The relationship between vitamin D deficiency and coronary artery ectasia

C-Reactive Protein, Uric Acid, and Coronary Artery Ectasia in Patients with Coronary Artery Disease

BACKGROUND Coronary artery ectasia (CAE) is frequently present with coronary artery disease (CAD). However, it is not clear why some patients with CAD progress to CAE while others do not. The pathogenesis of CAE is still poorly elucidated. C-reactive protein (CRP) and serum uric acid are well-known markers of inflammation. We aimed to investigate the possible associations among CRP, uric acid, and CAE in patients with CAD. MATERIAL AND METHODS We retrospectively evaluated data from 2400 patients undergoing coronary angiography. Seventy-four patients with CAE and CAD and 124 patients with only CAD detected on coronary angiography examination were included in this study. Univariate and multivariate logistic regression analyses were performed to evaluate the associated parameters of CAE in patients with CAD. RESULTS Patients with CAE and CAD were younger than patients with only CAD (63±9.5 vs 66.1±9.4, P=0.028). Male sex was more prevalent in patients with CAE and CAD than in patients with only CAD (86.5% vs 74.2%; P=0.029). CRP and uric acid were higher in patients with CAE and CAD compared to the patients with only CAD (10.9±12.8 vs 6.6±6.4; P=0.004; 5.9±1.4 vs 5.2±1.5; P=0.002, respectively). In multivariate regression analysis, age [P=0.029,OR(95% CI) 0.958(0.921-0.996)], CRP [P=0.010,OR (95% CI) 1.058 (1.014-1.103)], and uric acid [P=0.002,OR (95%CI) 1.527 (1.173-1.988)] were associated with CAE in patients with CAD. CONCLUSIONS The CRP and uric acid levels were higher in patients with CAE and CAD compared to the patients who only had CAD. Also, CRP and uric acid were associated with CAE. These results reflect the higher-grade vascular inflammation relative to atherosclerotic involvement in the presence of concomitant CAE in patients with CAD.

Monocyte Chemoattractant Protein-1 Is an Independent Predictor of Coronary Artery Ectasia in Patients with Acute Coronary Syndrome

Our purpose was to assess a possible association of inflammatory, lipid and mineral metabolism biomarkers with coronary artery ectasia (CAE) and to determine a possible association of this with acute atherotrombotic events (AAT). We studied 270 patients who underwent coronary angiography during an acute coronary syndrome 6 months before. Plasma levels of several biomarkers were assessed, and patients were followed during a median of 5.35 (3.88–6.65) years. Two interventional cardiologists reviewed the coronary angiograms, diagnosing CAE according to previously published criteria in 23 patients (8.5%). Multivariate binary logistic regression analysis was used to search for independent predictors of CAE. Multivariate analysis revealed that, aside from gender and a diagnosis of dyslipidemia, only monocyte chemoattractant protein-1 (MCP-1) (OR = 2.25, 95%CI = (1.35–3.76) for each increase of 100 pg/mL, p = 0.001) was independent predictor of CAE, whereas mineral metabolism markers or proprotein convertase subtilisin/kexin type 9 were not. Moreover, CAE was a strong predictor of AAT during follow-up after adjustment for other clinically relevant variables (HR = 2.67, 95%CI = (1.22–5.82), p = 0.013). This is the first report showing that MCP-1 is an independent predictor of CAE, suggesting that CAE and coronary artery disease may share pathogenic mechanisms. Furthermore, CAE was associated with an increased incidence of AAT.

Is there any association between vitamin D levels and isolated coronary artery ectasia?

Introduction

It has been postulated that low vitamin D levels are associated with coronary artery diseases. Coronary artery ectasia (CAE) is associated with atherosclerosis, congenital cardiac defects, immunological diseases and connective tissue diseases. In this study, we aimed to investigate whether there is an association between vitamin D and parathormone levels and isolated coronary artery ectasia and its extent.

Material and methods

The study included 93 participants: 47 patients (35 male, 12 female) with isolated CAE and 46 subjects (28 male, 18 female) with normal coronary arteries. Demographic characteristics of patients and controls were obtained from medical records, and Markis scores of patients were calculated. Serum vitamin D and parathormone levels were quantitatively measured by the paramagnetic particle chemiluminescence method.

Results

Serum vitamin D levels were found to be significantly lower in patients with isolated CAE than the control group (9.15 ±4.4 ng/ml, 13.35 ±5.9 ng/ml, p < 0.001). Parathormone levels were significantly higher in the CAE group than the control group (61.4 ±31.6, 48.7 ±25.5, p < 0.036). However, the study revealed no association between serum vitamin D levels and the extent of CAE according to the Markis classification (p = 0.23).

Conclusions

This study revealed that lower vitamin D levels and higher parathormone levels were associated with isolated CAE, but there was no association between vitamin D levels and the extent of CAE.

The Relationship between Vitamin D and Coronary Artery Ectasia in Subjects with a Normal C-Reactive Protein Level

Background and Objectives

Vitamin D is generally known to be closely related to inflammation. The effects of vitamin D on coronary artery disease (CAD) are not fully explained. Nowadays, coronary artery ectasia (CAE) cases are common and are regarded as being a kind of CAD. We aimed to investigate, in a case-control study, the relationship between vitamin D and CAE without an associated inflammatory process.

Subjects and Methods

This study population included 201 patients (CAE group, 121 males; mean age, 61.2±6.4 years) with isolated CAE; and 197 healthy individuals (control group, 119 males; mean age, 62.4±5.8 years), comprising the control group, who had normal coronary arteries. These participants concurrently underwent routine biochemical tests, tests for inflammatory markers, and tests for 25-OH vitamin D in whole-blood draws. These parameters were compared.

Results

There are no statistical significance differences among the groups for basic clinical characteristics (p>0.05). Inflammatory markers were recorded and compared to exclude any inflammatory process. All of them were similar, and no statistical significance difference was found. The average parathyroid hormone (PTH) level of patients was higher than the average PTH level in controls (41.8±15.1 pg/mL vs. 19.1±5.81 pg/mL; p<0.001). Also, the average 25-OH vitamin D level of patients was lower than the average 25-OH vitamin D level of controls (14.5±6.3 ng/mL vs. 24.6±9.3 ng/mL; p<0.001). In receiver operating characteristic curve analysis, the observed cut-off value for vitamin D between the control group and patients was 10.8 and 85.6% sensitivity and 75.2% specificity (area under the curve: 0.854, 95% confidence interval: 0.678-0.863).

Conclusion

We found that there is an association between vitamin D and CAE in patients who had no inflammatory processes. Our study may provide evidence for the role of vitamin D as a non-inflammatory factor in the pathophysiology of CAE.

Vitamin D and inflammation: evaluation with neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio

INTRODUCTION

Association of vitamin D, inflammation and endothelial dysfunction, beside the classic bone metabolism disorders, may explain the pathogenesis of numerous diseases associated with vitamin D deficiency. While large numbers of reports support the relationship of vitamin D with inflammation, several reports fail to confirm this relationship. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel and inexpensive markers of inflammation that can be studied in all centers. The goal of this study was to investigate the association between 25-hydroxy vitamin D (25(OH)D) and inflammation with the novel inflammatory markers NLR and PLR.

MATERIAL AND METHODS

This study was performed retrospectively. Results of the simultaneously performed 25(OH)D, parathyroid hormone, albumin, calcium, phosphorus, alkaline phosphatase and creatinine level measurements and complete blood count were recorded. The data of 4120 patients were included in the study.

RESULTS

Between vitamin D deficient and non-deficient groups there were significant differences in PLR (p < 0.001) and NLR (p = 0.001). Vitamin D had a significant negative correlation with PLR (p < 0.001) and NLR (p < 0.001). Multiple regression analysis indicated that 25(OH)D was independently and negatively correlated with PLR (OR = 0.994, 95% CI 0.991-0.998, p = 0.02).

CONCLUSIONS

Platelet-to-lymphocyte ratio and NLR were significantly associated with 25(OH)D levels, and PLR was found to be an independent predictor of 25(OH)D levels. Our study revealed an inverse association of vitamin D levels and inflammation with these inexpensive and universally available markers.

25-Hydroxy-vitamin D level may predict presence of coronary collaterals in patients with chronic coronary total occlusion

Introduction

Sufficient coronary collateral circulation (CCC) protects myocardial tissue against ischemia in patients with coronary chronic total occlusion (CTO). Vitamin D is a steroid hormone which has been related to increased prevalence of hypertension, left ventricular hypertrophy, heart failure, peripheral artery disease, coronary artery disease, myocardial infarction and cardiovascular mortality.

Aim

To investigate whether there is an association between serum 25-hydroxy-vitamin D levels and development of CCC in patients with coronary CTO.

Material and methods

A total of 188 patients with CTO at coronary angiography were included in this study. Vitamin D and parathyroid hormone (PTH) levels were measured on the day of coronary angiography. Development of collateral circulation was graded according to the Rentrop classification after coronary angiography. Then, patients were divided into two groups on the basis of CCC grades: group 1 included 68 (36%) patients with poorly developed CCC, and group 2 included 120 (64%) patients with well-developed CCC.

Results

Patients with poorly developed CCC had significantly lower serum 25-hydroxy-vitamin D levels compared to those with well-developed CCC (20 ±3 vs. 30 ±6 ng/ml, p<0.0001). Multivariate logistic regression analysis indicated serum 25-hydroxyvitamin D (25(OH)D) (OR = 1.794, 95% confidence interval (CI): 1.453–2.216; p<0.001) as an independent predictor of poor collateral flow in patients with CTO.

Conclusions

Low vitamin D level is an independent predictor of poor CCC in patients with CTO.