Plasma atherogenic indices are independent predictors of slow coronary flow

Atherogenic index of plasma and the clinical outcome of patients with acute coronary syndrome: a meta-analysis

BACKGROUND

The atherogenic index of plasma (AIP) has been related to an increased risk of coronary artery disease. However, previous studies evaluating the prognostic role of AIP for acute coronary syndrome (ACS) showed inconsistent results. This meta-analysis was conducted to systematically evaluate the association between AIP and the risk of major cardiovascular adverse events (MACE) of patients with ACS.

MATERIALS AND METHODS

Relevant cohort studies were retrieved by searching electronic databases, including PubMed, Web of Science, and Embase. A random-effects model was used to combine the data by incorporating the influence of between-study heterogeneity.

RESULTS

Thirteen datasets from nine cohort studies, involving 10,861 patients with ACS were included in the meta-analysis. Of them, 1546 (14.2%) developed MACE during follow-up. Pooled results suggested that a high AIP at admission was associated with an increased risk of MACE during follow-up (risk ratio [RR]: 1.54, 95% confidence interval [CI]: 1.30-1.82, p < 0.001; I2 = 48%). Subgroup analyses suggested a stronger association between a high AIP and an increased risk of MACE in older patients (mean age ≥60 years, RR: 2.26, 95% CI: 1.78-2.87, p < 0.001; I2 = 0%) than the younger ones (mean age <60 years, RR: 1.30, 95% CI: 1.17-1.44, p < 0.001; I2 = 0%; p for subgroup difference <0.001), which fully explained the heterogeneity.

CONCLUSION

A high AIP is associated with an increased risk of MACE in patients with ACS, particularly for older patients.

Association of atherogenic indices and triglyceride-total cholesterol-body weight index (TCBI) with severity of stenosis in patients undergoing angiography: a case-control study

OBJECTIVES

Coronary artery disease, caused by atherosclerosis, necessitates assessing plaque formation risk using indices like the atherogenic index of plasma (AIP), Castelli's risk indexes (CRI-I and CRI-II), the atherogenic coefficient (AC), and the triglyceride-total cholesterol-body weight index (TCBI). Although TCBI primarily assesses mortality risk, its relationship with stenosis severity is unclear. Utilizing data from a prior study, a case-control analysis was conducted on 1,187 subjects, which included 781 patients who underwent coronary angiography and 406 healthy controls. The indices were compared across varying degrees of arterial blockages.

RESULTS

AIP significantly correlated with stenosis severity in women, increasing the risk of three-vessel stenosis by 2.5 times. AC raised the risk of single-vessel stenosis in men by 2.7 times. CRI-I and CRI-II showed a positive relationship with arterial stenosis in women, with CRI-I increasing the risk of two and three-vessel blockages by 21.9% and 22.4%, respectively. A one-unit increase in CRI-II raised the risk by 33.1% for two arteries and 25.3% for three. In conclusion, AIP, CRI-I, and CRI-II in women, along with AC in men, correlated with arterial stenosis severity, while TCBI did not. Further research is needed to determine which index is most effective in predicting CAD risk.

Baseline characteristics and seven-year follow-up of patients with coronary slow flow: A cohort study in northeastern Iran

Introduction

An angiographic finding known as "coronary slow flow phenomenon" (CSFP) occurs when there is no discernible stenosis but the contrast flow is slower than usual. Although the prognosis for the majority of CSFP cases is favorable, frequent angina significantly lowers their quality of life. Therefore, this study aimed to explore the potential contributing risk factors and prognostic implications of CSFP on long-term cardiovascular outcomes.

Methods

This retrospective, cohort study was conducted between years 2014-2022 and included a total of 65 CSFP patients and 65 controls with normal coronary flow, as evidenced by coronary angiography. These two groups were examined in terms of future cardiovascular consequences due to this phenomenon, baseline demographic characteristics, and laboratory findings. A P value<0.05 was considered significant.

Results

In this study 130 people including 73 men and 57 women, who because of the typical chest pain and at least a noninvasive test took angiography, were explored. The median triglyceride (200.80±48.51 vs 131.79±34.22, P<0.001), total cholesterol (189.46±10.84 vs 103.43±8.13, P<0.001), and low-density lipoprotein (153.28±34.28 vs 103.34±19.70, P=0.01) were significantly higher in the affected people. During clinical follow-up, a higher number of major adverse cardiac events (8.97±2.95 vs 4.52±2.12, P<0.001) was observed in the CSFP cases. Moreover, a one-unit increase in body mass index raised the probability of adverse cardiac events by 0.912 in CSFP cases.

Conclusion

Our research indicated that individuals with CSFP were more likely to develop cardiac events including unstable angina. Furthermore, obesity and dyslipidemia could provoke this phenomenon.

Beyond traditional metrics: evaluating the triglyceride-total cholesterol-body weight index (TCBI) in cardiovascular risk assessment

BACKGROUND

Cardiovascular disease (CVD), a non-communicable condition, stands as the primary cause of death globally. This study seeks to evaluate the predictive power of atherogenic indices, which are recognized for their influence on CVD, alongside a newly developed index encompassing all three principal risk factors for CVD, referred to as the triglyceride-total cholesterol-body weight index (TCBI). The primary outcomes evaluated include both the incidence and mortality rates associated with CVD.

METHODS

A prospective cohort study was conducted on Mashhad stroke and heart atherosclerotic disorder (MASHAD) study data, involving 9704 healthy participants. Baseline variables were measured, and TCBI, Atherogenic Index of Plasma (AIP), Atherogenic Coefficient (AC), Castelli risk index I and II (CRI-I & II) were calculated using specific formulas.

RESULTS

Following a 10-year follow-up period, a significant positive relationship was observed between TCBI (HR: 1.078, 95% CI: 1.012-1.15), CRI-I (HR: 1.16, 95% CI: 1.007-1.337), and CRI-II (HR: 1.199, 95% CI: 1.001-1.437) with CVD mortality. However, no significant relationship was identified between TCBI and atherogenic indices related to CVD incidence, and neither AIP nor AC was associated with CVD mortality.

CONCLUSION

In conclusion, TCBI, in contrast to AC and AIP, was linked to increased CVD mortality. However, the more substantial predictive capabilities of CRI-I and CRI-II compared to TCBI emphasize the importance of traditional atherogenic indices for accurate risk assessment. These findings underscore the necessity of enhancing the TCBI formula to improve its effectiveness in assessing CVD risk.

The predictors of coronary slow flow in patients undergoing coronary angiography

BACKGROUND

A new challenge in coronary artery disease treatment has emerged, where specific populations exhibit ischemic symptoms without any obstruction in the epicardial coronary artery. Instead, they exhibit slow coronary contrast flow, referred to as coronary slow flow (CSF). This study aims to identify several predictors of CSF.

RESULTS

This case-control study was conducted at the Regional General Hospital of West Nusa Tenggara Province in Indonesia from December 2016 to February 2024. The study involved sixty subjects, with 30 in each group of CSF and normal epicardial coronary artery angiogram (NECA). CSF is enforced by the TIMI frame count (TFC) greater than 27 frames. Among all the predictors studied, coronary artery diameter (p < 0.001) and random blood sugar (p = 0.049) were found to affect the CSF significantly. In the multivariate analysis, coronary artery diameter remained a significant predictor (adjusted OR 10.08, 95% CI 2.64-38.50, p < 0.001), with an optimal cut-off point of more than 3.56 mm, a sensitivity of 76.7%, and a specificity of 70.7% (AUC = 0.787, p < 0.001).

CONCLUSION

The coronary artery diameter strongly predicts CSF in patients undergoing coronary angiography.

Relationship between Vitamin D Insufficiency, Lipid Profile and Atherogenic Indices in Healthy Women Aged 18-50 Years

Although vitamin D insufficiency has been correlated with an increased risk of cardiovascular disease (CVD), there are few data on the association between 25-hydroxyvitamin D (25(OH)D) and atherogenic indices predictive of CVD. This study investigated the relationship of vitamin D status with lipid profile and atherogenic indices in adult women in Morocco. Three hundred women aged 18 to 50 years from Meknes were included. Fasting 25(OH)D and lipid concentrations were assayed by a one-step electrochemiluminescence-based immunoassay and an enzymatic method, respectively. Atherogenic indices (atherogenic index of plasma (AIP), atherogenic coefficient (AC), non-HDL cholesterol (non-HDL-C), Castelli risk indices I and II (CRI-I and II), and CHOLIndex (CI)) were calculated using conventional lipid parameters. Logistic regression models and operating characteristic curve (ROC) analysis were used to assess the relationship of the variables and estimate the threshold of 25(OH)D levels associated with high atherogenic indices. 25(OH) D below 20 ng/mL was significantly associated with an enhanced risk of hypertriglyceridemia and elevated values of AIP, AC, non-HDL-C, and CRI-I with an OR (95% CI) of 4.904 (1.856-12.959), 3.637 (2.149-6.158), 3.589 (1.673-7.700), 2.074 (1.215-3.540), and 2.481 (1.481-4.123), respectively. According to the ROC analysis, the likelihood of hypertriglyceridemia and high values of AIP, AC, non-HDL-C, and CRI-I were associated with 25(OH)D thresholds ≤15.15 ng/mL, ≤17.5 ng/mL, ≤19.8 ng/mL, ≤20.1 ng/mL, and ≤19.5 ng/mL, respectively, all p < 0.01. Based on the atherogenic indices, this study indicates that vitamin D below 20 ng/mL may increase the risk of cardiovascular disease in adult women. Additional health measures are essential to raise awareness among women and health professionals of preventing and controlling cardiovascular risk factors, particularly among young individuals.

Could Pan-Immune-Inflammation Value be a Marker for the Diagnosis of Coronary Slow Flow Phenomenon?

Inflammation plays a key role in the pathogenesis of the coronary slow flow phenomenon (CSFP). The newly developed inflammatory marker, pan-immune-inflammation value (PIV), is associated with adverse cardiovascular events. This study investigated the predictive value of PIV for diagnosing CSFP in comparison to other inflammation-based markers. A total of 214 patients, 109 in the CSFP group and 105 in the normal coronary flow (NCF) group, were retrospectively included in the study. Coronary flow was calculated using the Thrombolysis in Myocardial Infarction frame count method. In addition to PIV, other inflammatory markers such as neutrophil-lymphocyte ratio, platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated for the patients. The average age of patients was 50.3 ± 8.4, with a male ratio of 55.1%. Compared to the NCF group, patients in the CSFP group had higher levels of hyperlipidemia, glucose, triglyceride, NLR, PLR, SII, and PIV, while their high-density lipoprotein cholesterol (HDL-C), was lower (p < 0.05). Logistic regression analysis demonstrated that HDL-C, glucose, triglyceride, and PIV were independent predictor factors for CSFP (p < 0.05). PIV is a strong and independent predictor factor for CSFP and superior in predicting CSFP compared to other inflammatory markers.

Understanding the pathogenesis of coronary slow flow: Recent advances

Coronary slow flow is taken to be indicative of delayed filling of terminal vessels of the coronary arteries in the absence of coronary stenosis, as detected using coronary angiography. Patients suffering from coronary slow flow typically experience recurrent chest pain, thereby markedly affecting their quality of life. The etiology and pathogenesis of coronary slow flow, which is gradually attracting clinical attention, have yet to be sufficiently established, although it is currently believed that they may be associated with endothelial dysfunction in the coronary arteries, inflammatory response, abnormalities in microvascular reserve function, subclinical atherosclerosis, blood cell and platelet abnormalities, and genetic factors. In this review, we provide a brief overview of recent progress in research on the pathogenesis of coronary slow flow with a view toward elucidating the possible underlying pathogenesis and identify targets and directions for the treatment of this condition.

Major Adverse Cardiovascular Events and Prognosis in Patients With Coronary Slow Flow

This study aimed to investigate its clinical implications, risk factors, prognosis, and overall long-term outcomes. Demographic profiles, various clinical characteristics, and clinical outcomes were compared between 614 patients with coronary slow flow (CSF) and 428 patients with normal coronary artery. The incidence of CSF was found to be 2.65%. Significant differences were observed between patients with CSF and control subjects in terms of sex, chest tightness, hyperlipidemia, smoking history, alcohol consumption, age, height, weight, body mass index, diastolic blood pressure, heart rate, and body surface area (P < 0.05). CSF (hazard ratio: 1.531; 95% confidence interval: 1.064-2.202; p = 0.022) proved to be independent prognostic predictors of major adverse cardiovascular events (MACEs). Kaplan-Meier survival evaluations for MACEs presented a worser outcome for patients with CSF. Patients with CSF are at high risk for cardiovascular events and experience generally poor clinical outcomes.

Assessment of correlation between lipid ratios and body mass index in patients with type 2 diabetes mellitus in Sarajevo, Bosnia and Herzegovina

Objective. Studies that have evaluated correlation between body mass index (BMI) and novel lipid indices such as triglycerides (TG)/high-density lipoprotein-cholesterol (HDL-C), total cholesterol (TC)/HDL-C, and low-density lipoprotein cholesterol (LDL-C)/HDL-C in type 2 diabetes mellitus (T2DM) are scarce. Hence, the aim of the present study was to explore the correlation between BMI and novel lipid indices in Bosnian patients with T2DM. Methods. Present study included 117 patients with T2DM (mean age: 66.51 years) and 68 controls (mean age: 68.37 years). BMI was calculated as weight/height². Lipids were measured by standard methods. TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios were separately calculated. The differences between the groups were assessed by Student's t-test or Man Whitney U test. Correlations were determined by Spearman's test. Results. In a total sample of T2DM patients, 41.0% were overweight and 44.4% were obese. In the control group, 51.5% of subjects were overweight and 25.0% were obese. In T2DM group, a significant correlation was observed between BMI and HDL-C, LDL-C, TG/HDL, TC/HDL-C, and LDL-C/HDL-C ratios. In the control group, there was a significant correlation found between BMI and HDL-C, TG, TG/HDL, TC/HDL-C, and LDL-C/HDL-C-ratios. Correlation between BMI and other lipid parameters in T2DM and the control group was not determined. Conclusion. The present study showed significant correlation between BMI and novel lipid indices in both T2DM patients and the control group of subjects. Possible explanation for the observed results might be prevalence of overweight and obese participants in this study sample. Since novel lipid indices are used in the prediction of cardiometabolic risk, results obtained in the present study have valuable clinical implications.

Study of some components of the influence and formation of blood flow in patients with "slow flow"

BACKGROUND

"Slow flow" is one very important concept in modern fundamental and clinical biomedicine. Slow coronary flow is indicative of delayed filling of the terminal coronary artery vessels, occurring in the absence of significant coronary stenosis. This group patient of patients exhibits a high incidence of disability and represents a significant financial and material burden for the state and the healthcare system in general.

OBJECTIVE

The primary objective of our study was to examine patients with slow coronary flow.

METHODS

We studied the standard parameters recommended by the international health care system (electrocardiography (by Medica QRS-12, Germany), through the electrical activity of a patient's heart by the electrical impulses (beating) of the heart; HC1(Germany); coagulogramma by Coatron M1 (Germany), troponin by AQT 90 (Germany); general blood test we used automatic human counting device HC1(Germany). Also, we investigate the original parameters (non-standard parameters, which we use in this pilot study) that we were first studied for this diagnosis and non-standard parameters.

RESULTS

A general blood test showed that patients with slow flow had a higher blood leukocyte count than the control group, but the amount of hemoglobin was normal, the hematocrit was much higher than in the control group, and the platelet count was close to the lower limit of clinical standards.We obtained details of blood flow by coagulation situation, such as prothrombin time, prothrombin index, international normalized ratio, activated partial thromboplastin time, thrombin time, fibrinogen, and rheological properties such as index of erythrocyte aggregability, index of erythrocyte deformability, plasma viscosity, in silico blood rheological index.

CONCLUSSION

Blood flow can be considered as a superposition of vortices with similar frequencies and wave vectors that change after bifurcations or other obstacles in the vascular network. These factors together determine the conditions for structuring the flow of moving blood. Disruption or alteration of these factors results in slow flow. It has been found that the speed of blood flow in the coronary arteries depends on changes in the number and function of red blood cells. Slow flow is directly influenced by the aggregation and deformation of red blood cells, their number, and plasma viscosity. Consequently, the rheological status plays a crucial role in determining blood flow and its velocity.

Coronary slow flow research: a bibliometric analysis

BACKGROUND

Studies on coronary slow flow are receiving increasing attention, but objective evaluations are still lacking. The purpose of this study was to visualize the current status and research hotspots of coronary slow flow through bibliometric analysis.

METHODS

All relevant publications on coronary slow flow from 2003 to 2022 were extracted from the Web of Science Core Collection database and analyzed by VOSviewer and CiteSpace visualization software. Year of publication, journal, country/region, institution, and first author of each paper, as well as research hotspots were identified.

RESULTS

A total of 913 publications were retrieved. The journal with the most publications was Coronary Artery Disease. The country/region with the most publications was Turkey, followed by China and the United States. The institution with the largest publication volume was Turkey Specialized Higher Education Research Hospital. The author with the largest publication volume was Chun-Yan Ma from China. Keyword analysis indicated that "treatment and prognosis", "pathogenesis and risk factors" and "diagnosis" were the clustering centers of coronary slow flow, and the research hotspots gradually changed with time, from pathogenesis to treatment and prognosis.

CONCLUSION

Future research will focus on the search for effective and non-invasive detection indicators and treatments of coronary slow flow. Collaboration needs to be enhanced between different institutions or countries/regions, which would improve clinical outcomes for patients with coronary slow flow.

Association between the atherogenic index of plasma and adverse long-term prognosis in patients diagnosed with chronic coronary syndrome

BACKGROUND

The Atherogenic Index of Plasma (AIP) is a newly identified biomarker associated with lipid metabolism, demonstrating significant prognostic capabilities in individuals diagnosed with cardiovascular disease. However, its impact within the context of chronic coronary syndromes (CCS) remains unexplored. Thus, the present investigation sought to examine the potential association between AIP levels and long-term clinical outcomes in patients diagnosed with CCS.

METHODS

A total of 404 patients diagnosed with CCS and who underwent coronary angiography were included in this study. The AIP index was calculated as log (triglycerides / high-density lipoprotein-cholesterol). The patients were categorized into four groups based on their AIP values: Q1 (< -0.064), Q2 (-0.064 to 0.130), Q3 (0.130 to 0.328), and Q4 (> 0.328). The occurrence of major adverse cardiovascular events (MACE) was monitored during the follow-up period for all patients. Cox regression analysis and Kaplan-Meier curve analysis were employed to examine the relationship between AIP and MACE. Furthermore, ROC analysis was utilized to determine the optimal cut-off value of AIP for predicting clinical MACE.

RESULTS

During the median 35 months of follow-up, a total of 88 patients experienced MACE. Notably, the group of patients with higher AIP values (Q4 group) exhibited a significantly higher incidence of MACE compared to those with lower AIP values (Q1, Q2, and Q3 groups) (31.7% vs. 16.8%, 15.7%, and 23.0% respectively; P = 0.023). The Kaplan-Meier curves illustrated those patients in the Q4 group had the highest risk of MACE relative to patients in the other groups (log-rank P = 0.014). Furthermore, the multivariate Cox regression analysis demonstrated that individuals in the Q4 group had a 7.892-fold increased risk of MACE compared to those in the Q1 group (adjusted HR, 7.892; 95% CI 1.818-34.269; P = 0.006). Additionally, the ROC curve analysis revealed an optimal AIP cut-off value of 0.24 for predicting clinical MACE in patients with CCS.

CONCLUSION

Our data indicate, for the first time, that AIP is independently associated with poor long-term prognosis in patients suffering from CCS. The optimal AIP cut-off value for predicting clinical MACE among CCS patients was 0.24.

Evaluation of Atherosclerotic Risk by Oxidative Contributors in Alcohol Use Disorder

Objective

Alcohol Use Disorder (AUD) is a condition described as the inability to control or stop alcohol consumption. The patients with AUD have an increased risk of developing atherosclerosis-related diseases. The present study aimed to evaluate oxidative contributors of atherosclerotic risk factors in patients with AUD.

Methods

The male subjects diagnosed with AUD (n = 45) and the male subjects as control (n = 35) were enrolled in this study. All participants were undergone psychiatric evaluation and sociodemographic tests. Also, serum oxidative contributors of atherosclerosis including myeloperoxidase (MPO), ferroxidase, catalase (CAT), and lipid hydroperoxides (LOOH) were measured. Additionally, serum lipid profile tests and atherogenic indicators including atherogenic index of plasma (AIP) and non-high-density lipoprotein (HDL) cholesterol were also analyzed.

Results

The AUD subject had significantly elevated MPO activity and LOOH levels with decreased antioxidant capacity. AIP and non-HDL cholesterol levels, the atherogenic indicators, were also higher in AUD group compared to the control group. We found the MPO activity and LOOH levels were positively correlated with AIP, non-HDL cholesterol levels, and amount of alcohol consumption. Additionally, CAT activity was negatively correlated with duration of alcohol consumption.

Conclusion

Our results revealed that MPO and LOOH levels were elevated by severe alcohol intake and the atherogenic indicators, AIP and non-HDL cholesterol, were significantly correlated alcohol induced elevated oxidative risk factors. Therefore, it can be suggested that MPO activity and LOOH levels may be useful to determine jeopardy of atherosclerotic and the therapeutic interventions that reduce oxidative load could be taken into account to prevent atherosclerotic diseases before clinical manifestation.

Genetic Determinants of Atherogenic Indexes

Atherogenesis and dyslipidemia increase the risk of cardiovascular disease, which is the leading cause of death in developed countries. While blood lipid levels have been studied as disease predictors, their accuracy in predicting cardiovascular risk is limited due to their high interindividual and interpopulation variability. The lipid ratios, atherogenic index of plasma (AIP = log TG/HDL-C) and the Castelli risk index 2 (CI2 = LDL-C/HDL-C), have been proposed as better predictors of cardiovascular risk, but the genetic variability associated with these ratios has not been investigated. This study aimed to identify genetic associations with these indexes. The study population (n = 426) included males (40%) and females (60%) aged 18-52 years (mean 39 years); the Infinium GSA array was used for genotyping. Regression models were developed using R and PLINK. AIP was associated with variation on APOC3, KCND3, CYBA, CCDC141/TTN, and ARRB1 (p-value < 2.1 × 10^-6). The three former were previously associated with blood lipids, while CI2 was associated with variants on DIPK2B, LIPC, and 10q21.3 rs11251177 (p-value 1.1 × 10^-7). The latter was previously linked to coronary atherosclerosis and hypertension. KCND3 rs6703437 was associated with both indexes. This study is the first to characterize the potential link between genetic variation and atherogenic indexes, AIP, and CI2, highlighting the relationship between genetic variation and dyslipidemia predictors. These results also contribute to consolidating the genetics of blood lipid and lipid indexes.

The atherogenic index of plasma: A novel factor more closely related to non-alcoholic fatty liver disease than other lipid parameters in adults

Background and aims

The relationship of non-alcoholic fatty liver disease (NAFLD) with the atherogenic index of plasma (AIP) is unclear. This study aims to detect the association between AIP and NAFLD, compare the discriminative power of AIP with other lipid parameters for NAFLD, and establish a discriminant model using physical examination data.

Methods

Participants aged over 20 years who underwent routine physical examination in Beijing Chaoyang Hospital from April 2016 to August 2020 were included. We categorized subjects based on hepatic ultrasound results and analyzed the association between NAFLD risk and AIP, conventional plasma lipids, remnant cholesterol (RC), triglyceride and glucose (TyG) index, and other atherogenic indices (n = 112,200) using logistic regression, restricted cubic spline regression, and receiver operating characteristic curve.

Results

Out of the 112,200 subjects, 30.4% had NAFLD. The body weight index, plasma glucose, conventional lipids, TyG index, AIP, atherogenic coefficient (AC), and coronary risk index (CRI) were significantly higher, while HDL-C was lower (p < 0.001) in patients with NAFLD than those without NAFLD (all p < 0.001). Compared with conventional lipids, RC, TyG index, AC, and CRI, AIP had a stronger correlation with the risk of NAFLD (OR 6.71, 95% CI 6.23–7.22, p < 0.001) after adjusting confounders and presented a non-linear dose–response relationship (p < 0.0001). The optimal cut-off value of AIP was 0.05 and the area under the curve (AUC) was 0.82 (95% CI: 0.81–0.82) with high sensitivity and specificity. The AUC of the simplified three-variable NAFLD discriminant model was 0.90 in both the training set and the validation set.

Conclusion

AIP was significantly associated with NAFLD and showed superior discriminative performance to other lipid parameters. These findings might help screen NAFLD in high-risk individuals and reduce the prevalence of NAFLD.

Dyslipidemia and the Prevalence of Hypertension: A Cross-Sectional Study Based on Chinese Adults Without Type 2 Diabetes Mellitus

Background

In clinical practice, it is frequently observed that patients with hypertension often coexist with dyslipidemia. However, studies on atherosclerotic indices and the prevalence of hypertension are still limited. The purpose of this study was to assess the relationship between atherosclerotic indices and the prevalence of hypertension in Chinese adults without type 2 diabetes mellitus.

Methods

In this paper, a cross-sectional study was conducted based on 117,056 adults in 11 Chinese cities (Shanghai, Beijing, Wuhan, Suzhou, Shenzhen, Changzhou, Nantong, Guangzhou, Hefei, Nanjing, and Chengdu) from 2010 to 2016. Besides, the raw data was obtained from the public database (www.Datadryad.org), while eight atherosclerosis indices namely the atherogenic coefficient (AC), Castelli's risk index I (CRI-I) and II (CRI-II), the atherogenic index of plasma (AIP), the cholesterol index, the lipoprotein combined index (LCI), non-high-density lipoprotein cholesterol (non-HDL-C) and triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) were analyzed in this study. Apart from that, two groups of continuous variables were measured using the Mann-Whitney test, and categorical variables were analyzed using the Chi-square test. Differences between multiple groups of continuous variables were investigated using Kruskal-Wallis one-way analysis of variance (ANOVA) and Dunn's test. Furthermore, Spearman correlation analysis and multivariate logistic regression analyses were performed to assess the relationship between atherosclerotic indices and blood pressure levels, and the prevalence of hypertension, respectively. The results of multivariate logistic regression analyses were expressed as the odds ratio (OR) and their corresponding 95% confidence intervals (CIs). Moreover, the receiver operating characteristic (ROC) curve was depicted to further analyze the predictive value of the atherosclerotic indices on the prevalence of hypertension.

Results

The atherosclerosis indices were higher in the hypertensive population compared to those in the normotensive population. Meanwhile, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were linearly and positively correlated with atherosclerotic indices. In addition, multivariate logistic regression analysis showed that the cholesterol index and non-HDL-C were observed to be positively associated with the prevalence of hypertension (p for trend &lt; 0.05). Moreover, the prevalence of hypertension increased by 3.7% (OR: 1.037; 95% CI: 1.009-1.065; p = 0.009) and 6.1% (OR: 1.06; 95% CI: 1.033–1.091; p &lt; 0.001), respectively, as per 1-standard deviation (SD) increase in the cholesterol index and non-HDL-C. Beyond that, ROC analysis demonstrated that the cholesterol index and non-HDL-C have a good predictive value for the prevalence of hypertension in women, with under the ROC curve (AUC) of 0.659 and 0.684 and cut-off values of 47.94 and 134.34 mg/dl, accordingly.

Conclusions

In Chinese adults without type 2 diabetes mellitus, atherosclerotic indices were significantly higher in hypertensive populations compared with those in normotensive populations, regardless of hypertension levels. Meanwhile, SBP and DBP were linearly and positively related to atherosclerotic indices. Besides, the cholesterol index and non-HDL-C were independent risk factors for the prevalence of hypertension, and they could be adopted for effectively predicting the prevalence of hypertension in women.

Endothelial Dysfunction in Psoriasis: An Updated Review

Although psoriasis is predominantly a chronic inflammatory skin disorder, epidemiological data provide a solid link between psoriasis, especially in its more severe forms, and increased risk for cardiovascular morbidity and mortality. Apart from the increased prevalence of traditional cardiovascular risk factors, chronic inflammation appears to act synergistically with the underlying process of endothelial dysfunction toward the development of accelerated atherosclerosis, subclinical vascular injury and subsequently, clinically evident cardiovascular manifestations. Endothelial dysfunction is regarded as an early precursor of atherosclerosis with a predictive value for the development of future cardiovascular events. A thorough understanding of the mechanisms of endothelial dysfunction in psoriasis might pave the path for the development of more accurate cardiovascular risk prediction tools and possible therapeutic targets aiming to alleviate the increased cardiovascular burden associated with the disease. The present review summarizes the available evidence about the role of chronic inflammation and other important pathophysiological mechanisms involved in the development of endothelial dysfunction in psoriasis. An overview of studies implementing the most widely applied circulating and vascular biomarkers of endothelial dysfunction in psoriasis patients will be provided, and the impact of systemic psoriasis treatments on endothelial dysfunction and patients' cardiovascular risk will be discussed.