ROC analysis (AUC > 0.91), sensitivity (>80%), and specificity (>94%), and they were correlated to LDH and AST (p < 0.05). OR values suggested, after adjusting for gender, age, lipid levels, smoking, type II diabetes, and hypertension history, that high levels of dU of positive logOR = 3.01, methionine of logOR = 3.48, and homoserine of logOR = 1.61 and low levels of isopentenyl diphosphate (IDP) of negative logOR = -5.15, uracil of logOR = -2.38, and arginine of logOR = -0.82 were independent risk factors of MI. Our study highlighted that metabolites belonging to pyrimidine, methionine, and arginine metabolism are deeply influenced in MI plasma samples. dU, homoserine, and methionine are potential markers to recognize MI cases from other cardiac chest pain cases after the onset of chest pains. Individuals with high plasma abundance of dU, homoserine, or methionine have increased risk of MI, too.

Association between α1-antitrypsin and acute coronary syndrome

α1-antitrypsin (AAT) is a protein released as part of the anti-inflammatory response. It regulates the activity of serine proteinases and has a crucial role in the pathogenesis of acute coronary syndrome (ACS). The present study aimed to examine its role in patients with ACS. The plasma samples of 117 patients were collected at the Cardiology Department of the Affiliated Hospital of Youjiang Medical University (Baise, China). These included 46 cases of ACS (who met the diagnostic criteria for ACS and had ≥50% luminal stenosis of any coronary vessel), 35 cases of stable angina (SA; with ≥50% luminal stenosis of any coronary vessel but in a stable condition) and 36 normal healthy controls (subjects with no luminal stenosis in their coronary arteries). Plasma AAT protein concentrations were measured by ELISA and clinical data were collected. The plasma levels of AAT protein in patients with ACS were lower than those in controls and cases of SA (P<0.05), and the levels tended to decrease with the number of coronary artery lesions involved. There were no significant associations of the expression of plasma AAT protein and the number of diseased vessels in patients or the degree of stenosis. There was no correlation between the plasma protein levels of AAT and Gensini scores of patients with ACS. In conclusion, the plasma AAT protein levels in patients with ACS may contribute to the occurrence and development of coronary artery disease.

Association of polymorphisms of preptin, irisin and adropin genes with susceptibility to coronary artery disease and hypertension

OBJECTIVES

Preptin, irisin and adropin are 3 new players in energy regulation that are related body mass index, lipids, glucose and insulin levels which may affect incidence of cardiovascular diseases. The aim of the present study was to evaluate eight single nucleotide polymorphisms (SNPs) of preptin genes (rs1003483, rs1004446, rs2239681, rs680, and rs3741204), irisin (rs16835198 and rs3480) and adropin (rs2281997) gene in patients with coronary artery disease (CAD) and hypertension.

METHODS

This case-control study was carried out on 372 volunteers, which were divided into 3 subgroups including: CAD patients with hypertension (CAD+H+), CAD patients with no hypertension (CAD+H-), and non-hypertensive non-CAD subjects as control group (CAD-H-) as health control. Genomic DNA from whole blood was extracted and eight SNPs were assessed using polymerase chain reaction- ligase detection reaction method.

RESULTS

A significant difference was found in the genotype and allele frequency of preptin rs1003483 gene in CAD+H+ compared to CAD+H- groups (P = .019 and P = .018, respectively). Allele frequency of rs1003483 was significantly different between CAD+H- groups and healthy control groups (P = .043). There also existed a significant difference the genotype frequency of rs1004446 gene in CAD+H+ compared to CAD+H- groups (P = .027).

CONCLUSIONS

The findings of present study revealed that the preptin rs1003483 and rs1004446 gene polymorphism might serve as predisposing factor in CAD and hypertension.

Association of Toll-like receptor 4 polymorphisms with the risk of coronary artery disease in the ethnic Zhuang population of the Guangxi Province of China

OBJECTIVES

Toll-like receptor 4 (TLR4) is known to be involved in the innate immunity and inflammatory responses that plays a crucial role in the pathogenesis of coronary artery disease (CAD). This study aimed to examine the potential relationship of TLR4 polymorphisms and serum TLR4 protein levels and the risk of CAD in the ethnic Zhuang population of China.

METHODS

1171 serum samples were collected from Zhuang patients, including 556 CAD cases (≥50% luminal stenosis of any coronary vessel) and 615 normal healthy controls (subjects with no luminal stenosis in coronary arteries). Detection of TLR4 polymorphisms was by single base extension polymerase chain reaction (Snapshot PCR) and DNA sequencing (rs11536879A/G and rs11536889G/C) gene sequence in all subjects. Serum TLR4 protein concentrations was measured by ELISA.

RESULTS

There are significant differences in the allele and genotype frequencies of TLR4 gene rs11536889 between Chinese Zhuang CAD patients and controls, especially in the males. Male carriers of rs11536879 andrs11536889 variant alleles show an increased risk of CAD compared to non-carriers. Serum TLR4 protein levels of CAD patients are higher than controls and the levels tended to increase with the number of coronary artery lesions. Serum TLR4 protein levels of CAD patients showed no correlation with rs11536879 and rs11536889 polymorphisms.

CONCLUSIONS

The rs11536879 and rs11536889 polymorphisms of TLR4 gene and serum TLR4 protein levels may contribute to the occurrence and development of CAD. However, the rs11536879 and rs11536889 polymorphisms have no significant effects on the expression of serum TLR4 protein in Zhuang patients with CAD.

Correlation between coronary artery disease and obstructive sleep apnea syndrome and analysis of risk factors

The correlation between coronary artery disease (CAD) and obstructive sleep apnea syndrome (OSAS) was investigated to analyze its risk factors. A total of 84 patients with suspected CAD due to chest tightness and pain or nocturnal angina, were selected. They were admitted and received coronary angiography in The Affiliated Hospital of Medical College Qingdao University from March, 2016 to June, 2017. The vital signs were monitored, and the sleep monitoring was performed before and after coronary angiography. Before angiography, the fasting blood was drawn for blood biochemical detection, followed by routine electrocardiogram and echocardiographic examination. In addition, the body mass index was calculated and whether patients suffered from hypertension and diabetes mellitus was observed. The patients were divided into the control group (patients with a negative coronary angiography) and the CAD group (patients with a positive coronary angiography). There were 34 cases in the control group, including 21 cases of OSAS (61.76%), and 50 in the CAD group, including 40 cases of OSAS (80.00%). Statistical analysis revealed that there were statistically significant differences in the apnea hypopnea index (AHI), lowest oxygen saturation, degree of coronary stenosis (Gensini score) and triglyceride level between the two groups (P<0.05). There were no statistically significant differences in the cholesterol level and prevalence rates of hypertension and diabetes mellitus between the two groups. Logistic regression analysis revealed that smoking and AHI >20 were the risk factors of CAD (OR=7.036 and 5.377). Thus, CAD is closely correlated with OSAS and AHI >20 is one of the risk factors of CAD.

Association between the GPAM rs1129555 SNP and serum lipid profiles in the Maonan and Han populations

The glycerol-3-phosphate acyltransferase mitochondrial gene (GPAM) variant has been associated with serum lipid levels in the Eurpean ancestry, but little is known about such association in Chinese populations. The aim of the present study was to investigate the relationship between the GPAM rs1129555 single nucleotide polymorphism (SNP) and several environment factors with blood lipid profiles in the Guangxi Maonan and Han populations. A total of 720 individuals of Maonan nationality and 780 participants of Han nationality were randomly selected from our previous stratified randomized samples. Genotyping of the rs1129555 SNP was carried out using the polymerase chain reaction-restriction fragment length polymorphism technique, and then confirmed by direct sequencing. The frequencies of C and T alleles were 72.85% and 27.15% in Maonan, and 65.19% and 34.81% in Han (P < 0.001); respectively. The frequencies of CC, CT, and TT genotypes were 51.53%, 42.36%, and 5.97% in Maonan, and 43.08%, 44.23%, and 12.69% in Han populations (P < 0.001). The T allele carriers had higher serum triglyceride (TG) in Han and higher low-density lipoprotein cholesterol (LDL-C) in both Maonan and Han than the T allele non-carriers (P < 0.05-0.01). Gender subgroup analyses showed that the T allele carriers had higher TG levels in Han males (P < 0.05) and higher LDL-C levels in Maonan males but not in famales (P < 0.01). Serum lipid parameters were also associated with several environmental factors (P < 0.05-0.001). These findings suggest that racial/ethnic- and/or gender-specific association occurs between the GPAM rs1129555 variant and serum lipid parameters in our study populations.

Association of rs662799 in APOA5 with CAD in Chinese Han population

Background

CAD (Coronary Artery Disease) is a complex disease that influenced by various environmental and genetic factors. Previous studies have found many single nucleotide polymorphisms (SNPs) associated with the risk of CAD occurrence. However, the results are inconsistent. In this study, we aim to investigate genetic etiology in Chinese Han population by analysis of 7 SNPs in lipid metabolism pathway that previously has been reported to be associated with CAD.

Methods

A total of 631 samples were used in this study, including 435 CAD cases and 196 normal healthy controls. SNP genotyping were conducted via multiplex PCR amplifying followed by NGS (next-generation sequencing).

Results

Rs662799 in APOA5 (Apolipoprotein A5) gene was associated with CAD in Chinese Han population (Odds-ratio = 1.374, P-value = 0.03). No significant association was observed between the rest of SNPs and CAD. Stratified association analysis revealed rs5882 was associated with CAD in non-hypertension group (Odds-ratio = 1.593, P-value = 0.023). Rs1800588 was associated with CAD in smoking group (Odds-ratio = 1.603, P-value = 0.035).

Conclusion

The minor allele of rs662799 was the risk factor of CAD occurrences in Chinese Han population.

Risk factor differences between type 2 diabetes patients with ischemic cerebrovascular versus coronary heart diseases at admission

AIMS

Type 2 diabetes mellitus (T2DM) is a major risk factor, and shares many common risk factors with ischemic cerebrovascular diseases (ICVD) and coronary heart diseases (CHD). Few studies have directly compared the differences in common risk factors between T2DM patients with ICVD and CHD at admission.

METHODS

In this cross-sectional study, T2DM patients with or without first-ever ICVD or CHD admitted to our hospital over 3 years were enrolled. Patients' data were retrospectively collected and compared using multivariate logistic regression analyses.

RESULTS

In total, 1208 T2DM patients were enrolled (57.5% men). The median age was 59 years (interquartile range [IQR] 51-69), and duration of diabetes was 7 years (IQR 3-10). Two hundred and two patients (16.7%) were diagnosed with ICVD, 345 (28.6%) with CHD, and 661 (54.7%) had neither ICVD nor CHD. Compared with T2DM patients without ICVD or CHD, ICVD and CHD patients had higher systolic blood pressure (SBP) and older age but lower high-density lipoprotein cholesterol levels (all p<0.01), whereas reduced estimated glomerular filtration rate was only associated with CHD (p<0.05). Furthermore, ICVD patients had higher SBP (every 10-mmHg increase, OR=1.38, 95% CI: 1.26-1.51) and HbA1c levels (OR=1.18, 95% CI: 1.06-1.31) than CHD patients.

CONCLUSIONS

T2DM patients with ICVD and CHD have differences in common risk factors at admission. Higher systolic blood pressure and HbA1c levels may indicate ICVD.

Association between LGALS2 3279C>T and coronary artery disease: A case-control study and a meta-analysis

Coronary artery disease (CAD) has become the main cause of mortality worldwide. Lectin galactoside-binding soluble-2 (LGALS2) is involved in the cytokine lymphotoxin-α (LTA) cascade that may influence the progress of CAD. The aim of the present study was to assess the association between the LGALS2 3279C>T (rs7291467) polymorphism and CAD. A total of 562 cases and 572 controls were recruited to examine the association. A systematic meta-analysis was performed to evaluate the contribution of LGALS2 3279C>T polymorphism to the risk of CAD among 12,093 cases and 11,020 controls. There was no significant association found in the present case-control study. However, the meta-analysis showed that LGALS2 3279C>T played a protective role in CAD [P=0.008, odds ratio (OR), 0.90; 95% confidence interval (95% CI), 0.82-0.97] and particularly in the Asian population (P=0.006; OR, 0.82; 95% CI, 0.71-0.94). The present case-control study did not find a significant association between LGALS2 3279C>T and CAD in the Eastern Han Chinese population. However, the meta-analysis indicated that LGALS2 3279C>T played a protective role in CAD, suggesting an ethnic difference in the association of the locus with CAD.

Association of the ST3GAL4 rs11220462 polymorphism and serum lipid levels in the Mulao and Han populations

Background

A previous genome-wide association study has displayed the association of the ST3 beta-galactoside alpha-2,3-sialytransferase 4 (ST3GAL4) gene variant and lipid traits in the individuals of European ancestry, but the reproducibility of this association has not been detected in the Chinese population. The present study was undertaken to detect the association of ST3GAL4 rs11220462 single nucleotide polymorphism (SNP) and several environmental factors with serum lipid profiles in the Mulao and Han populations.

Methods

A total of 700 unrelated individuals of Mulao nationality and 694 subjects of Han nationality were randomly selected from our previous stratified randomized samples. Genotypes of the SNP were determined via polymerase chain reaction and restriction fragment length polymorphism in combination with gel electrophoresis, and then verified by direct sequencing.

Results

Serum apolipoprotein (Apo) B levels were higher and the ApoAI/ApoB ratio was lower in Mulao than in Han (P < 0.05-0.01). There were no significant differences in the genotypic and allelic frequencies of the ST3GAL4 rs11220462 SNP between the two ethnic groups or between males and females. The A allele carriers in both Mulao males and females had higher total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and ApoB levels than the A allele non-carriers (P < 0.05-0.01). The subjects with AA genotype in Han males but not in females had higher TC and triglyceride (TG) levels than the subjects with AG or GG genotype (P < 0.01 for each). Multiple linear regression analyses showed that the levels of TC, LDL-C and ApoB in Mulao females; TC and LDL-C in Mulao males; and TC in Han males were correlated with the genotypes (P < 0.05-0.001). Serum lipid parameters were also associated with several environmental factors in both ethnic groups (P < 0.05 -0.001).

Conclusions

The association of ST3GAL4 rs11220462 SNP and serum lipid levels was different between the Mulao and Han populations, suggesting that there may be a racial/ethnic-specific association, and/or sex-specific association between the ST3GAL4 rs11220462 SNP and serum lipid parameters in some ethnic groups.

Synergistic effects of elevated homocysteine level and abnormal blood lipids on the onset of stroke

Hyperhomocysteinemia and abnormal blood lipids are independent risk factors for stroke. However, whether both factors exert a synergistic effect in the onset of stroke remains unclear. The present study is a retrospective analysis of 2 089 cases of stroke and 2 089 control cases of simple intervertebral disk protrusion using a paired multivariate logistic regression method. Adjusting for known confounding variables including the patients' age, gender, smoking status, alcohol consumption status, patient and family medical history, and clinical biochemical indices, elevated homocysteine level was related to the onset of stroke. Patients with elevated homocysteine levels and abnormal blood lipids showed a 40.9 % increase in the risk for stroke compared to patients with normal homocysteine levels and blood lipids (odds ratio 1.409; 95% confidence interval 1.127-1.761). These results indicate that elevated homocysteine and abnormal blood lipids exert synergistic effects in the onset of stroke. Patients with elevated homocysteine levels and abnormal blood lipids are predisposed to stroke.