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Wang XL, Zhang W, Li Z, Han WQ, Wu HY, Wang QR, Liu XH, Xing K, Cheng G, Chang FJ. Vascular damage effect of circulating microparticles in patients with ACS is aggravated by type 2 diabetes. Mol Med Rep 2021; 23:474. [PMID: 33899122 PMCID: PMC8097757 DOI: 10.3892/mmr.2021.12113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 11/03/2020] [Indexed: 01/18/2023] Open
Abstract
As a common factor of both type 2 diabetes mellitus (T2DM) and acute coronary syndrome (ACS), circulating microparticles (MPs) may provide a link between these two diseases. The present study compared the content and function of MPs from patients with ACS with or without T2DM. MPs from healthy subjects (n=20), patients with ACS (n=24), patients with T2DM (n=20) and patients with combined ACS and T2DM (n=24) were obtained. After incubating rat thoracic tissue with MPs, the effect of MPs on endothelial‑dependent vasodilatation, expression of caveolin‑1 and endothelial nitric oxide synthase (eNOS), phosphorylation of eNOS at the S1177 and T495 sites and its association with heat shock protein 90 (Hsp90), and the generation of NO and superoxide anion (O2˙‑) were determined. MP concentrations were higher in patients with T2DM and patients with ACS with or without T2DM than in healthy subjects. Moreover, MPs from patients with T2DM or ACS led to impairment in endothelial‑dependent vasodilatation, decreased expression of NO, as well as eNOS and its phosphorylation at Ser1177 and association with Hsp90, but increased eNOS phosphorylation at T495, caveolin‑1 expression and O2˙‑ generation. These effects were strengthened by MPs from patients with ACS combined with T2DM. T2DM not only increased MP content but also resulted in greater vascular impairment effects in ACS. These results may provide novel insight into the treatment of patients with ACS and T2DM.
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Affiliation(s)
- Xu-Lan Wang
- Department of Nursing, Xian'yang Vocational and Technical College, Fengxi New Town United Avenue, Xi'an, Shaanxi 712000, P.R. China
| | - Wei Zhang
- Department of Cardiology, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Zhe Li
- Department of Cardiology, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Wen-Qi Han
- Department of Cardiology, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Hao-Yu Wu
- Department of Cardiology, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Qun-Rang Wang
- Department of Cardiology, Affiliated Hospital of Shaanxi Traditional Chinese Medicine University, Xianyang, Shaanxi 712000, P.R. China
| | - Xin-Hong Liu
- Department of Cardiology, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Kun Xing
- Department of Cardiology, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Gong Cheng
- Department of Cardiology, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Feng-Jun Chang
- Department of Cardiology, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
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Mihanfar A, Nejabati HR, Fattahi A, Latifi Z, Pezeshkian M, Afrasiabi A, Safaie N, Jodati AR, Nouri M. The role of sphingosine 1 phosphate in coronary artery disease and ischemia reperfusion injury. J Cell Physiol 2018; 234:2083-2094. [PMID: 30341893 DOI: 10.1002/jcp.27353] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 08/17/2018] [Indexed: 12/15/2022]
Abstract
Coronary artery disease (CAD) is a common cause of morbidity and mortality worldwide. Atherosclerotic plaques, as a hallmark of CAD, cause chronic narrowing of coronary arteries over time and could also result in acute myocardial infarction (AMI). The standard treatments for ameliorating AMI are reperfusion strategies, which paradoxically result in ischemic reperfusion (I/R) injury. Sphingosine 1 phosphate (S1P), as a potent lysophospholipid, plays an important role in various organs, including immune and cardiovascular systems. In addition, high-density lipoprotein, as a negative predictor of atherosclerosis and CAD, is a major carrier of S1P in blood circulation. S1P mediates its effects through binding to specific G protein-coupled receptors, and its signaling contributes to a variety of responses, including cardiac inflammation, dysfunction, and I/R injury protection. In this review, we will focus on the role of S1P in CAD and I/R injury as a potential therapeutic target.
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Affiliation(s)
- Aynaz Mihanfar
- Department of Biochemistry, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamid Reza Nejabati
- Stem Cell and Regenerative Medicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Fattahi
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Latifi
- Stem Cell and Regenerative Medicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Pezeshkian
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abbas Afrasiabi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naser Safaie
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Reza Jodati
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Nouri
- Stem Cell and Regenerative Medicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Cheng G, Shan XF, Wang XL, Dong WW, Li Z, Liu XH, Zhang W, Xing K, Chang FJ. Endothelial damage effects of circulating microparticles from patients with stable angina are reduced by aspirin through ERK/p38 MAPKs pathways. Cardiovasc Ther 2017; 35. [PMID: 28520220 DOI: 10.1111/1755-5922.12273] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/11/2017] [Accepted: 05/14/2017] [Indexed: 01/11/2023] Open
Affiliation(s)
- Gong Cheng
- Department of Cardiology; Shaanxi Provincial People's Hospital; Xi'an Shaanxi China
| | - Xue-Feng Shan
- Department of Children's Cardiac surgery; First Affiliated Hospital of Xinjiang Medical University; Urumuqi Xinjiang China
| | - Xu-Lang Wang
- Department of Nursing; Xian'yang Vocational and Technical College; Xian'yang Shaanxi China
| | - Wei-Wei Dong
- Xinjiang Petroleum Institute; Urumuqi Xinjiang China
| | - Zhe Li
- Department of Cardiology; Shaanxi Provincial People's Hospital; Xi'an Shaanxi China
| | - Xin-Hong Liu
- Department of Cardiology; Shaanxi Provincial People's Hospital; Xi'an Shaanxi China
| | - Wei Zhang
- Department of Cardiology; Shaanxi Provincial People's Hospital; Xi'an Shaanxi China
| | - Kun Xing
- Department of Cardiology; Shaanxi Provincial People's Hospital; Xi'an Shaanxi China
| | - Feng-Jun Chang
- Department of Cardiology; Shaanxi Provincial People's Hospital; Xi'an Shaanxi China
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Zhou X, Wu X, Sun H, Li J. Efficacy and safety of eptifibatide versus tirofiban in acute coronary syndrome patients: A systematic review and meta-analysis. J Evid Based Med 2017; 10:136-144. [PMID: 28449419 DOI: 10.1111/jebm.12253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 03/21/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Glycoprotein IIb/IIIa inhibitors were the strongest available antiplatelet therapy and have been shown to reduce cardiac ischemic complications in patients undergoing percutaneous coronary intervention. However, evidences are still lacking on the superiority of eptifibatide over tirofiban or vice versa in patients with acute coronary syndrome. OBJECTIVE To compare the efficacy and safety of eptifibatide and tirofiban used among patients with acute coronary syndrome by performing a systematic review and meta-analysis of randomized controlled trials. METHODS A systematic search was conducted in Pubmed, Ovid/Medline, Ovid/Embase, Clinicaltrials.gov, CBM and CNKI to identify randomized controlled trials comparing eptifibatide with tirofiban for acute coronary syndrome until November 2015. The methodological quality was assessed with the Cochrane bias risk assessment tool. RESULTS 1256 patients from 9 randomized controlled trials were finally included. Compared with tirofiban, eptifibatide could reduce more risk of thrombolysis in myocardial infarction minor bleeding (RR 0.61, 95%CI 0.38, 0.98). However, no significant differences were observed for major adverse cardiac events (RR 0.41, 95%CI 0.15 to 1.12), major bleeding, thrombocytopenia in the two treatment groups. The relative treatment benefits were similar in subgroups of patients according to types of acute coronary syndrome, or undergoing percutaneous coronary intervention. CONCLUSION Available evidence suggests that the safety of eptifibatide is slightly superior to tirofiban in patients with acute coronary syndrome, but no significant difference was observed on efficacy. Future studies should focus on the randomized controlled trials with larger sample, multi-center, long-term follow-up, high quality to compare the two drugs.
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Affiliation(s)
- Xiaoqin Zhou
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Xinyu Wu
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Huan Sun
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Jing Li
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
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Han WQ, Chang FJ, Wang QR, Pan JQ. Microparticles from Patients with the Acute Coronary Syndrome Impair Vasodilatation by Inhibiting the Akt/eNOS-Hsp90 Signaling Pathway. Cardiology 2015; 132:252-60. [DOI: 10.1159/000438782] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/17/2015] [Indexed: 11/19/2022]
Abstract
Objectives: Endothelial dysfunction is involved in the development of the acute coronary syndrome (ACS). Plasma microparticles (MPs) from other diseases have been demonstrated to initiate coagulation and endothelial dysfunction. However, whether MPs from ACS patients impair vasodilatation and endothelial function remains unclear. Methods: Patients (n = 62) with ACS and healthy controls (n = 30) were recruited for MP isolation. Rat thoracic aortas were incubated with MPs from ACS patients or healthy controls to determine the effects of MPs on endothelial-dependent vasodilatation, the phosphorylation of Akt and endothelial nitric oxide synthase (eNOS), the interaction of eNOS with heat shock protein 90 (Hsp90), and nitric oxide (NO) and superoxide anion (O2-) production. The origin of MPs was assessed by flow cytometry. Results: MP concentrations were increased in patients with ACS compared with healthy controls. They were positively correlated with the degree of coronary artery stenosis. MPs from ACS patients impair endothelial-dependent vasodilatation, decrease both Akt and eNOS phosphorylation, decrease the interaction between eNOS and Hsp90, and decrease NO production but increase O2- generation in rat thoracic aortas. Endothelial-derived MPs and platelet-derived MPs made up nearly 75% of MPs. Conclusions: Our data indicate that MPs from ACS patients negatively affect endothelial-dependent vasodilatation via Akt/eNOS-Hsp90 pathways.
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Kwon YW, Yang HM, Cho HJ. Cell therapy for myocardial infarction. Int J Stem Cells 2014; 3:8-15. [PMID: 24855535 DOI: 10.15283/ijsc.2010.3.1.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2010] [Indexed: 12/27/2022] Open
Abstract
Ischemic heart disease, particularly acute myocardial infarction (MI), is the worldwide health care problem and the leading cause of morbidity and mortality. The fundamental treatment of MI remains a major unmet medical need. Although recent tremendous advances have been made in the treatment for acute MI such as percutaneous coronary intervention (PCI) and medical and surgical therapies, myocardial cell loss after ischemia and subsequent, adverse cardiac remodeling and heart failure are demanding for new therapeutic strategy. Since the first experimental studies of adult stem cell therapy into the ischemic heart were performed in the early 1990s, the identification and potential application of stem and/or progenitor cells has triggered attempts to regenerate damaged heart tissue and cell-based therapy is a promising option for treatment of MI. In this review, we would like to discuss the pathogenesis of acute MI, current standard treatments and their limitation, clinical results of recent stem or progenitor cell therapy which have shown a favorable safety profile with modest improvement in cardiac function, and putative mechanisms of benefits.
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Affiliation(s)
- Yoo-Wook Kwon
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Han-Mo Yang
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea ; Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jai Cho
- Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea ; Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Cooke J, Murphy T, McFadden E, O'Reilly M, Cahill MR. Can mean platelet component be used as an index of platelet activity in stable coronary artery disease? Hematology 2013; 14:111-4. [DOI: 10.1179/102453309x385160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- John Cooke
- Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland
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Mukhopadhyay R. Mouse models of atherosclerosis: explaining critical roles of lipid metabolism and inflammation. J Appl Genet 2013; 54:185-92. [PMID: 23361320 DOI: 10.1007/s13353-013-0134-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/14/2013] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
Abstract
Atherosclerosis is the most common cause of death globally. It is a complex disease involving morphological and cellular changes in vascular walls. Studying molecular mechanism of the disease is hindered by disease complexity and lack of robust noninvasive diagnostics in human. Mouse models are the most popular animal models that allow researchers to study the mechanism of disease progression. In this review we discuss the advantage and development of mouse as a model for atherosclerotic research. Along with commonly used models, this review discusses strains that are used to study the role of two critical processes associated with the disease-lipid metabolism and inflammation.
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Affiliation(s)
- Rupak Mukhopadhyay
- Department of Molecular Biology and Biotechnology, Tezpur University, Napaam, Assam, 784 028, India.
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Ikeda S, Tanaka N, Arai T, Chida K, Muramatsu M, Sawabe M. Polymorphisms of LTA, LGALS2, and PSMA6 genes and coronary atherosclerosis: a pathological study of 1503 consecutive autopsy cases. Atherosclerosis 2012; 221:458-60. [PMID: 22310064 DOI: 10.1016/j.atherosclerosis.2012.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 12/31/2011] [Accepted: 01/03/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Recent genome-wide association studies have identified polymorphisms of lymphotoxin-α (LTA), galectin-2 (LGALS2), and proteasome subunit a type 6 (PSMA6) genes as genetic risk factors for myocardial infarction (MI). However, their effects on coronary atherosclerosis, an intermediate phenotype of MI, remain largely unknown. METHODS We investigated the correlation between polymorphisms of the LTA, LGALS2, and PSMA6 genes and the severity of pathological coronary stenosis index (CSI) and MI in 1503 consecutive autopsy cases of Japanese elderly patients. RESULTS The polymorphisms LTA rs1041981 and LGALS2 rs7291467 were associated with CSI with odds ratios of 1.54 (95% CI, 1.17-2.01; AA+CA over CC) and 1.62 (95% CI, 1.11-2.37; TT over CC+CT), respectively. PSMA6 rs1048990 was not associated with CSI. None of the SNPs was associated with MI in our sample. CONCLUSION Our findings indicate that the LTA and LGALS2 polymorphisms affect the subclinical phenotype of the coronary artery, which predisposes to the incidence of MI.
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Affiliation(s)
- Shinobu Ikeda
- Department of Molecular Epidemiology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.
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11
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Barbagallo CM, Rizzo M, Noto D, Frasheri A, Pernice V, Rubino A, Pieri D, Pinto V, Cefalù AB, Giordano C, Notarbartolo A, Averna MR. Accumulation of apoE-enriched triglyceride-rich lipoproteins in patients with coronary artery disease. Metabolism 2006; 55:662-8. [PMID: 16631444 DOI: 10.1016/j.metabol.2006.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 01/08/2006] [Indexed: 10/24/2022]
Abstract
Triglycerides (TGs) are vehicled by multiple particles with different abilities to promote atherosclerosis. Among plasma TG-rich lipoproteins (TRLs), subspecies may or may not contain apolipoprotein E (apoE) molecules: in this study, we evaluated the relative contribution of apoE-rich and apoE-poor TRLs to coronary atherosclerosis. We selected a group of males with premature coronary artery disease (CAD) without any of the classical nonlipid risk factors and/or high plasma lipid levels and evaluated the plasma concentration of TRL subspecies in comparison with healthy controls. Patients with CAD and controls had total cholesterol and TG levels within the normal range (despite slightly, even if significantly, higher TG levels in patients with CAD) and low-density lipoprotein cholesterol levels near optimal values. Nevertheless, patients with CAD had significantly lower high-density lipoprotein cholesterol, smaller low-density lipoprotein peak particle size, and a reduced HDL2b subfraction than controls. In addition, we observed higher concentrations of total TRL in patients with CAD together with a selective increase in apoE-rich particles. All these data were confirmed after correction for TG levels. We also investigated which parameters were associated with the spread of coronary atherosclerosis. Subjects with a single-vessel disease had selectively lower levels of apoE-rich fractions than patients with a multivessel disease. This was confirmed by multivariate analysis. Patients with a premature CAD free of nonlipid conventional risk factors, despite not having elevated lipid levels, show several lipoprotein abnormalities. Besides known atherogenic alterations, the accumulation of apoE-rich TRL subfractions may represent an additive factor that can potentially promote and initiate the atherosclerotic process.
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Affiliation(s)
- Carlo M Barbagallo
- Department of Internal Medicine, Faculty of Medicine, University of Palermo, and Intensive Care Unit, Villa Maria Eleonora Hospital, Palermo, Italy.
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Willoughby SR, Stewart S, Holmes AS, Chirkov YY, Horowitz JD. Platelet nitric oxide responsiveness: a novel prognostic marker in acute coronary syndromes. Arterioscler Thromb Vasc Biol 2005; 25:2661-6. [PMID: 16254202 DOI: 10.1161/01.atv.0000193622.77294.57] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Nitric oxide (NO) is critically important in the regulation of vascular tone and the inhibition of platelet aggregation. We have shown previously that patients with acute coronary syndromes (ACS) or stable angina pectoris have impaired platelet responses to NO donors when compared with normal subjects. We tested the hypotheses that platelet hyporesponsiveness to NO is a predictor of (1) cardiovascular readmission and/or death and (2) all-cause mortality in patients with ACS (unstable angina pectoris or non-Q-wave myocardial infarction). METHODS AND RESULTS Patients (n=51) with ACS had evaluation of platelet aggregation within 24 hours of coronary care unit admission using impedance aggregometry. Patients were categorized as having "normal" (> or =32% inhibition of ADP-induced aggregation with the NO donor sodium nitroprusside; 10 micromol/L; n=18) or "impaired" (<32% inhibition of ADP-induced aggregation; n=33) NO responses. We then compared the incidence of cardiovascular readmission and death during a median of 7 years of follow-up in these 2 groups. Using a Cox proportional hazards model adjusting for age, sex, index event, postdischarge medical treatment, revascularization status, left ventricular systolic dysfunction, concurrent disease states, and cardiac risk factors, impaired NO responsiveness was associated with an increased risk of the combination of cardiovascular readmission and/or death (relative risk, 2.7; 95% CI, 1.03 to 7.10; P=0.041) and all-cause mortality (relative risk, 6.3; 95% CI, 1.09 to 36.7; P=0.033). CONCLUSIONS Impaired platelet NO responsiveness is a novel, independent predictor of increased mortality and cardiovascular morbidity in patients with high-risk ACS.
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Affiliation(s)
- Scott R Willoughby
- Basil Hetzel Institute, Queen Elizabeth Hospital, Department of Medicine, University of Adelaide, Adelaide, Australia
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Davies JR, Rudd JF, Fryer TD, Weissberg PL. Targeting the vulnerable plaque: the evolving role of nuclear imaging. J Nucl Cardiol 2005; 12:234-46. [PMID: 15812381 DOI: 10.1016/j.nuclcard.2005.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The majority of acute ischemic events relating to atherosclerosis are caused by plaque rupture and ensuing thrombosis. The risk of plaque rupture is dictated in part by plaque morphology, which in turn is influenced by pathophysiologic mechanisms at the cellular and molecular level. Anatomic imaging modalities such as intravascular ultrasound, high-resolution magnetic resonance imaging, and multislice computed tomography can identify morphologic features of the vulnerable plaque, such as a large lipid core and thin fibrous cap, but give little or no information regarding molecular and cellular mechanisms, such as endothelial function, macrophage activation, lipid transport and metabolism, and cell death. Recent studies suggest that nuclear imaging may be able to provide images of sufficient quality to identify and quantify some of these molecular and cellular pathophysiologic processes. In the future this could allow for the early identification and noninvasive monitoring of vulnerable plaque.
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Affiliation(s)
- John R Davies
- Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, ACCI Building, Hills Road, Cambridge CB2 2QQ, UK.
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Qin G, Zhang Y, Cao W, An R, Gao Z, Li G, Xu W, Zhang K, Li S. Molecular imaging of atherosclerotic plaques with technetium-99m-labelled antisense oligonucleotides. Eur J Nucl Med Mol Imaging 2004; 32:6-14. [PMID: 15605287 DOI: 10.1007/s00259-004-1700-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2004] [Accepted: 09/01/2004] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to visualise experimental atherosclerotic lesions using radiolabelled antisense oligonucleotides (ASONs). METHODS Atherosclerosis was induced in New Zealand White rabbits fed 1% cholesterol for approximately 60 days. In vivo and ex vivo imaging was performed in atherosclerotic rabbits and normal control rabbits after i.v. injection of 92.5+/-18.5 MBq (99m)Tc-labelled ASON or (99m)Tc-labelled sense oligonucleotides. Immediately after the in vivo imaging, the animals were sacrificed and ex vivo imaging of the aortic specimens was performed. Biodistribution of radiolabelled c-myc ASON was evaluated in vivo in atherosclerotic rabbits. RESULTS Planar imaging revealed accumulation of (99m)Tc-labelled c-myc ASON in atherosclerotic lesions along the artery wall. Ex vivo imaging further demonstrated that the area of activity accumulation matched the area of atherosclerotic lesions. In contrast, no atherosclerotic lesions were found in the vessel wall and no positive imaging results were obtained in animals of the control group. CONCLUSION This molecular imaging approach has potential for non-invasive imaging of atherosclerotic plaques at an early stage.
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Affiliation(s)
- Guangming Qin
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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15
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Wiggins BS, Spinler S. Antiplatelet and Antithrombin Therapy for Early Management of Acute Coronary Syndromes. J Pharm Pract 2004. [DOI: 10.1177/0897190004271778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute coronary syndromes (ACS) are defined as either unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), or ST-segment elevation myocardial infarction (STEMI). Their management is continuously evolving in terms of pharmacologic therapy. The usual cause of ACS is the disruption of an atherosclerotic plaque leading to formation of a thrombus within a coronary artery. Initial antiplatelet and antithrombin therapy for patients with ST-segment elevation (STE) ACS includes aspirin and unfractionated heparin (UFH). Patients presenting to the hospital early may undergo percutaneous intervention (PCI) with administration of additional medications such as clopidogrel and abciximab or may receive a fibrinolytic agent. Patients with non-ST-segment elevation (NSTE) ACS receive aspirin, clopidogrel, either a low-molecular-weight heparin or UFH, and, in selected patients, a glycoprotein (GP) IIb/IIIa receptor blocker. All of these agents have shown benefit when administered to patients with ACS, but results vary depending on the type of syndrome, timing of administration, and patient’s overall risk. Their mechanism of action, role in ACS, clinical practice recommendations, adverse effects, and monitoring are reviewed. Some inherent limitations to agents such as aspirin and UFH require the need for newer treatment approaches. Therefore, newer classes of drugs such as the direct thrombin inhibitor bivalirudin and the selective factor Xa inhibitor fondaparinux are being explored as alternatives to heparins for ACS management.
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Affiliation(s)
- Barbara S. Wiggins
- Heart Center, University of Virginia Health System, University of Virginia School of Nursing and School of Medicine, Charlottesville,
| | - Sarah Spinler
- Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, University of Pennsylvania, Department of Medicine, Cardiovascular Division, Philadelphia
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Furman MI, Gore JM, Anderson FA, Budaj A, Goodman SG, Avezum A, López-Sendón J, Klein W, Mukherjee D, Eagle KA, Dabbous OH, Goldberg RJ. Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the Global Registry of Acute Coronary Events (GRACE). Am Heart J 2004; 147:42-8. [PMID: 14691417 DOI: 10.1016/j.ahj.2003.07.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the association between elevated leukocyte count and hospital mortality and heart failure in patients enrolled in the multinational, observational Global Registry of Acute Coronary Events (GRACE). BACKGROUND Elevated leukocyte count is associated with adverse hospital outcomes in patients presenting with acute myocardial infarction (AMI). The association of this prognostic factor with hospital mortality and heart failure in patients with other acute coronary syndromes (ACS) is unclear. METHODS We examined the association between admission leukocyte count and hospital mortality and heart failure in 8269 patients presenting with an ACS. This association was examined separately in patients with ST-segment elevation AMI, non-ST-segment elevation AMI, and unstable angina. Leukocyte count was divided into 4 mutually exclusive groups (Q): Q1 <6000, Q2 = 6000-9999, Q3 = 10,000-11,999, Q4 >12,000. Multiple logistic regression analysis was performed to examine the association between elevated leukocyte count and hospital events while accounting for the simultaneous effect of several potentially confounding variables. RESULTS Increasing leukocyte count was significantly associated with hospital death (adjusted odds ratio [OR] 2.8, 95% CI 2.1-3.6 for Q4 compared to Q2 [normal range]) and heart failure (OR 2.7, 95% CI 2.2-3.4) for patients presenting with ACS. This association was seen in patients with ST-segment elevation AMI (OR for hospital death 3.2, 95% CI 2.1-4.7; OR for heart failure 2.4, 95% CI 1.8-3.3), non-ST-segment elevation AMI (OR for hospital death 1.9, 95% CI 1.2-3.0; OR for heart failure 1.7, 95% CI 1.1-2.5), or unstable angina (OR for hospital death 2.8, 95% CI 1.4-5.5; OR for heart failure 2.0, 95% CI 0.9-4.4). CONCLUSION In men and women of all ages with the spectrum of ACS, initial leukocyte count is an independent predictor of hospital death and the development of heart failure.
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Affiliation(s)
- Mark I Furman
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass 01655, USA.
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Zuka M, Okada Y, Nemori R, Fukuda A, Takekoshi N, Nakanishi I, Katsuda S. Vascular tissue fragility assessed by a new double stain method. Appl Immunohistochem Mol Morphol 2003; 11:78-84. [PMID: 12610361 DOI: 10.1097/00129039-200303000-00013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although matrix metalloproteinases (MMPs) are known to be involved in the development of atherosclerosis and the instability of atheromatous plaques, much remains to be learned about their roles at the tissue level. To help clarify this area, we established a new double staining method using film in situ zymography and immunohistochemistry. Using this technique, a comprehensive analysis of the gelatinolytic activity in human vessel tissue demonstrated that gelatinolytic activity is enhanced in the shoulder region and fibrous cap at superficial areas of the atheromatous plaque in the presence of thrombolysis. Enzyme assay clarified high activity in the superficial area (7.50 +/- 5.04 U/mg weight; P < 0.001). Gelatin zymography also indicated that addition of the antiplatelet agent, trapidil, alters the amount of secretion of MMP-2 and MMP-9 and their activation ratio. This novel approach to detect the activity of gelatinases in resected tissues may aid in the selection of optimal treatment of individual patients.
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Affiliation(s)
- Masahiko Zuka
- Department of Pathology and Division of Basic Science, Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan.
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18
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Stefanadis C, Toutouzas K, Vaina S, Vavuranakis M, Toutouzas P. Thermography of the cardiovascular system. J Interv Cardiol 2002; 15:461-6. [PMID: 12476648 DOI: 10.1111/j.1540-8183.2002.tb01089.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The identification of vulnerable plaque is one of the primary goals in cardiology during the last years. Several techniques have been developed for the anatomic and functional assessment of atherosclerotic plaques. Thermography is a new method for the evaluation of the inflammatory process locally within the atherosclerotic plaque. Several animal and clinical studies demonstrated the value of thermography not only for the detection of inflamed atherosclerotic plaques, but its use in new fields like in the evaluation of inflammation in the coronary vascular bed and the cardiovascular system. This article reviews the developments and the clinical implications of thermography.
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Gurbel PA, Galbut B, Bliden KP, Bahr RD, Roe MT, Serebruany VL, Gibler WB, Christenson RH, Ohman EM. Effect of eptifibatide for acute coronary syndromes: rapid versus late administration--therapeutic yield on platelets (The EARLY Platelet Substudy). J Thromb Thrombolysis 2002; 14:213-9. [PMID: 12913401 DOI: 10.1023/a:1025048726396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Receptors other than GP IIb/IIIa may mediate leukocyte-platelet-endothelial interactions that obstruct the microvasculature in acute coronary syndromes (ACS) and cause microinfarcts. The effect of eptifibatide on these receptors was investigated in a substudy of the EARLY Trial. METHODS Patients received early (in the Emergency Department, n = 27) or late (12-24 h, n = 28) eptifibatide. Ten platelet receptors by flow cytometry and platelet aggregation (10 micromol/L ADP) were measured serially at baseline, and at 3, 6, 12 and 24 h after randomization. RESULTS Platelet aggregation was rapidly inhibited by early eptifibatide therapy (baseline, 72 +/- 20%; 3 h post, 7 +/- 9%; p < 0.001). No significant differences were seen in either group for CD 31, CD 63, CD 107a, CD 107b, CD 41 (GPIIb/IIIa expression), or CD 62p. Leukocyte-platelet aggregate formation (mean fluorescense intensity) trended upward after presentation (early baseline, 43.1 +/- 26.0 versus 65.8 +/- 35.6, p =.09). PAC-1 (GP IIb/IIIa activity), CD 51/61 (vitronectin receptor) and CD 42b (GP Ib) were inhibited by eptifibatide (p <.05). CONCLUSIONS In Emergency Department patients with unstable angina, early eptifibatide rapidly and profoundly inhibits platelet aggregation and reduces GP IIb/IIIa activity and the expression of CD51/61 and CD 42b; the latter two effects may also contribute to the drug's anti-thrombotic effect. However, platelet-leukocyte aggregate formation, a marker of platelet activity rises within 24 h after presentation despite eptifibatide therapy and is a potential mechanism for microvascular obstruction.
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Affiliation(s)
- Paul A Gurbel
- Sinai Center for Thrombosis Research, Baltimore, Maryland 21215, USA.
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20
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Abstract
Atherosclerosis is a complex disease in which progressive cellular changes occur for decades before the acute manifestation of cardiovascular disease. Definition of atherogenic mechanisms in humans is hindered by the complexity and chronicity of the disease process, combined with the inability to sequentially characterize lesions in an individual patient because of shortcomings in noninvasive detection modalities. Therefore, there has been a reliance on animal models of the disease to define mechanistic pathways. Over the last decade, the mouse has become the predominant species used to create models of atherosclerosis. The initial interest was based on the great diversity of inbred strains with defined genetic backgrounds that provides a means of linking genes to the development of atherosclerosis. More recently, the ability to genetically modify mice to over or under express specific genes has facilitated the definition of pathways in the atherogenic process. All of the current mouse models of atherosclerosis are based on perturbations of lipoprotein metabolism through dietary and/or genetic manipulations. Although hyperlipidemia is necessary for the development of atherosclerosis, mouse models have demonstrated that many nonlipid factors can influence the severity and characteristics of lesions. This review selectively highlights some of the most commonly used mouse models of atherosclerosis and compare their lesions to those formed in the human disease.
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Affiliation(s)
- Alan Daugherty
- Gill Heart Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington 40536, USA.
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21
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Kennon S, Barakat K, Hitman GA, Price CP, Mills PG, Ranjadayalan K, Cooper J, Clark H, Timmis AD. Angiotensin-converting enzyme inhibition is associated with reduced troponin release in non-ST-elevation acute coronary syndromes. J Am Coll Cardiol 2001; 38:724-8. [PMID: 11527624 DOI: 10.1016/s0735-1097(01)01426-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study was done to determine the effects of angiotensin-converting enzyme (ACE) inhibition and other clinical factors on troponin release in non-ST-elevation acute coronary syndrome (ACS). BACKGROUND Troponin is now widely used as a marker of risk in ACS, but determinants of its release have not been defined. METHODS This was a prospective cohort study of 301 consecutive patients admitted with non-ST-elevation ACS. Baseline clinical data were recorded, ACE gene polymorphism was determined and serial blood samples were obtained for troponin-I assay. RESULTS Significant troponin-I release (>0.1 microg/l) was detected in 93 (31%) patients. Pretreatment with ACE inhibitors, recorded in 53 patients (17.6%), independently reduced the odds of troponin-I release (odds ratio 0.25; 95% confidence intervals 0.10 to 0.64) and was associated with lower maximum troponin-I concentrations (median [interquartile range]) compared with patients not pretreated with ACE inhibitors (0.44 microg/l [0.19 to 2.65 microg/l] vs. 4.18 microg/l [0.91 to 12.41 microg/l], p = 0.01). Pretreatment with aspirin, recorded in 173 patients (57.5%), did not significantly reduce the odds of troponin-I release after adjustment but was associated with lower maximum troponin-I concentrations compared with patients not pretreated with aspirin (2.31 microg/l [0.72 to 8.02 microg/l] vs. 5.85 microg/l [1.19 to 12.79 microg/l], p = 0.05). The ACE genotyping (n = 268) showed 81 patients (30%) DD homozygous and 77 (29%) II homozygous. There was no association between ACE genotype and troponin release. CONCLUSIONS We conclude that ACE inhibition reduces troponin release in non-ST-elevation ACS. This is likely to be mediated by the beneficial effects of treatment on vascular reactivity and the coagulation system.
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Affiliation(s)
- S Kennon
- Department of Cardiology, St. Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom.
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22
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Nishikawa K, Satomura K, Miyake T, Isoda K, Takase B, Nishizawa K, Arakawa K, Shibuya T, Ohsuzu F, Mizuno K. Relation between plasma fibrinogen level and coronary plaque morphology in patients with stable angina pectoris. Am J Cardiol 2001; 87:1401-4. [PMID: 11397364 DOI: 10.1016/s0002-9149(01)01563-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- K Nishikawa
- Internal Medicine-1, National Defense Medical College, Saitama, Japan.
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23
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Wiggins BS, Wittkowsky AK, Nappi JM. Clinical use of new antithrombotic therapies for medical management of acute coronary syndromes. Pharmacotherapy 2001; 21:320-37. [PMID: 11253856 DOI: 10.1592/phco.21.3.320.34211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Prevention and management of acute coronary syndromes (ACS) are focal points of interest among health care providers. Acute coronary syndromes is an all-encompassing term that refers to unstable angina, non-Q wave myocardial infarction, and Q wave myocardial infarction. These syndromes are usually the result of atherosclerotic plaque rupture leading to thrombus formation in a coronary artery. Heparin and aspirin are traditional antithrombotic treatments. They typically are administered with antiischemic therapies and often with fibrinolytic agents for patients with ST segment elevation associated with acute myocardial infarction. Although aspirin and heparin are important, they have significant limitations that have prompted development of newer antithrombotic approaches. Adenosine diphosphate inhibitors have been evaluated as either alternatives or adjunctive treatment to aspirin. Glycoprotein IIb-IIIa receptor inhibitors, low-molecular-weight heparins, and direct thrombin inhibitors have been studied as concurrent therapy with, or as alternatives to, heparin.
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Affiliation(s)
- B S Wiggins
- Department of Pharmacy, University of Washington Medical Center, Seattle 98195-6015, USA
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Kojima S, Nonogi H, Morii I, Sumida H, Sutani Y, Yasuda S, Daikoku S, Goto Y, Miyazaki S. Is Inflammation Related to the Clinical Severity of Unstable Angina? ACTA ACUST UNITED AC 2001; 65:414-8. [PMID: 11348045 DOI: 10.1253/jcj.65.414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The present study determined the white blood cell (WBC) count and the serum C-reactive protein (CRP) level in 27 patients with coronary spastic angina, 16 with Braunwald class IB unstable angina (UA) and 13 with Braunwald class IIIB. The relationship between the clinical presentation of UA and the requirement for emergency percutaneous transluminal coronary angioplasty (PTCA) was examined, and in patients with medically refractory angina, the determining factor among the clinical manifestations of angina was also investigated. In the acute phase, the WBC count and the serum CRP level were significantly higher in patients with Braunwald class IIIB than in those with coronary spastic angina or Braunwald class IB UA (p<0.001). In the Braunwald class IIIB group, a significantly higher rate of patients required emergency PTCA than that of the coronary spastic angina group (p<0.01). Patients with medically refractory angina had a significantly higher WBC count and higher serum CRP level on admission, and the WBC count on admission was independently associated with medically refractory angina by multivariate analysis (p<0.05). Inflammation may play a major pathological role in the rapid development of acute coronary syndrome.
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Affiliation(s)
- S Kojima
- Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan
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Hort W, Schwartzkopff B. Anatomie und Pathologie der Koronararterien. PATHOLOGIE DES ENDOKARD, DER KRANZARTERIEN UND DES MYOKARD 2000. [DOI: 10.1007/978-3-642-56944-9_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
Drug therapy for the management of acute coronary syndromes is rapidly expanding. Over the past few years, a number of new antithrombotic agents have been introduced, including low-molecular-weight heparins. The epidemiology and pathophysiology of acute coronary syndromes are discussed, with a historical perspective on the use of antithrombotic therapy.
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Affiliation(s)
- K A Stringer
- Department of Pharmacy Practice, School of Pharmacy, University of Colorado Health Sciences Center, Denver 80262, USA
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Herzum M, Schaefer JR, Hufnagel G, Maisch B. [Cytomegalovirus and herpes simplex virus in pathogenesis and progression of native arteriosclerosis and recurrent stenosis after intervention]. Herz 1998; 23:193-6. [PMID: 9646101 DOI: 10.1007/bf03044605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
An increasing number of clinical and experimental studies point to a contribution of various infectious organisms like chlamydia pneumoniae or herpesviruses to atherosclerosis in man. Cytomegalovirus induces atherosclerotic lesions in animals. In vitro studies reveal functional changes of endothelial cells after infection with cytomegalovirus. Infection with this virus renders endothelial cells immunogenic for cellular and humoral immune reactions. In man a significant association of infections with herpesviruses and atherosclerosis could be established in several studies. Cytomegalovirus infection has been incriminated as an independent risk factor in restenosis after coronary angioplasty.
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Affiliation(s)
- M Herzum
- Abteilung Innere Medizin-Schwerpunkt Kardiologie, Universitätsklinik, Philipps-Universität Marburg
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