Independent predictors of the severity of angiographic coronary atherosclerosis: the lack of association between impaired glucose tolerance and stenosis severity

Circulating miR-143 and miR-145 as promising biomarkers for evaluating severity of coronary artery stenosis in patients with acute coronary syndrome

BACKGROUND

Multiple studies have provided evidence that miR-143 and miR-145 play a crucial role in the pathogenesis and progression of atherosclerosis. In the present study, we aim to investigate the expression of plasma miR-143 and miR-145 in patients with acute coronary syndrome (ACS) and their association with the severity of coronary artery stenosis.

METHODS

The study enrolled 279 patients with ACS, including 201 patients with unstable angina (UA) and 78 patients with acute myocardial infarction (AMI), and 65 matched subjects as the control group. The plasma levels of miR-143 and miR-145 were detected by quantitative real-time PCR (qRT-PCR). Gensini score was applied to evaluate the severity of coronary artery stenosis.

RESULTS

Plasma levels of miR-143 and miR-145 in patients with ACS were both decreased compared with the control group (p < 0.001). Plasma levels of miR-143 and miR-145 were negatively correlated with Gensini score (miR-143: r = -0.246, p < 0.001; miR-145: r = -0.222, p < 0.001). Logistic regression analysis showed that miR-143 and miR-145 were protective factors for the onset of ACS, UA, or AMI separately. MiR-143 (AUC: 0.786, p < 0.001) and miR-145 (AUC: 0.793, p < 0.001) were able to predict the degree of coronary artery stenosis greater than 50 %.

CONCLUSION

The plasma levels of miR-143 and miR-145 were significantly decreased in ACS patients and were negatively correlated with coronary stenosis. In conclusion, plasma miR-143 and miR-145 levels can be used as noninvasive biomarkers for evaluating coronary artery stenosis.

The association of hemoglobin A1c and high risk plaque and plaque extent assessed by coronary computed tomography angiography

The objective of this study was to investigate the relationship of Hemoglobin A1c (HbA1c) and plaque characteristics including high risk plaque and plaque extent. We retrospectively examined 1079 consecutive coronary computed tomography (CT) angiography scans and the HbA1c results. We divided the patients into four groups by the HbA1c status: non-diabetic, ≤6.0; borderline, 6.1-6.4; diabetic low, 6.5-7.1; diabetic high, >7.1. We determined segment involvement score >4 as extensive disease. High risk plaque was defined as two feature positive (FP) plaque which consists of positive remodeling (remodeling index >1.1) and low attenuation (<30 HU). Univariate and multivariate analysis including conventional cardiovascular risk factors, symptoms and medication was performed. Univariate analysis showed that diabetic patients as well as borderline patients were significantly related with 2FP plaque and extensive disease. Although the relationship of borderline patients and 2FP plaque was marginal in multivariate analysis [odds ratio (OR) 1.53, 95% confidence interval (CI) 0.95-2.40, p = 0.07], the elevation of HbA1c was strongly associated with 2FP plaque (diabetic low, OR 2.19, 95% CI 1.37-3.45, p < 0.005; diabetic high, OR 4.14, 95% CI 2.57-6.67, p < 0.0005). The association of HbA1c elevation and extensive disease was quite similar between borderline and diabetic patients (borderline, OR 1.96, 95% CI 1.29-2.95, p < 0.005; diabetic low, OR 1.94, 95% CI 1.25-3.01, p < 0.005; diabetic high, OR 2.19, 95% CI 1.39-3.43, p < 0.005). Patients with elevated HbA1c of >6.0 are potentially at risk for future cardiovascular events due to increased high risk plaque and extensive disease, even below the diabetic level of 6.5. Coronary CT could be used for risk stratification of these patients.

Gender differences in the severity and extent of coronary artery disease

Objective

To investigate whether women presenting with suspected angina would show less severe coronary artery disease in than men as determined by the extent score.

Methods

We examined 994 participants of the Australian Heart Eye Study presenting for coronary angiography in the investigation of chest pain from June 2009 to February 2012. People were excluded if there was a history of coronary artery bypass surgery, previous stenting procedure or incomplete angiogram scoring. An extent and vessel score was calculated using invasive coronary angiography. Normal coronary arteries were defined as having no luminal irregularity (Extent score = 0). Obstructive coronary artery disease was defined as a luminal narrowing of greater than 50%.

Results

Women compared to men without infarction had a lower burden of CAD with up to 50% having normal coronary arteries in the 30–44 year group and 40% in the 45–59 year group. Compared to men, women with chest pain had lower mean extent scores (19.6 vs 36.8; P < 0.0001) and lower vessel scores (0.7 v 1.3; P < 0.0001). Although the mean extent score was lower in women than men with myocardial infarction, this was not statistically significant (34.8 vs 41.6 respectively; P = 0.18).

Conclusion

There is a marked difference in coronary artery disease severity and burden between females and males presenting for the investigation of suspected angina. Women are more likely to have normal coronary arteries or less severe disease than age-matched men, particularly if they do not present with myocardial infarction.

Combined use of high-sensitivity C-reactive protein and apolipoprotein B/apolipoprotein A-1 ratio prior to elective coronary angiography and oral glucose tolerance tests

OBJECTIVES

The study aimed to investigate the predictive value of the combination of high-sensitivity C-reactive protein (hs-CRP) and apolipoprotein B (apoB)/apoA-1 ratio for the outcomes of coronary angiography (CAG), echocardiography and oral glucose tolerance tests (OGTTs).

DESIGN AND METHODS

Hs-CRP, apoB, apoA-1, and the profiles of CAG, echocardiography and OGTTs as well as traditional risk factors were measured in 1757 cardiology patients.

RESULTS

Hs-CRP or apoB/apoA-1 ratio was significantly correlated with the presence and severity of angiographic profiles, the levels of left ventricular (LV) ejection fraction, LV mass and LV mass index, and the presence of abnormal glucose metabolism. The combination of hs-CRP and apoB/apoA-1 ratio had greater correlation with abnormal glucose metabolism than its individual components in patients with normal fasting glucose, and was an independent predictor for coronary artery disease.

CONCLUSIONS

The combination of hs-CRP and apoB/apoA-1 ratio may be a strong predictor for coronary artery disease and abnormal glucose metabolism.

A progressive increase in cardiovascular risk assessed by coronary angiography in non-diabetic patients at sub-diabetic glucose levels

OBJECTIVE

Diabetes mellitus type 2 (DM2) is a risk factor for coronary heart disease (CHD). While there is a clear correlation of fasting blood glucose (FBG) and 2 h post-challenge blood glucose values (2h-BG) with microvascular complications, the risk for CHD conferred by glucose dysregulation antecedent to DM2 is less clear. Therefore, we investigated associations of FBG and 2h-BG values with the prevalence of CHD assessed by coronary angiography as the most sensitive diagnostic tool.

RESEARCH DESIGN AND METHODS

Coronary angiography was performed in 1394 patients without known DM. Capillary blood glucose was analyzed before and 2 h after an oral glucose tolerance test. Associations between FBG as well as 2h-BG levels and the risk for CHD were assessed by logistic regression analysis.

RESULTS

1064 (75%) of patients were diagnosed with CHD. 204 (15%) were diagnosed with so far unknown DM2, 274 (20%) with isolated impaired fasting glucose (IFG), 188 (13%) with isolated impaired glucose tolerance (IGT) and 282 (20%) with both, IGT and IFG. We found a continuous increase in the risk for CHD with fasting and post-challenge blood glucose values even in the subdiabetic range. This correlation did however not suggest clear cut-off values. The increase in risk for CHD reached statistical significance at FBG levels of > 120 mg/dl (Odds Ratio of 2.7 [1.3-5.6] and 2h-BG levels > 140 mg/dl (141-160 mg/dl OR 1.8 [1.1-2.9], which was however lost after adjusting for age, sex and BMI.

CONCLUSIONS

In our study population we found a continuous increased risk for CHD at fasting and 2h-BG levels in the sub-diabetic glucose range, but no clear cut-off values for cardiovascular risk.

Glucometabolic state in Chinese patients undergoing elective coronary angiography

AIM

The aim of this study is to characterize the glucometabolic state of patients undergoing elective coronary angiography (CA) in a subpopulation in China.

METHODS AND RESULTS

This study recruited 896 patients undergoing elective CA for the evaluation of suspected coronary artery disease (CAD). Oral glucose tolerance tests (OGTTs) performed in patients without previously known diabetes revealed that 173 (19.2%) had newly diagnosed diabetes and 281 (31.5%) had impaired glucose regulation. The prevalence of abnormal glucose metabolism (AGM) was significant difference among three groups of CA diagnosis, including normal coronary, nonsignificant stenosis and CAD. Overall, the proportion of patients with type 2 diabetes increased from 22.0% at baseline to 41.2% post-OGTT analysis. In total, 270 (59.5%) patients with AGM would have remained undetected if OGTTs had not been performed. Patients with CAD, hypertension, dyslipidemia, obesity and high C-reactive protein levels were at high risk of AGM.

CONCLUSIONS

AGM is common and underestimated by FPG testing alone in patients undergoing elective CA. OGTTs should be routinely performed to assess the glucometabolic state of patients undergoing elective CA, especially in patients with high risks of AGM. Detecting the state of AGM in CA individuals may provide strategies to reduce the progression of AGM and associated complications.

The Relationship between Glucose Tolerance and Severity of Coronary Artery Disease Using the Gensini Score

Consecutive patients (n = 235) with coronary ischemia were studied; 69 patients (29%) had diabetes. An oral glucose tolerance test (OGTT) was administered to the 166 patients without diabetes; 76 (46%) had normal glucose tolerance (group I = NGT), 68 (41%) had impaired glucose tolerance ([IGT] group II = IGT), and 22 (13%) had diabetic glucose tolerance (DGT). The DGT patients were added to the known diabetics forming (Group III; n = 91). Multivessel disease was significantly more prevalent in group III; 30 patients (43%) in group I, 32 patients (51%) in group II, and 57 patients (69%) in group III ( P = .002). Gensini scores were 43.20 ± 24.92 in group I, 54.22 ± 42.61 in group II, and 60.59 ± 38.21 in group III. ( P = .037) The severity of coronary artery disease is related to abnormal glucose tolerance. Patients with IGT could be neglected in terms of interventions focused to improve risk factors.

Coronary angiographic studies of impaired glucose regulation and coronary artery disease in Chinese nondiabetic subjects

To investigate the prevalence and the extent of coronary artery disease (CAD) in nondiabetic Chinese patients with different categories of impaired glucose regulation (IGR): isolated impaired fasting glucose (I-IFG); isolated impaired glucose tolerance (I-IGT); and combined IFG and IGT (CGI). A total of 556 nondiabetic subjects who had undergone coronary angiography were included in this study. Subjects were classified according to the 75-g oral glucose tolerance test result: normal glucose tolerance (NGT) (n = 278), I-IFG (n = 52), I-IGT (n = 128), CGI (n = 98). Significant CAD is defined as the presence of one or more coronary vessels with the lumeninal reduction in diameter to ≥50% in a given subject. The severity and extent of coronary atherosclerosis are defined by the Gensini score, the worst artery score, and the number of diseased vessels with significant coronary stenosis (number of diseased vessels). The prevalence of significant CAD in I-IFG and I-IGT groups were similar (67.3%, P = 0.207; 67.4%, P = 0.068, respectively) but both were higher comparing with NGT group (57.9%), however, it was considerably higher in CGI group (85.9%, P < 0.001). The Gensini score, worst artery score, and number of diseased vessels were similar in NGT, I-IFG, and I-IGT groups, but all significantly increased in CGI group after adjustment for other traditional factors (all P < 0.001). Logistic regression analyses reveal fasting glucose but not 2-h glucose as a significant determinant in Gensini score, worst artery score, and number of diseased vessels. The prevalence and the extent of CAD did not differ significantly among subjects with NGT, I-IFG, and I-IGT, but increased significantly in those with CGI. Fasting glucose was more strongly associated with angiographically characterized coronary artery stenosis than 2-h glucose.

Determining the relationship between metabolic syndrome score and angiographic severity of coronary artery disease

BACKGROUND

Cardiovascular disease is leading cause of mortality and morbidity in developed and developing countries. Metabolic syndrome (MS) is a risk factor for coronary artery disease (CAD). The effect of MS on angiographic severity of CAD is not well defined. The aim of this study was to examine the effect of MS on angiographic severity of CAD by using Gensini score.

METHODS

The total number of 1003 patients who underwent elective coronary angiography in catheter laboratory were included in the study. MS score based on National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria which ranged between zero and five were calculated for each subject. Gensini scores were determined by examining coronary angiograms of the patients.

RESULTS

The study population consisted of 634 (63%) male, and 369 (37%) female subjects. The mean age was 59 +/- 11. MS based on NCEP ATP III was present in 246 (25%) patients. CAD was present in 691 patients (69%). The median of Gensini score was five (0-192) in the total sample, 18 (1-192) in the patients with CAD and 25 (0-192) in the patients with MS. A positive correlation was found between MS score and Gensini score (r = 0.402, p < 0.001).

CONCLUSIONS

In this study, it was determined that as the severity of MS increases, the angiographic severity of CAD increases as well. Besides, the most important factor on Gensini score was diabetes mellitus in male and hypertension in female subjects.

A high ankle-brachial index is associated with increased cardiovascular disease morbidity and lower quality of life

OBJECTIVES

The purpose of this study is to determine if an ankle-brachial index (ABI) >or=1.40 is associated with reduced quality of life (QoL).

BACKGROUND

Ankle-brachial index values >or=1.40 have been associated with some cardiovascular disease (CVD) risk factors and increased mortality, but the relationship to other disease morbidity such as reduced QoL has not been previously evaluated.

METHODS

The PARTNERS (PAD Awareness, Risk and Treatment: New Resources for Survival) program was a national cross-sectional study of 7,155 patients age >50 years recruited from 350 primary care sites. All sites performed the ABI using a Doppler device and a standardized technique.

RESULTS

A total of 296 subjects had an ABI >or=1.40 in at least 1 leg, and 4,420 had an ABI between 0.90 and 1.40. Diabetes, male gender, and waist circumference were positively associated with a high ABI, and smoking and dyslipidemia were inversely associated with a high ABI. After adjustment for age, gender, and the traditional CVD risk factors, and accounting for multiple comparisons, the high ABI group had significantly higher odds for foot ulcers (p < 0.005) and borderline associations with heart failure, stroke, and neuropathy. After the same adjustments and adjusting for patients with other CVD, the high ABI group scored 2.0 points lower on the physical component scale on the Medical Outcomes Study Standard Form-36 and 5.5 points lower on the Walking Impairment Questionnaire walking distance domain (p < 0.05 for both).

CONCLUSION

Individuals with a high ABI have higher odds for foot ulcers and neuropathy, as well as lower scores on some physical functioning QoL domains.

Traditional Risk Factors Are Predictive on Segmental Localization of Coronary Artery Disease

The aim of this study was to investigate the relationship between established risk factors and segmental localization of coronary artery disease. A total of 2760 patients who underwent coronary angiography were enrolled into the study. Coronary angiographic segmental evaluation was performed according to the scheme of American Heart Association. Patients were classified into 2 groups (group 1: normal coronary artery segments, group 2: coronary artery segments with coronary artery disease). Smoking was highly related with left main coronary artery disease (odds ratio = 7.5; P = .005). Diabetes mellitus and male sex increased the risk of atherosclerosis in all coronary vasculature (odds ratio = 2.7-2.2; P < .001- P < .001). Hypertension was correlated with distal coronary artery (odds ratio = 1.4; P < .001) and family history with distal circumflex lesions (odds ratio = 4.5; P = .005) High triglyceride levels were associated with right coronary artery lesions (odds ratio = 1.00; P =.03). The effect of advanced age was small (odds ratio = 1.08; P < .001). Risk factors may be predictive for segmental localization.

Severity of coronary artery disease in postmenopausal diabetic women

OBJECTIVE

Coronary artery disease (CAD) risk increases in women after the menopause. The aim of this study was to determine the effect of diabetes on the severity of CAD in postmenopausal women undergoing coronary angiography.

DESIGN

180 postmenopausal women underwent coronary angiography for suspected CAD. CAD severity was assessed by the number of arteries (0-3) with >50% stenosis in the angiography. Forty-four women had type 2 diabetes mellitus (T2DM). Predisposing risk factors and biochemical and hormonal parameters were recorded. The diabetic women were older (p=0.014), had higher BMI and waist circumference (p<0.001), higher prevalence of hypertension (p=0.002), higher levels of triglycerides, uric acid and higher HOMA-Insulin Resistance Index (p=0.009).

RESULTS

The women with diabetes had a higher prevalence of severe stenosis in the angiography: T2DM: 0-vessels 25%, 1-vessel disease 18.2%, 2-vessels disease 22.7%, 3-vessels disease 34.1%, vs. 49.2%, 23.5%, 22.1%, 5.1% in the non-diabetic women, respectively (p<0.001). Binary logistic regression analysis showed that T2DM was a significant predictor of severe CAD (>or=3 vessel disease) independently of age, family history of T2DM, BMI, time since menopause, hypertension and hypercholesterolemia. Women with T2DM also had lower sex hormone binding globulin (SHBG, p=0.010) levels compared to non-diabetic women.

CONCLUSIONS

Diabetic postmenopausal women develop more severe CAD compared to non-diabetic women. This association is independent of other predisposing factors and suggests an independent effect of T2DM on the atherosclerotic process, at least in women after menopause.

Impact of Abnormal Glucose Tolerance, Hypertension and Other Risk Factors on Coronary Artery Disease

BACKGROUND

The degree to which abnormal glucose tolerance contributes to the development of coronary artery disease (CAD) has not been clarified in Japanese. The relationship between abnormal glucose tolerance and severity of coronary artery stenosis, as well as the contributions of hypertension, diabetes and other risk factors for CAD to recurrence of the disease, were investigated in the present study.

METHODS AND RESULTS

The subjects were 474 consecutive patients (mean age: 63.8+/-11.3 years) with suspected CAD who were admitted to Sapporo Medical University Hospital during April 1, 1997 to March 31, 2004. The coronary index and stenosis score were higher in subjects with diabetes mellitus (DM) and in subjects with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) than in subjects with normal glucose tolerance (NGT). Ischemic episodes recurred during the observation period (mean 2.5 years) in 61 of 341 patients diagnosed as having CAD. In the follow-up subjects, systolic blood pressure (SBP) was significantly higher in the recurrence group than in the non-recurrence group, and SBP was a significant variable in logistic regression analysis after adjustment for age, gender, hemoglobin A1c, total cholesterol, body mass index, smoking history, family history and stenosis score. The relative risk of recurrence became 1.7-fold higher with a rise in SBP of 10 mmHg (95% confidence interval: 1.252-2.250). Analysis of the relationship between glucose tolerance and recurrence showed that the rate of recurrence was higher in patients with IFG+IGT+DM than in those with NGT.

CONCLUSIONS

CAD progresses not only in patients with DM but also in those with IGT. The rate of recurrence of ischemic episodes increases in individuals with IGT or DM, and suggesting that hypertension is a risk factor for recurrence of ischemic episodes. Management of glucose tolerance and blood pressure is therefore important for prevention of CAD in Japanese.

The apoB/apoA-I ratio: a strong, new risk factor for cardiovascular disease and a target for lipid-lowering therapy--a review of the evidence

During the last several years interest has focused on the importance of the lipid-transporting apolipoproteins--apoB transports all potentially atherogenic very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL) and LDL particles, and apoA-I transports and acts as the major antiatherogenic protein in the HDL particles. The evidence for the apoB/apoA-I ratio being a strong, new risk factor for cardiovascular (CV) disease and a target for lipid-lowering therapy is reviewed. Results from clinical prospective studies and lipid-lowering trials in healthy subjects and in patients with different clinical manifestations of atherosclerosis are reported. Risk of nonfatal and fatal myocardial infarction and stroke, and manifestations of atherosclerosis documented by angiographic, ultrasound and other techniques has been related to conventional lipids and apolipoproteins (apo). The cholesterol balance determined as the apoB/apoA-I ratio has repeatedly been shown to be a better marker than lipids, lipoproteins and lipid ratios. The results indicate that the apoB/apoA-I ratio is a simple, accurate and new risk factor for CV disease--the lower the apoB/apoA-I ratio, the lower is the risk. Guidelines should be developed in order to recognize the important clinical risk information embedded in the apoB/apoA-I ratio.