1
|
Characterization of Atherosclerosis Formation in a Murine Model of Type IIa Human Familial Hypercholesterolemia. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1878964. [PMID: 29977908 PMCID: PMC6011105 DOI: 10.1155/2018/1878964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/27/2018] [Accepted: 05/10/2018] [Indexed: 12/14/2022]
Abstract
A murine genetic model of LDL-cholesterol- (LDL-C-) driven atherosclerosis, based on complete deficiencies of both the LDL-receptor (Ldlr-/-) and key catalytic component of an apolipoprotein B-edisome complex (Apobec1-/-), which converts apoB-100 to apoB-48, has been extensively characterized. These gene deficiencies allow high levels of apoB-100 to be present and inefficiently cleared, thus leading to very high levels of LDL-C in mice on a normal diet. Many key features of atherosclerotic plaques observed in human familial hypercholesterolemia are found in these mice as they are allowed to age through 72 weeks. The general characteristics include the presence of high levels of LDL-C in plasma and macrophage-related fatty streak formation in the aortic tree, which progressively worsens with age. More specifically, plaque found in the aortic sinuses contains a lipid core with relatively high numbers of macrophages and a smooth muscle cell α-actin- and collagen-containing cap, which thins with age. These critical features of plaque progression suggest that the Ldlr-/-/Apobec1-/- mouse line presents a superior model of LDL-C-driven atherosclerosis.
Collapse
|
2
|
Abstract
PURPOSE OF REVIEW Despite the benefits of surgical coronary revascularization, patients continue to be at risk for ischemic events in the years that follow coronary artery bypass graft surgery (CABG), mandating the role for postoperative secondary preventive therapy. The purpose of this review was to present a summary on the subject of secondary prevention after CABG, including an overview of a recently published scientific statement, and highlight the newest studies in the field. RECENT FINDINGS Aspirin and statin therapy continue to be the mainstay of secondary prevention after CABG, although newer antiplatelet and lipid-lowering medicines are being actively studied for their potential benefits. Other important elements to secondary prevention after CABG include the aggressive management of hypertension, smoking cessation, and the initiation of cardiac rehabilitation. SUMMARY Secondary prevention is an essential component of postoperative care after CABG. Instituting preventive therapies after surgery optimizes graft patency and helps patients achieve the highest level of physical health and quality of life following CABG.
Collapse
|
3
|
Enas EA, Senthilkumar A, Vinod C, Puthumana N. Dyslipidaemia among Indo-Asians strategies for identification and management. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/14746514050050020601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ndo-Asians have the highest rates of coronary artery disease (CAD) despite the fact that nearly half are lifelong vegetarians. The incidence, prevalence, and mortality from CAD among overseas Indo-Asians have been 50% to 300% higher than the Europeans, Americans, and other Asians with a higher risk at younger ages. Approximately 10% of the adults in urban India have CAD, a rate similar to overseas Indians. Traditional risk factors do not fully explain the excess burden of CAD in Indo-Asians. Therefore, conventional approaches to testing and treatment of risk factors are not sufficient in this population. Indo-Asians have a higher prevalence of glucose intolerance, metabolic syndrome, diabetes, elevated concentrations of lipoprotein(a) (LP[a]), and homocysteine, and low concentrations of high density lipoprotein (HDL). HDL particles are also smaller in Indo-Asians than Whites. A more aggressive approach to all risk factors, including HDL, LP(a), triglycerides and homocysteine is warranted. The current evidence of established safety and broad spectrum lipoprotein benefits of niacin and statins would make these invaluable agents in the armamentarium against dyslipidaemia, especially in Indo-Asians. This is particularly true for those with metabolic syndrome, diabetic dyslipidaemia and Lp(a) excess.
Collapse
Affiliation(s)
- Enas A Enas
- Coronary Artery Disease in Indians (CADI) Research Foundation 1935 Green Trails Dr, Lisle, IL 60532, USA,
| | | | | | | |
Collapse
|
4
|
Kulik A, Ruel M, Jneid H, Ferguson TB, Hiratzka LF, Ikonomidis JS, Lopez-Jimenez F, McNallan SM, Patel M, Roger VL, Sellke FW, Sica DA, Zimmerman L. Secondary Prevention After Coronary Artery Bypass Graft Surgery. Circulation 2015; 131:927-64. [DOI: 10.1161/cir.0000000000000182] [Citation(s) in RCA: 260] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
5
|
Toth PP, Barylski M, Nikolic D, Rizzo M, Montalto G, Banach M. Should low high-density lipoprotein cholesterol (HDL-C) be treated? Best Pract Res Clin Endocrinol Metab 2014; 28:353-68. [PMID: 24840264 DOI: 10.1016/j.beem.2013.11.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The first observations linking a low serum level of HDL-C to increased risk for cardiovascular disease were made over 50 years ago. High serum levels of HDL-C appear to protect against the development of atherosclerotic disease, while low serum levels of this lipoprotein are among the most important predictors of atherosclerotic disease in both men and women and people of all racial and ethnic groups throughout the world. It has long been assumed that therapeutic interventions targeted at raising HDL-C levels would lower risk for such cardiovascular events as myocardial infarction, ischemic stroke, and death. Even after five decades of intensive investigation, evidence to support this assumption has been fleeting. A number of post hoc analyses of randomized controlled trials and meta-analyses suggest that HDL-C raising, particularly when coupled with aggressive LDL-C reduction, impacts risk for cardiovascular events and rates of progression of atherosclerotic disease. Unfortunately, four recent prospective trials performed with the intent of testing the "HDL hypothesis" (ILLUMINATE, dal-OUTCOMES, AIM-HIGH, and HPS2-THRIVE) failed to meet their primary composite endpoints. These results have lead many clinicians and investigators to question the validity of the assumption that HDL-C raising reduces risk for cardiovascular events. Additional trials with other drugs are underway. In the meantime, HDL-C cannot be considered a target of therapy. Given the complexity of the HDL proteome and lipidome, there is biological plausibility for how HDL particles might exert atheroprotection. We explore the evidence supporting the inverse relationship between HDL-C and cardiovascular disease risk, documented mechanisms by which HDL particles may exert atheroprotection, and the findings either supporting or negating specific therapeutic interventions in patients afflicted with low HDL-C.
Collapse
Affiliation(s)
- Peter P Toth
- CGH Medical Center, Sterling, IL 61081, USA; University of Illinois School of Medicine, Peoria, IL, USA.
| | - Marcin Barylski
- Department of Internal Medicine and Cardiological Rehabilitation, Medical University of Lodz, Lodz, Poland.
| | - Dragana Nikolic
- Biomedical Department of Internal Medicine and Medical Specialties University of Palermo, Palermo, Italy.
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties University of Palermo, Palermo, Italy; Euro-Mediterranean Institute of Science and Technology, Palermo, Italy.
| | - Giuseppe Montalto
- Biomedical Department of Internal Medicine and Medical Specialties University of Palermo, Palermo, Italy.
| | - Maciej Banach
- Nephrology and Hypertension, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland.
| |
Collapse
|
6
|
Jerzewski K, Ruel M, Voisine P, Le May MR, Kulik A. Does high-density lipoprotein influence the development of saphenous vein graft disease after coronary bypass surgery?: exploratory analysis from the CASCADE trial. J Cardiothorac Surg 2013; 8:172. [PMID: 23842141 PMCID: PMC3716982 DOI: 10.1186/1749-8090-8-172] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 07/08/2013] [Indexed: 11/21/2022] Open
Abstract
Background Low levels of high-density lipoprotein (HDL) purportedly increase the risk after coronary bypass surgery. This may relate to the development of saphenous vein graft (SVG) disease early postoperatively, but this premise has never been evaluated in the context of a prospective trial. Methods The CASCADE Trial was a multi-center study of 113 patients evaluating the use of postoperative clopidogrel. Patients received standard lipid management after surgery (96% statins). At 12 months, angiography and intravascular ultrasound was performed to assess SVG occlusion and intimal hyperplasia, respectively. In this exploratory analysis, we evaluated the influence of HDL levels on the development of SVG disease at 12 months, using the established cut-off of <40 mg/dL suggesting increased risk. Results While HDL levels increased over the time-period of the trial (P < 0.0001), 51.1% of patients had HDL levels <40 mg/dL 12 months after surgery. Slightly more SVG occlusions occurred amongst patients with HDL levels <40 mg/dL (6.8%), compared to patients with HDL levels >40 mg/dL (4.0%, P = 0.5). With multivariate adjustment, HDL level <40 mg/dL was associated with a trend towards more SVG occlusions (odds ratio: 3.2; P = 0.12). Lower HDL level was also associated with more intimal hyperplasia on ultrasound at 12 months (P = 0.10). Patients who had HDL levels >60 mg/dL had the least amount of intimal hyperplasia, significantly less than the remainder of the cohort (P = 0.01). Conclusions Within this population, lower HDL levels were associated with trends towards more graft occlusions and more vein intimal hyperplasia. Modulation of postoperative HDL levels may represent a valuable future strategy for the reduction of SVG disease.
Collapse
|
7
|
The metabolic syndrome, oxidative stress, environment, and cardiovascular disease: the great exploration. EXPERIMENTAL DIABETES RESEARCH 2012; 2012:271028. [PMID: 22829804 PMCID: PMC3399393 DOI: 10.1155/2012/271028] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 05/21/2012] [Indexed: 12/24/2022]
Abstract
The metabolic syndrome affects 30% of the US population with increasing prevalence. In this paper, we explore the relationship between the metabolic syndrome and the incidence and severity of cardiovascular disease in general and coronary artery disease (CAD) in particular. Furthermore, we look at the impact of metabolic syndrome on outcomes of coronary revascularization therapies including CABG, PTCA, and coronary collateral development. We also examine the association between the metabolic syndrome and its individual component pathologies and oxidative stress. Related, we explore the interaction between the main external sources of oxidative stress, cigarette smoke and air pollution, and metabolic syndrome and the effect of this interaction on CAD. We discuss the apparent lack of positive effect of antioxidants on cardiovascular outcomes in large clinical trials with emphasis on some of the limitations of these trials. Finally, we present evidence for successful use of antioxidant properties of pharmacological agents, including metformin, statins, angiotensin II type I receptor blockers (ARBs), and angiotensin II converting enzyme (ACE) inhibitors, for prevention and treatment of the cardiovascular complications of the metabolic syndrome.
Collapse
|
8
|
Seneff S, Wainwright G, Mascitelli L. Is the metabolic syndrome caused by a high fructose, and relatively low fat, low cholesterol diet? Arch Med Sci 2011; 7:8-20. [PMID: 22291727 PMCID: PMC3258689 DOI: 10.5114/aoms.2011.20598] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 08/15/2010] [Accepted: 08/23/2010] [Indexed: 01/24/2023] Open
Abstract
The metabolic syndrome (MetS) is manifested by a lipid triad which includes elevated serum triglycerides, small LDL particles, and low high-density lipoprotein (HDL) cholesterol, by central obesity (central adiposity), insulin resistance, glucose intolerance and elevated blood pressure, and it is associated with an increased risk of type 2 diabetes and coronary heart disease. We have developed a new hypothesis regarding MetS as a consequence of a high intake in carbohydrates and food with a high glycemic index, particularly fructose, and relatively low intake of cholesterol and saturated fat. We support our arguments through animal studies which have shown that exposure of the liver to increased quantities of fructose leads to rapid stimulation of lipogenesis and accumulation of triglycerides. The adipocytes store triglycerides in lipid droplets, leading to adipocyte hypertrophy. Adipocyte hypertrophy is associated with macrophage accumulation in adipose tissue. An important modulator of obesity-associated macrophage responses in white adipose tissue is the death of adipocytes. Excess exposure to fructose intake determines the liver to metabolize high doses of fructose, producing increased levels of fructose end products, like glyceraldehyde and dihydroxyacetone phosphate, that can converge with the glycolytic pathway. Fructose also leads to increased levels of advanced glycation end products. The macrophages exposed to advanced glycation end products become dysfunctional and, on entry into the artery wall, contribute to plaque formation and thrombosis.
Collapse
Affiliation(s)
- Stephanie Seneff
- Department of Electrical Engineering and Computer Science, MIT, Cambridge, MA, USA
| | | | - Luca Mascitelli
- Medical Service, Comando Brigata Alpina “Julia”, Udine, Italy
| |
Collapse
|
9
|
Effects of losartan compared with atenolol on lipids in patients with hypertension and left ventricular hypertrophy: the Losartan Intervention For Endpoint reduction in hypertension study. J Hypertens 2009; 27:567-74. [DOI: 10.1097/hjh.0b013e32831daf96] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Prevalence of low high-density lipoprotein cholesterol and hypertriglyceridaemia in patients treated with hypolipidaemic drugs. Arch Cardiovasc Dis 2009; 102:43-50. [DOI: 10.1016/j.acvd.2008.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Revised: 06/09/2008] [Accepted: 06/17/2008] [Indexed: 12/12/2022]
|
11
|
Kolovou GD, Anagnostopoulou K, Pilatis ND, Salpea KD, Hoursalas IS, Petropoulos I, Bilianou HI, Cokkinos DV. Fasting serum triglyceride and high-density lipoprotein cholesterol levels in patients intended to be treated for dyslipidemia. Vasc Health Risk Manag 2007; 1:155-61. [PMID: 17315402 PMCID: PMC1993943 DOI: 10.2147/vhrm.1.2.155.64079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of the present investigation was to evaluate the influence of serum triglycerides (TG) on other plasma lipids in patients to be treated for dyslipidemia. Methodology Lipid profiles of a cohort of 801 patients (487 males and 314 females) aged 57 ± 9 years (mean ± SD) were evaluated. Patients were stratified according to their plasma lipid levels. They were divided into various groups on the basis of serum TG (≥150 or <150 mg/dL) and high-density lipoprotein cholesterol (HDL-C) (≥40 or <40 mg/dL). Results Patients with TG ≥ 150 mg/dL had a higher total cholesterol and lower HDL-C levels compared with those with TG < 150 mg/dL, (p < 0.001). Patients with HDL-C < 40 mg/dL had a lower serum total cholesterol and higher TG compared with those with HDL-C ≥ 40 mg/dL (p = 0.011 and p < 0.0001, respectively). In all patients as well as in the subgroups, an inverse correlation between TG and HDL-C was found (r = −0.377, p < 0.001). Conclusions Although, the metabolic pathway for TG and HDL-C is closely linked, an inverse correlation between TG and HDL-C levels seems to exist in the entire sampled population. This correlation also appears to persist in fasting patients with low levels of TG.
Collapse
|
12
|
Arora R, Sowers JR, Saunders E, Probstfield J, Lazar HL. Cardioprotective Strategies to Improve Long-Term Outcomes Following Coronary Artery Bypass Surgery. J Card Surg 2006; 21:198-204. [PMID: 16492288 DOI: 10.1111/j.1540-8191.2006.00210.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Cardioprotective strategies implemented to prevent ischemic events in patients at risk for cardiovascular disease have decreased morbidity and prolonged survival. In this review, we have used evidence-based medicine and number-needed-to-treat (NNT) analyses to determine which interventions are most beneficial in minimizing ischemic events and prolonging survival following coronary artery bypass graft (CABG) surgery. METHODS Therapeutic interventions available to minimize ischemic events in the post-CABG patient were analyzed using ACC/AHA Classifications and Level of Evidence Criteria. Based on these recommendations, NNT analyses were performed to determine the effectiveness of each intervention compared to the number of patients needed to be treated before a benefit was apparent. RESULTS The most beneficial intervention to improve mortality following CABG was the use of high tissue angiotensin-converting enzyme inhibitors, followed by statins and smoking cessation. CONCLUSIONS NNT analyses and evidence-based medicine recommendations provide surgeons with cardioprotective strategies to improve long-term outcomes following CABG surgery.
Collapse
Affiliation(s)
- Rohit Arora
- Department of Medicine, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | | | | | | | | |
Collapse
|
13
|
Leung H, Wang JJ, Rochtchina E, Wong TY, Klein R, Mitchell P. Dyslipidaemia and microvascular disease in the retina. Eye (Lond) 2006; 19:861-8. [PMID: 15359242 DOI: 10.1038/sj.eye.6701668] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE There are few data on the effect of serum lipids on microvascular disease. This study assessed the relationships between serum lipid levels and microvascular disease, as seen in the retina, among participants who attended a population-based study in Australia (n=3654, aged 49+years). METHODS Diameters of retinal arterioles and venules were measured from digitised photographs of each participant to obtain an estimate of generalised arteriolar narrowing. Focal arteriolar narrowing, arteriovenous nicking, and retinopathy lesions (microaneurysms, haemorrhages, hard/soft exudates) were graded using a standard protocol. Fasting blood tests were performed in 89% of subjects. Adjusted means were calculated using general linear models. Logistic regression models were used to determine the odds ratios for retinal microvascular signs. RESULTS After controlling for age, sex, body mass index, smoking, and mean arterial blood pressure, elevated high-density lipoprotein cholesterol was associated with narrower retinal arterioles (Ptrend=0.002) and venules (Ptrend=0.03) and with increased odds of generalised arteriolar narrowing (odds ratio 1.6, 95% confidence interval 1.1-2.2 for the highest vs the lowest quintile of high-density lipoprotein cholesterol). Serum triglyceride had a U-shaped relationship with venular diameter (Ptrend=0.003). We found no consistent pattern of association between serum total cholesterol or low-density lipoprotein cholesterol and any retinal microvascular signs. CONCLUSIONS These findings suggest that microvascular disease in the retina may result from processes distinct from dyslipidaemia.
Collapse
Affiliation(s)
- H Leung
- Department of Ophthalmology and the Westmead Millennium Institutes, Centre for Vision Research, The University of Sydney, Australia
| | | | | | | | | | | |
Collapse
|
14
|
Abstract
Circulating levels of HDL cholesterol are inversely related to the risk of atherosclerosis, and therapeutic increases in HDL reduce the incidence of cardiovascular events. A new study shows that HDL-associated lysophospholipids stimulate the production of the potent antiatherogenic signaling molecule NO by the vascular endothelium.
Collapse
Affiliation(s)
- Philip W Shaul
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
| | | |
Collapse
|
15
|
|
16
|
Sprecher DL, Watkins TR, Behar S, Brown WV, Rubins HB, Schaefer EJ. Importance of high-density lipoprotein cholesterol and triglyceride levels in coronary heart disease. Am J Cardiol 2003; 91:575-80. [PMID: 12615263 DOI: 10.1016/s0002-9149(02)03309-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
17
|
Abstract
Increased LDL oxidation is associated with coronary artery disease. The predictive value of circulating oxidized LDL is additive to the Global Risk Assessment Score for cardiovascular risk prediction based on age, gender, total and HDL cholesterol, diabetes, hypertension, and smoking. Circulating oxidized LDL does not originate from extensive metal ion-induced oxidation in the blood but from mild oxidation in the arterial wall by cell-associated lipoxygenase and/or myeloperoxidase. Oxidized LDL induces atherosclerosis by stimulating monocyte infiltration and smooth muscle cell migration and proliferation. It contributes to atherothrombosis by inducing endothelial cell apoptosis, and thus plaque erosion, by impairing the anticoagulant balance in endothelium, stimulating tissue factor production by smooth muscle cells, and inducing apoptosis in macrophages. HDL cholesterol levels are inversely related to risk of coronary artery disease. HDL prevents atherosclerosis by reverting the stimulatory effect of oxidized LDL on monocyte infiltration. The HDL-associated enzyme paraoxonase inhibits the oxidation of LDL. PAF-acetyl hydrolase, which circulates in association with HDL and is produced in the arterial wall by macrophages, degrades bioactive oxidized phospholipids. Both enzymes actively protect hypercholesterolemic mice against atherosclerosis. Oxidized LDL inhibits these enzymes. Thus, oxidized LDL and HDL are indeed antagonists in the development of cardiovascular disease.
Collapse
MESH Headings
- 1-Alkyl-2-acetylglycerophosphocholine Esterase
- Animals
- Aryldialkylphosphatase
- Coronary Artery Disease/etiology
- Esterases/metabolism
- Humans
- Lipoproteins, HDL/antagonists & inhibitors
- Lipoproteins, HDL/physiology
- Lipoproteins, LDL/antagonists & inhibitors
- Lipoproteins, LDL/metabolism
- Lipoproteins, LDL/physiology
- Membrane Proteins
- Mice
- Models, Cardiovascular
- Phospholipases A/metabolism
- Receptors, Immunologic/biosynthesis
- Receptors, Lipoprotein
- Receptors, Scavenger
- Scavenger Receptors, Class B
- Thrombosis/etiology
Collapse
Affiliation(s)
- A Mertens
- Center for Experimental Surgery and Anesthesiology, Katholieke Universiteit Leuven, Belgium
| | | |
Collapse
|
18
|
Brull DJ, Sanders J, Rumley A, Lowe GD, Humphries SE, Montgomery HE. Statin therapy and the acute inflammatory response after coronary artery bypass grafting. Am J Cardiol 2001; 88:431-3. [PMID: 11545771 DOI: 10.1016/s0002-9149(01)01696-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- D J Brull
- Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, Department of Medicine, Royal Free and University College London Medical School, London, United Kingdom.
| | | | | | | | | | | |
Collapse
|