Predictive value of high sensitivity C-reactive protein in three-vessel disease patients with and without type 2 diabetes

Diabetic Status and Thrombogenicity: Association and Prognostic Implications After Percutaneous Coronary Intervention

BACKGROUND

A heightened prothrombotic environment, combined with premature and more aggressive atherosclerosis, contributes to the elevated cardiovascular risk in patients with diabetes mellitus (DM).

OBJECTIVES

The aim of this study was to evaluate the association between DM status and thrombogenicity and their prognostic implications in patients with significant coronary artery disease.

METHODS

A total of 2,501 patients with coronary artery disease undergoing percutaneous coronary intervention, with on-admission glycated hemoglobin and thrombogenicity indexes (measured by thromboelastography). Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death, myocardial infarction, or stroke within 4-year follow-up.

RESULTS

Patients with DM (n = 970 [38.8%]) demonstrated significantly higher platelet-fibrin clot strength (PFCS), as indicated by maximal amplitude (median [Q1-Q3]: 67.1 [62.2-72.2] mm vs. 65.5 [61.0-70.4] mm; P < 0.001), and reduced fibrinolytic activity, measured by lysis at 30 minutes (median [Q1-Q3]: 0.1% [0.0%-1.0%] vs. 0.2% [0.0%-1.3%]; P = 0.003), compared to patients without DM. PFCS level was closely related with diabetic status, showing a positive relationship with glycated hemoglobin level up to 7.0% and then reaching a plateau. In a multivariable analysis, high PFCS phenotype defined as maximal amplitude ≥68 mm (HR: 1.39; 95% CI: 1.07-1.81; P = 0.015) and DM phenotype (HR: 1.38; 95% CI: 1.05-1.79; P = 0.018) were independently associated with MACE occurrence. The presence of diabetic phenotype and high PFCS exhibited an additive effect on MACE occurrence (HR: 2.49; 95% CI: 1.77-3.51; P < 0.001).

CONCLUSIONS

In percutaneous coronary intervention-treated patients, diabetic status and clot-strength value were significantly correlated. High clot-strength phenotype increased the risk for MACE, irrespective of diabetic phenotype. (Gyeongsang National University Hospital Registry [GNUH]; NCT04650529).

Microbiota based personalized nutrition improves hyperglycaemia and hypertension parameters and reduces inflammation: a prospective, open label, controlled, randomized, comparative, proof of concept study

Background

Recent studies suggest that gut microbiota composition, abundance and diversity can influence many chronic diseases such as type 2 diabetes. Modulating gut microbiota through targeted nutrition can provide beneficial effects leading to the concept of personalized nutrition for health improvement. In this prospective clinical trial, we evaluated the impact of a microbiome-based targeted personalized diet on hyperglycaemic and hyperlipidaemic individuals. Specifically, BugSpeaks®-a microbiome profile test that profiles microbiota using next generation sequencing and provides personalized nutritional recommendation based on the individual microbiota profile was evaluated.

Methods

A total of 30 participants with type 2 diabetes and hyperlipidaemia were recruited for this study. The microbiome profile of the 15 participants (test arm) was evaluated using whole genome shotgun metagenomics and personalized nutritional recommendations based on their microbiota profile were provided. The remaining 15 participants (control arm) were provided with diabetic nutritional guidance for 3 months. Clinical and anthropometric parameters such as HbA1c, systolic/diastolic pressure, c-reactive protein levels and microbiota composition were measured and compared during the study.

Results

The test arm (microbiome-based nutrition) showed a statistically significant decrease in HbA1c level from 8.30 (95% confidence interval (CI), [7.74-8.85]) to 6.67 (95% CI [6.2-7.05]), p < 0.001 after 90 days. The test arm also showed a 5% decline in the systolic pressure whereas the control arm showed a 7% increase. Incidentally, a sub-cohort of the test arm of patients with >130 mm Hg systolic pressure showed a statistically significant decrease of systolic pressure by 14%. Interestingly, CRP level was also found to drop by 19.5%. Alpha diversity measures showed a significant increase in Shannon diversity measure (p < 0.05), after the microbiome-based personalized dietary intervention. The intervention led to a minimum two-fold (Log2 fold change increase in species like Phascolarctobacterium succinatutens, Bifidobacterium angulatum, and Levilactobacillus brevis which might have a beneficial role in the current context and a similar decrease in species like Alistipes finegoldii, and Sutterella faecalis which have been earlier shown to have some negative effects in the host. Overall, the study indicated a net positive impact of the microbiota based personalized dietary regime on the gut microbiome and correlated clinical parameters.

Prognostic Value of Fibrinogen-to-Albumin Ratio in Coronary Three-Vessel Disease

OBJECTIVE

To investigate the prognostic value of fibrinogen-to-albumin ratio (FAR) in the adverse outcomes of patients with coronary three-vessel disease (TVD).

METHODS

A total of 4061 patients with TVD between 2013 and 2018 were analyzed in this retrospective cohort study. The best cut‑off value of the FAR determined by receiver operating characteristic (ROC) curve analysis was 0.084. 2782 (68.5%) patients were in the low FAR group (FAR < 0.084) and 1279 (31.5%) patients were in the high FAR group (FAR ≥ 0.084), respectively. Three multivariate Cox proportional hazards models were applied to determine the associations of FAR with clinical outcomes. The concordance index (C-index), net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to assess the incremental predictive value of the FAR and baseline models with respect to the additive effects of the established traditional risk factors on the discrimination of clinical outcomes. The primary endpoint was all-cause mortality. The secondary endpoint was major adverse cardiac and cerebrovascular events (MACCEs).

RESULTS

The median follow-up duration was 2.4 years (range 1.1-4.1 years). Multivariate Cox regression analyses showed that the incidence of all-cause mortality (4.7% vs 2.2%, adjusted hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.12-2.52, p=0.011) and MACCE (34.6% vs 27.3%, HR 1.28, 95% CI 1.13-1.46, p<0.001) were significantly higher in the high FAR group compared to the low FAR group. The C-index was 0.72 (p < 0.001), the value of NRI was 0.3778 (p < 0.001), and the value of IDI was 0.0098 (p < 0.001) for those with FAR. After FAR was added to the traditional model, the discrimination and risk reclassification ability can be significantly improved for all-cause mortality. The similar results were found for MACCE.

CONCLUSION

Higher level of FAR was associated with all-cause mortality and MACCE among patients with TVD. FAR could help to improve the prognostic performance of the traditional risk factors for TVD patients.