Abstract Background Despite well-controlled low-density lipoprotein cholesterol (LDL-C), hypertriglyceridemia is an independent predictor of coronary events. We investigated the risk of ...atherosclerotic cardiovascular disease through examining the relation between triglyceride (TG) metabolism and LDL-heterogeneity as assessed by polyacrylamide-gel electrophoresis (PAGE). Methods and results Estimated LDL-particle size relative LDL migration (LDL-Rm value) measured by PAGE with the LipoPhor system (Joko, Tokyo, Japan) was evaluated in 645 consecutive patients with one additional risk factor for atherosclerotic cardiovascular disease.Multivariate regression analysis after adjustments for traditional risk factors revealed an elevated triglyceride-rich lipoproteins (TRLs)-related markers TG, remnant-like particle cholesterol (RLP-C), very LDL (VLDL) fraction, apolipoprotein (apo) C-II, and apo C-III level to be an independent predictor of smaller-size LDL-particle size, both in the overall population, and in a subset of patients with serum LDL-C <100 mg/dL. Even among the patients with LDL-C levels <100 mg/dL, the serum levels of atherogenic lipid markers in those with a LDL-Rm value ≥0.40, suggesting the presence of large amounts of small-dense LDL and upper limit (mean + 2 standard deviation) in this population, were significantly higher than in those with a LDL-Rm value <0.40. Moreover, the serum levels of TRLs-related markers showed high accurate area under the receiver-operating characteristic curve (TG, 0.896; RLP-C, 0.875; VLDL fraction, 0.803; apo C-II, 0.778; and apo C-III, 0.804, respectively) in terms of evaluation of the indicators of LDL-Rm value ≥0.40. Conclusion To further reduce the risk of atherosclerotic cardiovascular disease, it may be of particular importance to pay attention not only to the quantitative change in the serum LDL-C, but also TG-metabolism associated with LDL-heterogeneity. Combined evaluation of TRLs-related markers and LDL-Rm value may be useful for assessing the risk of atherosclerotic cardiovascular disease.
Abstract Background There is growing evidence to suggest that measurement of apolipoprotein A-1 (apoA-1), the main surface protein on high-density lipoprotein (HDL) particles, is superior to ...measurement of the serum HDL-cholesterol level as a predictor of the occurrence of coronary disease (CAD). We investigated the association of systemic inflammation as an initiator of CAD along with the serum apoA-1 level. Methods and results This study was designed as a hospital-based cross-sectional study on 652 consecutive outpatients with at least one risk factor for CAD to investigate the relationships between the serum high-sensitivity C-reactive protein (hs-CRP) and the peripheral blood white blood cell (WBC) count and the serum apoA-1 level between April 2009 and October 2009. Multivariate analysis after adjustments for traditional coronary risk factors revealed reduced apoA-1 as an independent indicator of higher hs-CRP and WBC count, both in the overall subject population ( β : −0.270 and −0.116, p < 0.0001 and 0.003) and in a patient subset with serum low-density lipoprotein cholesterol <100 mg/dL ( β : −0.280 and −0.128, p < 0.0001 and 0.045). However, in the patients who could be followed up 6 months later, the increase in the apoA-1 level was associated with a decrease in the hs-CRP level, but not with a decrease in the WBC count. Conclusions Increased serum apoA-1 levels may be associated with decreased hs-CRP levels and decreased WBC counts as predictive inflammatory biomarkers of the onset of CAD. In particular, increase in the hs-CRP level and decrease in the apoA-1 level may be useful indices of the risk of CAD.
Although several studies have shown the relation between temperature/atmospheric pressure and pulmonary embolism (PE), their results are inconsistent. Furthermore, diurnal temperature range (DTR) and ...diurnal pressure range (DPR) were not fully evaluated for their associations with hospital admissions for PE. Study subjects comprised cases of 1,148 PE treated at institutions belonging to the Tokyo Cardiovascular Care Unit Network from January 2005 to December 2012. Patient data were combined with a variety of daily local climate parameters obtained from the Japan Meteorological Agency. Every 1°C increase in the DTR at lag0 corresponded to an increased relative risk of hospital admission for PE (odds ratio OR 1.036, 95% confidence interval CI 1.003 to 1.070). In the cooler season (November to April), an increase of 1 hPa (barometric pressure) in the DPR at lag4 and lag5 was associated with an increased relative risk of hospital admission for PE (OR 1.042, 95% CI 1.007 to 1.077 and OR 0.952, 95% CI 0.914 to 0.992, respectively). An increase in the PE hospitalization rate was seen only in the cool season. Using a metropolitan database, we showed that DTR and DPR have different impacts on hospital admissions for PE. In conclusion, we found that an increase in the DTR increases the PE hospitalization rate, especially during the cooler season. The impact of DTR and DPR on PE incidence and related hospitalizations needs to be further evaluated.
Abstract Background Oral infection contributes to atherosclerosis and coronary heart disease. We hypothesized that dental caries may be associated with out-of-hospital cardiac arrests (OHCA) of ...cardiac origin, but not non-cardiac origin. Methods and results We compared the age-adjusted incidence of OHCA (785,591 cases of OHCA: 55.4% of cardiac origin and 44.6% of non-cardiac origin) to the age-adjusted prevalence of dental caries between 2005 and 2011 in the 47 prefectures of Japan. In both the total population and males over 65 years, the number of cases of dental caries was significantly associated with the number of OHCA of total and cardiac origin from 2005 to 2011, but not those of non-cardiac origin. In the total population, the age-adjusted prevalence of dental caries was not significantly associated with the age-adjusted incidence of OHCA (total OHCA: r correlation coefficient = 0.22, p = 0.14; OHCA of cardiac origin: r = 0.25, p = 0.09; OHCA of non-cardiac origin: r = −0.002, p = 0.99). Among male patients over 65 years, the age-adjusted prevalence of dental caries was significantly associated with OHCA of total and cardiac origin, but not non-cardiac origin (total OHCA: r = 0.47, p < 0.001; OHCA of cardiac origin: r = 0.37, p = 0.01; OHCA of non-cardiac origin: r = 0.28, p = 0.054). Conclusions While oral hygiene is important in all age groups, it may be particularly associated with OHCAs of cardiac origin in males over 65 years.
It has been reported that influenza infection is associated with out-of-hospital cardiac arrest of cardiac origin (OHCA-CA). However, the association between OHCA-CA and influenza epidemics in adults ...has not been well investigated. We analyzed data from the All-Japan Utstein Registry, a prospective, nationwide, population-based, observational study, regarding OHCA-CA cases and the Infectious Diseases Weekly Report for influenza cases: 17,710 OHCA-CA cases and 764,808 influenza cases were recorded between 2005 and 2015 in Fukuoka, Japan. The weekly average number of OHCA-CA cases was positively associated with the number of patients with influenza infection (r = 0.70, P < .0001). To eliminate the effects of season and age, we investigated only adults in winter. The weekly number of OHCA-CA cases was positively associated with the number of patients with influenza infection in weeks when there was a high frequency of influenza infection in adults (r = 0.36, P = .006), but not in weeks with a medium (r = 0.26, P = .05) or low frequency of influenza infection (r = 0.003, P = 1.0). In weeks during which there was a high frequency of influenza infection, the weekly number of OHCA-CA cases was positively associated with the number of influenza infections in males (r = 0.37, P = .006), but not females (r = 0.18, P = .2). The number of OHCA-CA cases was positively associated with the number of influenza infections in adult males during weeks in which there was a high frequency of influenza infections. To help prevent OHCA-CA in males, it might be beneficial to announce influenza epidemics specifically in adults, in addition to all ages.
Abstract Objective To elucidate the current status of use of inferior vena cava filters (IVCFs) in cases of pulmonary embolism at institutions belonging to the Tokyo CCU Network. Methods We conducted ...a retrospective investigation of 832 consecutive cases of pulmonary embolism reported on survey forms to the Tokyo CCU Network between 2005 and 2010. Results Of 832 cases of pulmonary embolism, IVCFs were used in 338 (40.6%) and not used in 415 (49.9%). Their use was unclear in 79 (9.5%) cases. The use rate gradually increased each year from 2005 until 2008 but decreased from 2009 onward. Moreover, 68.9% of the IVCFs used in cases were non-permanent types. In terms of pulmonary embolism severity, the rate of use was 37.2% in non-massive cases, 49.4% in sub-massive cases, 46.9% in massive cases, and 31.9% in collapse cases. Thirty-day mortality in cases of collapse in which IVCFs were not used was extremely high at 75.8%, suggesting that in many cases, rapid deterioration may occur with insufficient time for IVCF insertion. The differences in IVCF usage rate among institutions were large in the range of 12.5–90% from 2005 to 2008, which slightly declined to the range of 25.0–72.2% from 2009 to 2010. Conclusions We elucidated the current IVCF use status in cases of pulmonary embolism at institutions belonging to the Tokyo CCU Network. Since the status of use differed among institutions, future studies of effective methods of use are required.
The purpose of this study was to clarify the relation between differential leukocyte counts and inhibition of the development of coronary atherosclerosis in patients with coronary artery disease. A ...6-month prospective study was conducted in 84 patients treated with pravastatin. Plaque volume, as assessed by volumetric analysis using intravascular ultrasound, decreased significantly by 12.6% (p <0.0001 vs baseline) after treatment; furthermore, a corresponding decrease of total leukocyte count (8.9%, p <0.01 vs baseline) was seen. Change in plaque volume was correlated with changes in monocyte (r = 0.35, p = 0.002) and lymphocyte (r = 0.25, p = 0.03) counts but not with changes in neutrophil, eosinophil, or basophil counts. In a multivariate regression analysis with changes in serum lipids, traditional risk factors, and medications as covariates, the decrease in monocyte count was identified as an independent predictor of coronary plaque regression (beta coefficient 0.313, 95% confidence interval 0.089 to 0.353, p = 0.0014). No correlation was found between change in monocyte count and changes in any other lipid levels. This study demonstrated that monocyte count was the only leukocyte type significantly and independently associated with coronary atherosclerotic regression, even after adjustment for changes in any lipid levels. In conclusion, the decrease in monocyte count as a nonlipid-lowering effect of statins may be used as a novel marker of coronary atherosclerotic regression.
Abstract Background Soluble thrombomodulin (sTM) is a useful marker of vascular endothelial damage. Although n-3 polyunsaturated fatty acids (n-3 PUFAs) (eicosapentaenoic acid: EPA; docosahexaenoic ...acid: DHA) have various cardiovascular protective effects, their effect in preventing vascular endothelial damage remains unclear. Furthermore, little is known about the association of EPA and DHA with sTM using the cross-sectional study method. Methods and results This pilot study was designed as a hospital-based cross-sectional study to investigate the relationships between serum n-3 PUFA levels and sTM level in patients with the presence of one or more risk factors for atherosclerosis. Of the 534 sequential patients who had routinely been registered to a study cohort of our institute, 324 patients without chronic kidney disease (because sTM is eliminated by renal excretion and the serum sTM level is increased by renal dysfunction) were enrolled in this study. In a multivariate analysis after adjustment for atherosclerotic risk factors, elevated EPA + DHA level was an independent variable of decreased sTM level ( β = −0.183, p = 0.0006). The serum levels of EPA and DHA showed a strong correlation ( r = 0.736, p < 0.0001); however, multivariate analysis including EPA and DHA revealed that serum DHA ( β = −0.243, p = 0.003), but not serum EPA ( β = 0.049, p = 0.538), was identified as an independent negative determinant of sTM level. Conclusion Although there are numerous unresolved issues in regard to the differences in the cardiovascular protective effects between EPA and DHA, DHA may be associated with a decrease in sTM. A large-scale trial would be warranted to demonstrate whether the beneficial effect of n3-PUFAs therapy on endothelial damage and improvement of endothelial function might also result in fewer clinical cardiovascular events.
Basing the study design or treatment strategy on SBP at presentation seems to be reasonable approach in conducting clinical trials in the acute phase of heart failure.
Some investigations have looked into the ability of measurements of apolipoprotein B/apolipoprotein A-I (apoB/apoA-I) ratio to predict cardiovascular events. We hypothesized that a decrease in the ...apoB/apoA-1 ratio by statin therapy would act on suppression of coronary plaque progression. A 6-month prospective study was conducted of 64 patients with coronary artery disease treated with pravastatin. The plaque volume, assessed by volumetric intravascular ultrasonography, had decreased significantly by 12.6% (p <0.0001 vs baseline). Although a significant decrease of 6.4% and 14.6% was found in the serum level of apoB and the apoB/apoA-1 ratio (p = 0.0001 and p <0.0001, respectively, vs baseline), a significant increase of 14.0% of and 12.0% in the level of apoA-I and apoA-II (both p <0.0001 vs baseline). No significant changes were found in the level of apoC-II or apoE. A stepwise regression analysis revealed that the change in the apoB/apoA-1 ratio was an independent predictor of the change in coronary plaque volume (β coefficient 0.386; p = 0.0023). In conclusion, our results have indicated that the decrease in the apoB/apoA-I ratio is a simple predictor for coronary atherosclerotic regression: the lower the apoB/apoA-I ratio, the lower the risk of coronary atherosclerosis.
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