Elevated soluble CD40 ligand (sCD40L) levels are associated with an increased risk of cardiovascular events in patients with acute coronary syndromes and in middle-aged healthy women. However, the ...relationship between sCD40L and global risk assessment remains unclear. The present study was designed to examine the relationship between sCD40L and Framingham Coronary Heart Disease Risk Scores (FCRS) in healthy middle-aged men. The study population consisted of 400 active and retired male firefighters, with no previous history of cardiovascular disease, as part of the
Firefighters and Their Endothelium (FATE) study. FCRS correlated poorly with sCD40L levels (
p
=
0.14). Soluble CD40L concentrations correlated only with total (
r
=
0.105;
p
=
0.035) and LDL cholesterol (
r
=
0.104;
p
=
0.039), and CRP levels (
r
=
0.11;
p
=
0.03). Compared with participants with sCD40L levels <4.36
ng/mL (75th percentile), participants with sCD40L levels >4.36
ng/mL had higher total (
p
=
0.016) and LDL cholesterol (
p
=
0.018), CRP levels (
p
=
0.034) and FCRS (
p
=
0.012). Multivariate analysis revealed that CRP level was the only parameter that independently correlated with the sCD40L levels (
p
=
0.032). This is the first study to evaluate the relationship between sCD40L levels and Framingham global risk assessment in a large cohort of otherwise healthy individuals. We demonstrate that sCD40L levels poorly correlate with both the individual components and the calculated FCRS. Long-term follow-up of the FATE study will shed light on whether the predictive value of sCD40L is independent of Framingham based global risk assessment.
The effect of iron status on vascular health Yunker, Leanne M; Parboosingh, Jillian S; Conradson, Heather E ...
Vascular medicine (London, England),
05/2006, Letnik:
11, Številka:
2
Journal Article
Recenzirano
The effect of increased iron stores on the progression of atherosclerosis and endothelial health remains inconclusive. This study was designed to evaluate the relationship between hemochromatosis ...genotypes, serum ferritin levels and presymptomatic vascular abnormalities in a cohort of healthy subjects. Carotid intima-media thickness (CIMT) and brachial flow-mediated vasodilation (FMD) were assessed by high-resolution ultrasound in 907 male (47 ± 10 years) participants enrolled in the Firefighters and their Endothelium (FATE) study. Analyses of the hemochromatosis C282Y, H63D and S65C alleles were simultaneously determined by a single nucleotide polymorphism (SNP) primer extension method. It was found that brachial FMD was not related to serum ferritin or hemochromatosis genotype status. The presence of a hemochromatosis-associated genotype (n = 18) or heterozygosity for the C282Y genotype (n = 98) was not associated with an increased mean CIMT. After adjustment for conventional risk factors, serum ferritin was also not associated with mean CIMT. In conclusion, neither ferritin nor a hemochromatosis genotype was related to brachial endothelial function or carotid atherosclerosis. The present study does not support the hypothesis that mild to moderately increased iron stores are associated with enhanced atherosclerosis risk.
Objective: Apolipoprotein E (APOE) E4, apolipoprotein B-100 (
APOB) Q3611 allele, the angiotensin converting enzyme (
ACE) deletion (D) allele and glycoprotein IIIa (
GP3A) P33 mutant allele are ...reported to predispose to early-onset coronary heart disease (CHD). These associations were not all confirmed in more recent studies. To determine the impact of these alleles on CHD, we examined the prevalence of these mutations in patients presenting with early-onset CHD and compared them to those manifesting CHD later in life. The delayed-onset was considered a sign of longevity and would serve as a comparative group to assess prevalence of the biochemical and genetic risk factors.
Methods: 300 patients with a history of myocardial infarction or angina pectoris and angiographically documented CHD were studied. Patients were divided into two groups: group 1 (G1 = 150 patients) presenting with these findings under the age of 50 years; while group 2 (G2 = 150 patients) were patients presenting for the first time over the age of 65 years. Prevalence of the alleles of APOE, APOB, ACE and
GP3A was assessed by molecular analysis. An association of any of these genotypes with early onset CHD could lead to a higher prevalence in the younger age group.
Results and Conclusions: None of the suspected alleles namely
APOB Q3611 G1: 10.7% vs. G2: 9.0%,
p = 0.57,
ACE D (G1: 52.0% vs. G2: 49.7%,
p = 0.57), or the
GP3A P33 (G1: 17.3% vs. G2: 15.7%;
p = 0.58) showed any significant difference between the two groups. Subjects with
APOE E4 were more frequent in the younger age group (G1: 18.3% vs. G2: 13.7%;
p = 0.047), while
APOE E2 was more frequent in G2 (G2: 10.0% vs. G1: 2.7%;
p = 0.0002). Multivariate analysis showed an odds ratio of
APOE E2 allele in G1 of 0.27 with a confidence interval of 0.10–0.73.
We calculated distributions of epicardial potentials from body-surface electrocardiograms (ECGs) recorded during controlled myocardial ischemia and compared them with scintigraphic estimates of ...ischemia’s
extent/severity>. The study population consisted of patients suffering from single-vessel coronary artery disease, referred for elective percutaneous transluminal coronary angioplasty of either the left anterior descending (
n = 7), the right coronary (
n = 9), or the left circumflex (
n = 2) artery. After the target vessel had been dilated, a 1960s “study” inflation was performed with a non-perfusion-type balloon catheter; at its commencement, technetium-99m sestamibi was injected via a femoral-vein catheter, and ECGs were recorded throughout the inflation from 120 leads. Single photon emission computed tomographic imaging was performed one hour after the injection of radionuclide to obtain an “occlusion image”, and again one hour after a repeat injection 24 hours later to obtain a “control image”; the latter image was subtracted from the former, to derive a scintigraphic difference map (Δ map). The ECGs were signal-averaged over a 10-s window at preinflation and peak-inflation states, the preinflation averaged complexes were subtracted from the peak-inflation ones to produce body-surface Δ maps, and the corresponding Δ maps of epicardial potentials were calculated by applying the electrocardiographic inverse solution; this procedure is referred to as
electrocardiographic imaging. The ECG-derived epicardial Δ maps related spatially to the scintigraphic Δ maps in all patients. The percent areas and surface integrals of positive values in ECG-derived Δ maps were found to be very good single-variable predictors of the
extent (
r = 0.73;
p = 0.0006) and
severity (
r = 0.72;
p = 0.0008) of the scintigraphically-estimated perfusion defect; a regression equation using two ECG-derived predictors further improved the agreement with scintigraphic estimates (
r = 0.81;
p = 0.0004 for estimates of
severity). These findings suggest that noninvasive electrocardiographic imaging might provide quantitative estimates of the
extent/
severity of myocardial ischemia that agree closely with those provided by scintigraphic techniques.
Objectives: The common K variant of butyrylcholinesterase (BChE-K), an enzyme which metabolizes acetylcholine and organophosphates, has been associated with Alzheimer’s disease, especially in the ...presence of the apolipoprotein E ϵ4 allele (APOE-ϵ4). Although APOE-ϵ4 has been associated with the development of coronary artery disease (CAD), an association between the BChE-K variant and CAD has not been explored. Paraoxonase 1 (PON1), located within HDL, is an enzyme which also metabolizes organophosphates and may be antiatherogenic. The R192 variant of PON1 (PON1-R) has been associated with CAD.
Design and methods: To determine whether BChE-K is also associated with premature CAD, we examined the frequency of BChE-K among patients with early-onset CAD (
n = 150; < 50 yr) vs. late-onset CAD (
n = 150; > 65 yr) by molecular analysis. We also examined the frequency of the PON1-R allele in both groups, and explored whether there was synergism between BChE-K and APOE-ϵ4, BChE-K and PON1-R or PON1-R and APOE-ϵ4.
Results: The frequency of the BChE-K allele tended to be greater among early-onset CAD patients compared to late-onset CAD patients (41.3% vs. 31.3%;
p = 0.07), but without any significant difference between males and females. There was no difference in the prevalence of the PON1-R allele between those with early- or late-onset CAD (46.0% vs. 52.7%;
p = 0.25). Twenty-two patients with early-onset CAD had both the BChE-K plus APOE-ϵ4 alleles (14.7%) compared to 11 late-onset CAD patients (7.3%) (
p = 0.04). There was no such association between BChE-K and PON1-R, nor PON1-R and APOE-ϵ4.
Conclusions: Our study suggests that there is a minor association between BChE-K and early-onset CAD, especially in the presence of the APOE-ϵ4 allele.
Objective: In the presence of low serum folate, mutant 5,10-methylenetetrahydrofolate reductase (MTHFR+ A223V/C677T) in the homozygous state (+/+), may predispose to higher plasma homocysteine (tHct) ...levels and coronary artery disease (CAD). To determine the impact of this relationship on predisposition to early-onset CAD, we examined the prevalence of the mutation and plasma tHct in patients with early-onset CAD and compared them to patients manifesting CAD later in life.
Methods: Three hundred patients with history of acute myocardial infarction or angina pectoris and angiographically documented CAD were studied. Patients consisted of two groups: group 1 (G1 = 150 patients) presenting with these findings under age 50; while group 2 (G2 = 150) presented for the first time over age 65 years. Prevalence of the MTHFR+ mutation was assessed by molecular analysis, and plasma tHct and folate were measured. An association of the +/+ genotype with early onset CAD could lead to its higher prevalence in the younger age group.
Results: There was no significant difference in the frequency of the (+/+) genotype between the two groups (G1: 11.3% vs. G2: 11.3%). However, patients with the (+/+) genotype in both groups had higher tHct when plasma folate was below the mean value (G1: p < 0.0001 while G2: p < 0.01).
Conclusion: The mutant MTHFR genotype was not found to be a determining factor in early-onset CAD. Higher tHct values were obtained in the older age group, which is expected because other studies have shown that tHct levels increase with age. A significant relation was shown between MTHFR genotype and low folate status yielding high tHct levels in those with the (+/+) genotype. As this relation was seen in both groups, although to a lesser extent in the older G2, it does not explain the underlying cause of early-onset CAD.
Abstract Background To determine whether pre-activation of the cardiac catheterization lab by Emergency Health Services (EHS) with a single call system in the field was associated with reduced time ...to reperfusion in patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Methods Consecutive STEMI patients identified by EHS and subsequently taken to the Queen Elizabeth II Health Sciences Center (QEIIHSC) for PPCI between February 1, 2011 and January 30, 2013 were examined. Patients who had pre-activation of the catheterization lab from the field (pre-act group) after the acquisition of the LifeNet® system (Physio Control, Redmond Washington) were compared to those who had usual activation (routine group) prior to the acquisition of the LifeNet® system, for outcomes including treatment timeline data and mortality. Results 271 patients were included in the analysis, 149 patients in the pre-act group and 122 patients in the routine group. Door-to-device (DTD) times of less than 90 min were achieved more frequently in the Pre-act group (91.9% vs. 62.2%; P < 0.001). DTD time was shorter in the Pre-act group (48 min IQR: 38 to 63 min vs. 78 min IQR: 64–101 min; p = 0.001) as was first medical contact-to-device (FMCTD) time (91 min IQR: 78 to 106 min vs. 115 min IQR: 90 to 139 min; P < 0.001). False activation of the catheterization lab was infrequent (1.3%). Conclusions Implementation of catheterization lab pre-activation using the LifeNet® system was associated with more efficient reperfusion times as measured by reduced FMCTD and DTD times without excess false activation rates.
The study assessed the outcomes of patients undergoing percutaneous coronary intervention (PCI) to bypass grafts, focusing on all-cause mortality and target vessel failure (TVF) rates.
A ...single-centre registry analysis included 364 patients who underwent PCI on coronary bypass grafts between 2008 and 2019. The study analyzed all-cause mortality and TVF, which encompassed target lesion revascularization, target vessel revascularization, and medically treated occluded target graft post-PCI.
The median age of the patients was 71 years (interquartile range: IQR 65-78), with 82.1% being male. Most patients (94.8%) received PCI on saphenous vein grafts, and the median graft age was 13.0 years (IQR: 8.4-17.6). Drug-eluting stents were used more frequently (54.4%) than bare-metal stents (45.6%), with a median stent diameter of 3.5 mm (IQR: 3-4) and length of 19 mm (IQR: 18-28). Outcome differences were not significant for PCI sites (aorto-ostial, graft body, anastomosis), use of drug-eluting stents, or use of protection devices. The 1-year mortality rate was 3.3%, whereas the combined rate of TVF or death was 20.3%. After 5 years, the mortality rate increased to 14.9%, and the combined TVF or death rate rose to 40.3%. Multivariable analyses revealed that chronic kidney disease was independently associated with mortality (hazard ratio HR 1.74, 95% confidence interval CI 1.16-2.61, P = 0.007), whereas hypertension (HR 2.42, 95% CI 1.32-4.42, P = 0.004) and increased stent length (HR 1.01, 95% CI 1.00-1.02, P = 0.007) were independently associated with the TVF-or-mortality outcome.
Patients undergoing PCI to bypass grafts experience considerable adverse outcomes over a 5-year period, highlighting the need for further strategies in managing this high-risk population.
L’étude visait à évaluer l’issue des patients ayant subi une intervention coronarienne percutanée (ICP) sur un greffon coronarien, en mettant l’accent sur le taux de mortalité toutes causes confondues et le taux d’échecs de revascularisation du vaisseau cible (EVC).
Une analyse du registre d’un seul établissement a porté sur 364 patients ayant subi une ICP sur un greffon coronarien de 2008 à 2019. L’étude a analysé la mortalité toutes causes confondues et les EVC, qui comprenaient la revascularisation de la lésion cible, la revascularisation du vaisseau cible et le traitement médical de l’occlusion du greffon coronarien cible après l’ICP.
L’âge médian des patients était de 71 ans (intervalle interquartile IIQ de 65 à 78) et 82,1 % d’entre eux étaient de sexe masculin. La plupart des patients (94,8 %) avaient subi une ICP sur un greffon de veine saphène; l’âge médian des greffons était de 13,0 ans (IIQ de 8,4 à 17,6). Les endoprothèses médicamentées avaient été utilisées plus fréquemment (54,4 %) que les endoprothèses non médicamentées (45,6 %), le diamètre médian de l’endoprothèse étant de 3,5 mm (IIQ de 3 à 4) et sa longueur, de 19 mm (IIQ de 18 à 28). Les différences pour ce qui est de l’issue clinique n’étaient pas significatives à l’égard des sites d’ICP (aorto-ostial, corps du greffon, anastomose), de l’utilisation d’une endoprothèse médicamentée, ou encore de l’utilisation de dispositifs de protection. Le taux de mortalité à 1 an était de 3,3 %, alors que le taux combiné d’EVC ou de décès était de 20,3 %. Après 5 ans, le taux de mortalité avait augmenté à 14,9 %, alors que le taux combiné d’EVC ou de décès s’élevait à 40,3 %. Les analyses multivariables ont révélé que la néphropathie chronique était indépendamment associée au décès (rapport des risques instantanés RRI de 1,74, intervalle de confiance IC à 95 % de 1,16 à 2,61, p = 0,007), alors que l’hypertension (RRI de 2,42, IC à 95 % de 1,32 à 4,42, p = 0,004) et une longueur accrue de l’endoprothèse (RRI de 1,01, IC à 95 % de 1,00 à 1,02, p = 0,007) étaient indépendamment associées à une issue d’EVC ou de décès.
Les patients qui ont subi une ICP sur un greffon coronarien présentent des complications considérables sur une période de 5 ans, ce qui souligne le besoin de mettre en place davantage de stratégies de prise en charge pour cette population à risque élevé.
Display omitted
