Current Evidence on Prevention of Atrial Fibrillation: Modifiable Risk Factors and the Effects of Risk Factor Intervention

Atrial fibrillation (AF) is one of the most encountered arrhythmias in clinical practice. It is also estimated that the absolute AF burden may increase by greater than 60% by 2050. It is inevitable that AF will become one of the largest epidemics in the world and may pose a major health problem for countries. Although AF rarely causes mortality in the acute period, it causes a significant increase in mortality and morbidity, including a fivefold increase in the risk of stroke, a twofold increase in dementia, and a twofold increase in myocardial infarction in the chronic period. Despite all the advances in the treatment of AF, it is better understood day by day that preventing AF may play a key role in reducing AF and its related complications. Modification of the main modifiable factors such as quitting smoking, abstaining from alcohol, changing eating habits, and exercise seems to be the first step in preventing AF. The strict adherence to the treatment process of secondary causes predisposing to AF such as DM, hypertension, obesity, and sleep apnea is another step in the prevention of AF. Both an individual approach and global public health campaigns can be highly beneficial to reduce the risk of AF. In this review, we aimed to summarize the current evidence on the relationship between modifiable risk factors and AF, and the impact of possible interventions on these factors in preventing or reducing the AF burden in the light of recently published guidelines and studies.

Systemic Immune-Inflammation Index and C-Reactive Protein/Albumin Ratio Could Predict Acute Stent Thrombosis and High SYNTAX Score in Acute Coronary Syndrome

Acute stent thrombosis (AST) is associated with increased morbidity and mortality. The main aim of this study was to evaluate the prognostic value of the systemic immune-inflammation index (SII) and C-reactive protein (CRP) to albumin ratio (CAR) in predicting AST and high SYNTAX score in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). The criteria of the Academic Research Consortium were used to determine definite stent thrombosis. A total of 2077 consecutive patients with ACS undergoing PCI were retrospectively enrolled. Platelet, white blood cell and neutrophil counts, as well as SII, CRP, CAR, and peak cardiac troponin I (cTnI) values were significantly higher, whereas the lymphocyte count and albumin values were significantly lower in the AST (+) group compared with the AST (-) group (P < .05). SYNTAX score showed significant positive correlations with SII (r = .429, P < .001) and CRP (r = .402, P < .001). Multivariate logistic regression analysis showed that SII and CAR, as well as age, diabetes mellitus, stent length, and peak cTnI are independent predictors of AST and high SYNTAX score. In conclusion, the SII and CAR are simple, relatively cheap, and reliable inflammatory biomarkers that can predict AST and high SYNTAX scores in ACS.

Oxidative stress biomarkers and burden of coronary atherosclerosis assessed based on SYNTAX score

Letter in regards to: Akboga MK, Balci KG, Maden O et al. Usefulness of monocyte to HDL-cholesterol ratio to predict high SYNTAX score in patients with stable coronary artery disease. Biomark. Med. 10(4), 375-383 (2016). In response to: Soylemez S.Oxidative stress and SYNTAX score in patients with stable coronary artery disease. Biomark. Med. 11(8), doi:10.2217/bmm-2016-0326 (2017) (Epub ahead of print).

Association of lymphocyte-monocyte ratio and monocyte-to-high-density lipoprotein ratio with the presence and severity of rheumatic mitral valve stenosis

Aim: We aimed to evaluate the relationships between monocyte-to-high-density lipoprotein ratio (MHR) and lymphocyte-to-monocyte ratio (LMR) and rheumatic mitral valve stenosis (RMVS). Methodology: A total of 368 patients with mitral stenosis and 80 healthy participants were included. Patients were categorized into two groups in respect to the severity of RMVS as mild-moderate group (mitral valve area ≥1.0 cm2) and severe group (mitral valve area <1.0 cm2). Results: The MHR (10.6 ± 2.3, 11.6 ± 2.6, 13.8 ± 3.1; p < 0.001) and C-reactive protein levels (control group, nonsevere RMVS and severe RMVS groups 3.4 ± 0.7, 4.4 ± 1.1, 5.2 ± 1.4, respectively; p < 0.001) were significantly increased whereas LMR (4.51 ± 1.3, 3.57 ± 1.3, 3.14 ± 1.4; p < 0.001) levels were significantly decreased in parallel to the severity of mitral stenosis. Discussion/conclusion: MHR and LMR can be used to predict severity of RMVS.

Assessment of monocyte to high density lipoprotein cholesterol ratio and lymphocyte-to-monocyte ratio in patients with metabolic syndrome

AIM

We aimed to investigate the relationships between metabolic syndrome (MS) and monocyte to high density lipoprotein cholesterol ratio (MHR) and lymphocyte-to-monocyte ratio (LMR).

METHODS

762 patients (n = 371 MS present and n = 391 MS absent) were enrolled.

RESULTS

MHR was significantly higher [13.9 (10.5-18.1) vs 11.1 (8.0-14.8); p < 0.001], whereas LMR was significantly lower [4.5 (3.6-5.7) vs 3.6 (2.9-4.8); p < 0.001] in patients with MS. LMR [OR: 0.796 (95% CI): 0.711-0.892); p < 0.001], MHR [OR: 1.052 (95% CI: 1.018-1.088); p = 0.003] and C-reactive protein [OR: 1.048 (95% CI: 1.032-1.065); p < 0.001] remained as independent variables for the presence of MS.

CONCLUSION

The present study shows that both LMR and MHR may be novel and useful indicators of MS.

Evaluation of the Predictive Value of CHA2DS2-VASc Score for In-Stent Restenosis

The CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke, vascular disease, age 65-74 years, female gender) score is used to estimate thromboembolic risk in atrial fibrillation (AF). Its usefulness in predicting in-stent restenosis (ISR) is unknown. We evaluated the predictive value of the CHA2DS2-VASc score in AF-free patients who have undergone stent implantation. A total of 1350 patients who underwent coronary angiography and successful bare-metal stent implantation were analyzed. The CHA2DS2-VASc score was calculated before percutaneous coronary intervention, and the association between the score and ISR was investigated. Patients (n = 700; mean age: 61.4 [8.7] years, 63% men) were divided in 2 subgroups according to the presence of ISR; 265 of 700 patients had ISR. Mean CHA2DS2-VASc score was significantly higher in the ISR (+) group than the ISR (−) group (3.7 [1.8] vs 2.1 [1.4], P < .001). According to multivariate logistic regression analysis, diabetes, hyperlipidemia, smoking, stent length, and CHA2DS2-VASc score were independent predictors of ISR. In conclusion, the CHA2DS2-VASc score may be useful as a new and simple tool to predict ISR.

Relation between lymphocyte to monocyte ratio and short-term mortality in patients with acute pulmonary embolism

INTRODUCTION

The relationship between inflammation and mortality after acute pulmonary embolism (APE) has previously been investigated with different variables (platelet/lymphocyte ratio, etc).

OBJECTIVES

We investigated the predictive value of lymphocyte to monocyte ratio (LMR) for mortality in first 30 days after APE.

METHODS

The study population included 264 APE patients of which 230 patients were survivors, 34 patients were non-survivors.

RESULTS

LMR was significantly lower in non-survivors after APE (P < .001). Neutrophil-to-lymphocyte ratio (NLR) was higher in non-survivors after APE (P < .001). Platelet-to-lymphocyte (PLR) had no significance between both groups (P: .241). Simplified pulmonary embolism severity index and LMR were independent predictors of mortality in patients with APE (P: .008 and P: .001, respectively).

CONCLUSION

LMR as a novel marker of inflammation seemed to be an independent predictor of short-term mortality in patients with APE.

Tp-e Interval, Tp-e/QTc Ratio, and Fragmented QRS Are Correlated with the Severity of Liver Cirrhosis

BACKGROUND

Arrhythmias and electrocardiographic changes are reported in several noncardiac diseases, including liver cirrhosis (LC). We intended to evaluate the interval from the peak to the end of the electrocardiographic T wave (Tp-e), Tp-e/QTc ratio, and fQRS as presumed markers of arrhythmias in LC.

METHODS

In this cross-sectional study, a total of 88 consecutive patients with LC according to clinical, biological, ultrasonographic, or histological criteria and 73 control subjects were enrolled. The severity of cirrhosis was classified according to Pugh-Child's classification and Model for End-Stage Liver Disease (MELD) score. Tp-e interval, Tp-e/QTc ratio, and fQRS rates were measured from the 12-lead electrocardiogram.

RESULTS

Tp-e interval, Tp-e/QTc ratio and fQRS rates were significantly increased in parallel to the severity of LC (P < 0.001, P < 0.001, and P = 0.003, respectively). In correlation analysis, Pugh-Child stage showed a significantly positive correlation with Tp-e interval (r = 0.462, P < 0.001), QTc interval (r = 0.373, P < 0.001), Tp-e/QTc ratio (r = 0.352, P < 0.001), and fQRS (r = 0.407, P < 0.001). Furthermore, Tp-e interval (r = 0.414, P < 0.001) and Tp-e/QTc ratio (r = 0.426, P< 0.001) had significant positive correlation with MELD score.

CONCLUSIONS

Our study demonstrated that Tp-e interval, Tp-e/QTc ratios, and fQRS rates were significantly increased in parallel to the severity of LC. Thus, these findings may implicate that Tp-e interval, Tp-e/QTc ratio, and fQRS may be novel and useful indicators for prediction of arrhythmias in LC.

Usefulness of monocyte to HDL-cholesterol ratio to predict high SYNTAX score in patients with stable coronary artery disease

AIM

We aimed to investigate whether baseline monocyte to high-density lipoprotein cholesterol ratio (MHR), an easily available inflammatory and oxidative stress marker, is associated with SYNTAX score.

PATIENTS & METHODS

In this cross-sectional study, n = 1229 consecutive patients with coronary artery disease were classified into two groups, low SYNTAX score (≤22) and high SYNTAX score (≥23).

RESULTS

MHRs were significantly higher in patients with high SYNTAX score (p < 0.05). In multivariate regression analysis, MHR remained as independent predictor of high SYNTAX score together with C-reactive protein (CRP), hypertension and diabetes mellitus. In correlation analysis, MHR showed significant positive correlations with SYNTAX score (r = 0.371, p < 0.001) and CRP level (r = 0.336, p < 0.001).

CONCLUSION

This study suggests MHR is independently associated with burden of coronary atherosclerosis.

Usefulness of the Macruz Index for Predicting Successful Percutaneous Mitral Balloon Valvuloplasty in Patients with Mitral Stenosis

OBJECTIVE

The aim of this study was to determine whether the Macruz index (P/P-R segment) could predict the severity of valvular involvement and the success of percutaneous mitral balloon valvuloplasty (PMBV) in patients with mitral stenosis (MS).

SUBJECTS AND METHODS

Sixty-one patients with MS eligible for PMBV and 72 healthy subjects (61 females and 11 males) with sinus rhythm were enrolled into this study. PMBV was performed in all patients using a percutaneous transseptal antegrade approach and a multitrack balloon technique. The P/P-R segment ratio and echocardiographic variables were measured before and 48-72 h after the procedure. The optimal cutoff point for differences in the Macruz index to determine clinical success was evaluated by receiver operating characteristic analysis by calculating the area under the curve as giving the maximum sum of sensitivity and specificity for the significant test.

RESULTS

In the patient group (mean age 42.9 ± 11.1 years), the preprocedural Macruz index was significantly higher than in the control group (2.79 ± 1.03 vs. 1.29 ± 0.11; p < 0.001). In the successful-procedure group (n = 53), the mean postindex value was significantly lower (2.12 ± 0.71 vs. 2.81 ± 1.0, p = 0.020), and the decrease in the Macruz index was significantly higher than in the unsuccessful-procedure group (p = 0.007). An index decrease of 0.105 was the best cutoff value to distinguish the successful-PMBV group from the unsuccessful- PMBV group (area under the curve = 0.888, 95% confidence interval 0.788-0.988, p < 0.001).

CONCLUSION

The Macruz index was significantly higher in patients with MS compared to healthy subjects. A greater decrease in the Macruz index was associated with a successful PMBV.

Increased red cell distribution width predicts occlusion of the infarct-related artery in STEMI

OBJECTIVE

Infarct-related artery (IRA) patency yields a better outcome in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Red cell distribution width (RDW) emerges as a marker of adverse cardiovascular events and mortality in STEMI. Therefore, we aimed to assess the relationship between IRA patency and RDW value on admission in patients with STEMI undergoing primary PCI.

METHODS

A total of 564 patients with STEMI undergoing primary PCI were recruited in this study. According to thrombolysis in myocardial infarction (TIMI) flow grade in the IRA before PCI, the study population was divided into two groups as TIMI 0 or 1 group (occluded IRA, n = 398) and TIMI 2 or 3 group (patent IRA, n = 166).

RESULTS

RDW was significantly higher in the occluded IRA group (15.1 ± 1.7 versus 13.4 ± 1.3, p < 0.001) as compared to the patent IRA group. White blood cell (WBC) count, platelet count, creatine kinase-myocardial band (CK-MB) and troponin-I levels were also significantly higher in the occluded IRA group (p < 0.05). Moreover, RDW showed positive correlations with troponin-I (r = 0.397, p < 0.001), CK-MB (r = 0.344, p < 0.001) and WBC (r = 0.219, p < 0.001). In multivariate regression analysis, RDW (OR: 0.483, 95% CI: 0.412-0.567, p < 0.001) and WBC count were significantly and independently associated with IRA patency.

CONCLUSIONS

Our findings suggested that RDW value and WBC count on admission were independent predictors of IRA patency in patients with STEMI. As RDW is an easily available, simple and cheap biomarker, it can be used in daily practice as a novel predictor for IRA patency.

Relationship between serum vitamin D levels and angiographic severity and extent of coronary artery disease

BACKGROUND

Vitamin D is known for its effect in calcium and bone homeostasis. There is an increasing evidence for health benefits accomplished by activated vitamin D that go beyond these classical functions. Previous studies have suggested that lower vitamin D levels are associated with increased cardiovascular disease risk. Therefore, we aimed to evaluate relationship between vitamin D levels and extent and severity of coronary artery disease.

MATERIALS AND METHODS

A total of 746 patients in whom coronary angiography was performed between August 2012 and July 2013 were enrolled in this study. Serum vitamin D levels were measured, and patients were grouped according to their serum vitamin D levels (vitamin D <20 ng/mL (n = 602) Group 1 versus >20 ng/dL (n = 144) Group 2). Gensini score system was used to evaluate the association between serum vitamin D levels and severity and extent of coronary artery disease.

RESULTS

There was no significant difference between the groups in terms of baseline characteristics and demographic characteristics. Mean serum vitamin D levels of all patient cohort was 15.54 ± 7.46 ng/mL. Group 1 and Group 2 had an average serum vitamin D levels of 12.6 ± 3.3 ng/mL and 27.5 ± 7.8 ng/mL, respectively. Gensini score for all cohort was 26.25 ± 34.32. Group 1 had an average Gensini score of 26.4 ± 35.7; on the other hand, Gensini score was 25.5 ± 27.5 in Group 2 (P = 0.097).

CONCLUSIONS

This study failed to demonstrate significant relationship between serum vitamin D levels and the severity and extent of coronary artery disease. Further studies with more participation and homogenous groups with comparable individual and environmental features are needed to evaluate the association of serum vitamin D levels and cardiovascular diseases.

The association of the platelet-to-lymphocyte ratio with mitral annular calcification

OBJECTIVES

Mitral annular calcification (MAC) and atherosclerosis are similar in regard to risk factors and pathogenesis. Increased platelet-to-lymphocyte ratio (PLR) has been shown to be associated with atherosclerotic diseases in previous studies. In this study, we aimed to show the association of PLR levels with the presence of MAC.

DESIGN

A total of 1060 patients [n = 704 MAC (+), and n = 356 MAC (-)] who were admitted to our cardiology department were enrolled between January 2014 and December 2014. Demographic, clinical, and laboratory parameters of all participants were recorded. PLR was calculated from the complete blood count.

RESULTS

The MAC (+) group comprised of those older in age and having a higher rate of hypertension. The mean PLR value was also significantly higher in the MAC (+) group, as compared to that in the MAC (-) group (129.1 ± 32.2 vs 103.5 ± 23.8, p < 0.001). There was a statistically significant and positive correlation between the neutrophil-to-lymphocyte ratio (NLR) and PLR (r = 0.644, p < 0.001). Age, hypertension, mean platelet volume, NLR, and PLR (OR: 1.109, 95% CI: 1.101-1.123, p < 0.001) were independently associated with the presence of MAC.

CONCLUSIONS

Our results demonstrated that the PLR was significantly increased in patients with MAC, and that the PLR was independently associated with the presence of MAC.

Platelet to lymphocyte ratio as a novel indicator of inflammation is correlated with the severity of metabolic syndrome: A single center large-scale study

Metabolic syndrome (MetS) as a cluster of several cardio-metabolic components is rapidly growing public-health problem worldwide and significantly associated with poor cardiovascular outcomes. Increased visceral adiposity activates the important pathways connecting low-grade chronic inflammation, oxidative stress and blood coagulation. Recently, platelet to lymphocyte ratio (PLR) has been evidenced as a novel indirect inflammatory marker. Therefore, for the first time, we aimed to investigate the association of PLR with both the presence and severity of MetS. In this cross-sectional study, a total of 1146 participants were enrolled (n = 539 with MetS and n = 607 without MetS). MetS was defined according to NCEP-ATP III criteria. MetS (+) group revealed significantly higher PLR and C-reactive protein (CRP) levels as compared to MetS (-) group (p < 0.05). There was a graded relationship between increasing number of MetS components and PLR (p < 0.05). Also, PLR was positively correlated with CRP level (r = 0.163, p < 0.001). In multivariate regression analysis, PLR [1.121 (1.113-1.135), p < 0.001], CRP [1.044 (1.029-1.060), p < 0.001], and age [1.030 (1.017-1.043), p < 0.001] were remained as independent predictors for the presence of MetS. In conclusion, our findings showed that increased PLR was significantly associated with both the presence and severity of MetS which was linked to systemic inflammation based on the correlation between PLR and CRP. As PLR is an easily available, simple and cheap indirect indicator of inflammation, it can be used in clinical practice as a predictor of MetS.

Association of Monocyte-to-HDL Cholesterol Ratio with Slow Coronary Flow is Linked to Systemic Inflammation

BACKGROUND

Previous studies proposed that both inflammation, oxidative stress, and impaired endothelial dysfunction have a significant role in occurrence of slow coronary flow (SCF). monocyte-to-high density lipoprotein cholesterol ratio (MHR) is a recently emerged indicator of inflammation and oxidative stress, which have been studied only in patients with chronic kidney disease.

HYPOTHESIS

We aimed to assess the relationship between MHR and SCF.

METHODS

Patients who had angiographically normal coronary arteries were enrolled in this retrospective study (n = 253 as SCF group and n = 176 as control group). Patients who had corrected thrombolysis in myocardial infarction frame counts (cTFCs) above the normal cutoffs were defined as with SCF.

RESULTS

The MHR and high-sensitivity C-reactive protein (hsCRP) were significantly higher in the SCF group. In correlation analysis, MHR has a significantly positive correlation with cTFC and serum hsCRP levels (P < .001). In multivariate logistic regression analysis, MHR was found as independently associated with the presence of SCF (odds ratio: 1.24, P < .001).

CONCLUSION

Higher MHR which indicates an enhanced inflammation and oxidative stress was significantly and independently associated with the presence of SCF. Besides, MHR was positively correlated with serum hsCRP level as a conventional marker for systemic inflammation.

The Relationship Between Epicardial Adipose Tissue Thickness and Infarct-Related Artery Patency in Patients With ST-Segment Elevation Myocardial Infarction

We investigated the relationship between epicardial adipose tissue (EAT) and infarct-related artery (IRA) patency before mechanical reperfusion in patients with ST-segment elevation myocardial infarction (STEMI). Patients (n = 640) were divided into 2 groups based on the thrombolysis in myocardial infarction (TIMI) flow grade. Impaired flow was defined as TIMI grades 0, 1, and 2, and normal flow was defined as TIMI 3. On the admission angiography, 65 (10.2%) patients had TIMI 3 flow, and the remaining 575 (89.8%) had TIMI 0, 1, or 2 flow. The impaired flow group patients had a higher incidence of diabetes mellitus (53.7% vs 41.5%, P = .035), higher EAT thickness (5.66 ± 1.84 vs 4.87 ± 2.09 mm, P = .001), and lower ejection fraction (43.1% ± 8.9% vs 47.4% ± 9.1%, P = .025). Multivariate stepwise logistic regression analysis showed that IRA patency was independently associated with EAT thickness (odds ratio [OR] 0.785; 95% confidence interval [CI] 0.712-0.858; P = .001) and neutrophil–lymphocyte ratio (OR 0.815; 95% CI 0.732-0.917; P = .025). Thickness of EAT was an independent predictor of lower TIMI flow in IRA in patients with STEMI.

The effect of statin treatment on P-wave characteristics and atrial conduction time

BACKGROUND AND AIM

The aim of this study was to evaluate the effect of statin treatment on P-wave morphology, dispersion, and tissue Doppler imaging-derived atrial conduction time (PA-TDI), which are known to be predictors of atrial fibrillation (AF).

METHODS

A total of 132 patients with guideline-directed statin indications but no clinical atrial tachyarrhythmias were studied. P-wave duration, P-wave dispersion, and P-wave amplitude on surface 12-lead electrocardiogram and PA-TDI were evaluated before and after three months of statin (either atrovastatin 10-40 mg/d or rosuvastatin 10-20 mg/d) treatment.

RESULTS

Total and low-density lipoprotein cholesterol were significantly reduced after statin therapy. P-wave dispersion significantly decreased from 39.6 ± 9.4 to 36.9 ± 9.6 ms. Statin treatment significantly decreased both the maximum (from 1.5 ± 0.36 to 1.45 ± 0.33 mV, p = 0.001) and the minimum (from 1.07 ± 0.28 to 1.04 ± 0.27 mV, p = 0.01) P-wave amplitude. The PA-TDI value was found to be significantly shorter after statin treatment (121.7 ± 18.7 vs. 118.7 ± 15.8 ms, p = 0.016) CONCLUSIONS: Short-term statin therapy was shown to significantly affect P-wave amplitude, P-wave dispersion, and atrial conduction time in a broad range of patients without any clinical atrial tachyarrhythmia.

Association of Platelet to Lymphocyte Ratio With Inflammation and Severity of Coronary Atherosclerosis in Patients With Stable Coronary Artery Disease

The platelet to lymphocyte ratio (PLR) has recently emerged as a potential inflammatory biomarker. Hence, we assessed the relationship between PLR and the extent/severity of coronary artery disease (CAD) using the Gensini score in association with the inflammatory marker C-reactive protein (CRP) in patients with stable CAD. Angiographic data of 1646 patients were analyzed in this cross-sectional study. Patients were categorized according to Gensini scores as no CAD (control), mild, and severe CAD groups. The PLR in the control group was significantly lower than those of mild and severe CAD groups. In multivariate logistic regression analysis, PLR was found to be an independent predictor of the presence of severe CAD (odds ratio: 1.043 [1.036-1.049], P < .001). Furthermore, there was a significant correlation between PLR and the severity of CAD (r = .370, P < .001) and CRP levels (r = .312, P < .001). In conclusion, PLR was independently and positively associated with the severity of coronary atherosclerosis. These results suggest that PLR is an easily available and cheap inflammatory indicator that can be used in predicting the severity of CAD.

Association of serum total bilirubin level with severity of coronary atherosclerosis is linked to systemic inflammation

OBJECTIVE

Although cardiovascular protective action of bilirubin has been attributed to its antioxidant effect, there was scarce data regarding the anti-inflammatory properties. Herein, we aimed to assess the relationship between serum total bilirubin level and severity of coronary artery disease (CAD) in association with the direct inflammatory marker such as C-reactive protein (CRP), the other indirect markers included in inflammation process such as neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) in patients with stable CAD.

METHODS

Angiographic data of 1501 patients were analyzed in this retrospective cross-sectional study. Patients were categorized according to Gensini scores as control, mild CAD and severe CAD groups. The association of clinical and laboratory parameters with the severity of CAD were determined by multivariable linear regression analysis.

RESULTS

Total bilirubin level in the control group was significantly higher than those of the other groups. After multivariable linear regression analysis total bilirubin [β=-3.131 (-4.481, -1.782), p<0.001] was significantly associated with the severity of CAD. Futhermore, there was a moderate and significant inverse correlation between serum total bilirubin level and the severity of CAD (r=-0.173, p<0.001), CRP (r=-0.112, p<0.001), NLR (r=-0.070, p=0.026) and RDW (r=-0.074, p=0.027).

CONCLUSION

Serum total bilirubin level was independently and inversely associated with the severity of coronary atherosclerosis in patients with stable CAD. In addition, total bilirubin level was inversely correlated with CRP, NLR and RDW. These results suggest that besides its already known effect on the oxidative stress, higher serum total bilirubin level may exhibit an anti-inflammatory effect in the coronary atherosclerotic process.

Increased Platelet to Lymphocyte Ratio is Related to Slow Coronary Flow

Previous studies showed that both inflammation and platelets have a role in development of slow coronary flow (SCF). Platelet to lymphocyte ratio (PLR) as an emerging inflammatory indicator was significantly associated with adverse cardiovascular events. Therefore, we aimed to assess the relationship between PLR and SCF. Patients who had angiographically normal coronary arteries were enrolled in this retrospective study (n = 221 as SCF group and n = 293 as control group). Patients who had thrombolysis in myocardial infarction frame counts (TFC) above the normal cutoffs were considered to have SCF. Both PLR and C-reactive protein (CRP) were significantly higher in the SCF group. In correlation analysis, PLR has a significantly positive correlation with the left anterior descending artery TFC (P = .001), circumflex artery TFC (P < .001), right coronary artery TFC (P < .001), and serum CRP level (P < .001). In multiple logistic regression analysis, PLR was independently associated with presence of SCF (odds ratio: 1.014, P < .001). In conclusion, higher PLR levels were significantly and independently related to the presence of SCF. Besides, PLR was positively correlated with serum CRP level as a conventional marker for systemic inflammation.