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Hypertriglyceridemia influences the degree of postprandial lipemic response in patients with metabolic syndrome and coronary artery disease: from the CORDIOPREV study.
Alcala-Diaz, JF, Delgado-Lista, J, Perez-Martinez, P, Garcia-Rios, A, Marin, C, Quintana-Navarro, GM, Gomez-Luna, P, Camargo, A, Almaden, Y, Caballero, J, et al
PloS one. 2014;(5):e96297
Abstract
OBJECTIVE To determine whether metabolic syndrome traits influence the postprandial lipemia response of coronary patients, and whether this influence depends on the number of MetS criteria. MATERIALS AND METHODS 1002 coronary artery disease patients from the CORDIOPREV study were submitted to an oral fat load test meal with 0.7 g fat/kg body weight (12% saturated fatty acids, 10% polyunsaturated fatty acids, 43% monounsaturated fatty acids), 10% protein and 25% carbohydrates. Serial blood test analyzing lipid fractions were drawn at 0, 1, 2, 3 and 4 hours during the postprandial state. Total and incremental area under the curves of the different postprandial parameters were calculated following the trapezoid rule to assess the magnitude of change during the postprandial state. RESULTS Postprandial lipemia response was directly related to the presence of metabolic syndrome. We found a positive association between the number of metabolic syndrome criteria and the response of postprandial plasma triglycerides (p<0.001), area under the curve of triglycerides (p<0.001) and incremental area under the curve of triglycerides (p<0.001). However, the influence of them on postprandial triglycerides remained statistically significant only in those patients without basal hypertriglyceridemia. Interestingly, in stepwise multiple linear regression analysis with the AUC of triglycerides as the dependent variable, only fasting triglycerides, fasting glucose and waist circumference appeared as significant independent (P<0.05) contributors. The multiple lineal regression (R) was 0.77, and fasting triglycerides showed the greatest effect on AUC of triglycerides with a standardized coefficient of 0.75. CONCLUSIONS Fasting triglycerides are the major contributors to the postprandial triglycerides levels. MetS influences the postprandial response of lipids in patients with coronary heart disease, particularly in non-hypertriglyceridemic patients.
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Effects of pitavastatin on fasting and postprandial endothelial function and blood rheology in patients with stable coronary artery disease.
Arao, K, Yasu, T, Umemoto, T, Jinbo, S, Ikeda, N, Ueda, S, Kawakami, M, Momomura, S
Circulation journal : official journal of the Japanese Circulation Society. 2009;(8):1523-30
Abstract
BACKGROUND Because postprandial hypertriglyceridemia and hyperglycemia may promote atherosclerosis, the present study investigated the effects of a clinical dose of pitavastatin on endothelial function and blood rheology in patients with coronary artery disease (CAD) before and after eating a test meal. METHODS AND RESULTS The 16 patients with stable CAD and mild dyslipidemia and 6 age-matched healthy men as controls were recruited. In each group, forearm blood flow (FBF) was measured during postischemic reactive hyperemia and blood samples were taken before and 2 h after the test meal. Urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) was also measured. The patients were started on pitavastatin 2 mg/day. The tests were repeated after 6 months. Maximum FBF during hyperemia in the baseline fasting phase was significantly lower in CAD patients than in control subjects (P=0.040). Fasting and postprandial FBF during reactive hyperemia significantly improved after pitavastatin treatment (P<0.05 vs baseline data for each phase) associated with reduced urine 8-OHdG, increased plasma adiponectin and improved lipid profile. No significant differences in baseline rheological parameters were seen between controls and CAD patients. CONCLUSIONS Pitavastatin significantly improved fasting and postprandial dyslipidemia and endothelial dysfunction in CAD patients, partly via reducing oxidative stress and increasing plasma adiponectin, although rheological parameters remained unchanged.
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Measurement of coronary calcium scores by electron beam computed tomography or exercise testing as initial diagnostic tool in low-risk patients with suspected coronary artery disease.
Geluk, CA, Dikkers, R, Perik, PJ, Tio, RA, Götte, MJ, Hillege, HL, Vliegenthart, R, Houwers, JB, Willems, TP, Oudkerk, M, et al
European radiology. 2008;(2):244-52
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Abstract
We determined the efficiency of a screening protocol based on coronary calcium scores (CCS) compared with exercise testing in patients with suspected coronary artery disease (CAD), a normal ECG and troponin levels. Three-hundred-and-four patients were enrolled in a screening protocol including CCS by electron beam computed tomography (Agatston score), and exercise testing. Decision-making was based on CCS. When CCS>or=400, coronary angiography (CAG) was recommended. When CCS<10, patients were discharged. Exercise tests were graded as positive, negative or nondiagnostic. The combined endpoint was defined as coronary event or obstructive CAD at CAG. During 12+/-4 months, CCS>or=400, 10-399 and <10 were found in 42, 103 and 159 patients and the combined endpoint occurred in 24 (57%), 14 (14%) and 0 patients (0%), respectively. In 22 patients (7%), myocardial perfusion scintigraphy was performed instead of exercise testing due to the inability to perform an exercise test. A positive, nondiagnostic and negative exercise test result was found in 37, 76 and 191 patients, and the combined endpoint occurred in 11 (30%), 15 (20%) and 12 patients (6%), respectively. Receiver-operator characteristics analysis showed that the area under the curve of 0.89 (95% CI: 0.85-0.93) for CCS was superior to 0.69 (95% CI: 0.61-0.78) for exercise testing (P<0.0001). In conclusion, measurement of CCS is an appropriate initial screening test in a well-defined low-risk population with suspected CAD.
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Variability of repeated coronary artery calcium measurements by 1.25-mm- and 2.5-mm-thickness images on prospective electrocardiograph-triggered 64-slice CT.
Horiguchi, J, Matsuura, N, Yamamoto, H, Hirai, N, Kiguchi, M, Fujioka, C, Kitagawa, T, Kohno, N, Ito, K
European radiology. 2008;(2):209-16
Abstract
High reproducibility on coronary artery calcium scoring is a key requirement in monitoring the progression of coronary atherosclerosis. The purpose of this prospective study is to assess the reproducibility of 1.25-mm- and 2.5-mm-thickness images on prospective electrocardiograph-triggered 64-slice CT with respect to 2.5-mm-thickness images on spiral overlapping reconstruction. One hundred patients suspected of coronary artery disease were scanned twice repeatedly, both on prospective electrocardiograph-triggered step-and-shoot and retrospective electrocardiograph-gated spiral scans. Using 1.25-mm-thickness collimation, 1.25-mm- and 2.5-mm-thickness image sets on prospective scans and 2.5-mm-thickness image sets with 1.25-mm increment (overlapping) on retrospective scans were obtained. Coronary artery calcium scores, interscan variability and interobserver variability were evaluated. The mean interscan variability in coronary artery calcium measurement on 1.25-mm prospective/2.5-mm prospective/2.5-mm overlapping retrospective scans were Agatston: 10%/18%/12%, volume: 10%/12%/10% and mass: 8%/13%/11% for observer 1 and Agatston: 8%/14%/10%, volume: 7%/9%/10% and mass: 7%/10%/9% for observer 2, respectively. The mean interobserver variability was 5% to 14%. In conclusion, prospective electrocardiograph-triggered 64-slice CT using the 1.25-mm prospective scan shows the lowest variability. The 2.5-mm prospective scan on volume or mass scoring shows variability of around 10%, comparable to 2.5-mm-thickness spiral overlapping reconstruction images.
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Early detection of progressive renal dysfunction in patients with coronary artery disease.
Fuiano, G, Mancuso, D, Indolfi, C, Mongiardo, A, Sabbatini, M, Conte, G, De Nicola, L, Minutolo, R, Mazza, G, Cianfrone, P, et al
Kidney international. 2005;(6):2773-80
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BACKGROUND An association between renal hemodynamic dysfunction and coronary artery disease (CAD) has been documented in chronic renal failure; however, no information is available in CAD patients with normal glomerular filtration rate (GFR). This study was aimed at evaluating early abnormalities and outcome of renal function in CAD patients. METHODS In 15 nondiabetic patients with normal renal function and no significant stenoses in renal arteries, and having undergone coronary arteriography, we studied systemic and renal hemodynamics before and after a vasodilating stimulus induced by aminoacid (AA) infusion. A control group (C) consisted of 15 sex- and age-matched kidney donors. The statistical adequacy of the sample size was preliminarily verified. Renal clearances were repeated after two years. RESULTS At baseline, GFR (mL/min/1.73 m2) averaged 81.4 +/- 3.8 in CAD and 83.7 +/- 1.4 in C (P= NS); RPF (mL/min/1.73 m2) was 297 +/- 22 in CAD and 456 +/- 15 in C (P < 0.0001); filtration fraction was higher in CAD (P < 0.001). Plasma renin activity was higher in CAD (P < 0.005). The number of coronary stenoses was inversely correlated with RPF but not with GFR. In CAD, at variance with C, AA did not induce any increment of GFR, while RPF increased without achieving the unstimulated value of C. Blood pressure was comparable in CAD and C at baseline and not modified by AA. After two years, a significant decrease in GFR (-14%, P < 0.001) and RPF (-15%, P < 0.001) occurred only in CAD, and in either group, the response to AA did not differ from that detected at baseline. CONCLUSION In CAD patients with normal GFR, reduction in renal perfusion and absence of renal functional reserve likely represent early markers of progressive renal dysfunction.
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Effects of vitamin C on intracoronary L-arginine dependent coronary vasodilatation in patients with stable angina.
Tousoulis, D, Xenakis, C, Tentolouris, C, Davies, G, Antoniades, C, Crake, T, Stefanadis, C
Heart (British Cardiac Society). 2005;(10):1319-23
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Abstract
OBJECTIVE To assess the effects of intravenous vitamin C administration on the vasomotor responses to intracoronary L-arginine infusion in epicardial coronary arteries. METHODS 28 patients with coronary artery disease and stable angina were enrolled in the study. Eight patients received intracoronary infusions of 150 micromol/min L-arginine before and after intravenous infusion of vitamin C, 10 patients received intracoronary infusions of 150 micromol/min L-arginine before and after intravenous infusion of normal saline, and 10 patients received intracoronary normal saline before and after intravenous infusion of vitamin C. The diameter of proximal and distal coronary artery segments was measured by quantitative angiography. RESULTS Infusion of L-arginine caused significant dilatation of both proximal (4.87 (0.96)%, p < 0.01 v normal saline) and distal (6.33 (1.38)%, p < 0.01 v normal saline) coronary segments. Co-infusion of vitamin C and L-arginine dilated proximal coronary segments by 8.68 (1.40)% (p < 0.01 v normal saline, p < 0.01 v L-arginine) and distal segments by 13.07 (2.15)% (p < 0.01 v normal saline, p < 0.01 v L-arginine). Intravenous infusion of vitamin C caused a borderline increase in proximal and distal coronary segment diameters (1.93 (0.76)% and 2.09 (1.28)%, respectively, not significant). CONCLUSIONS L-arginine dependent coronary segment vasodilatation was augmented by the antioxidant vitamin C in patients with coronary artery disease. Thus, vitamin C may have beneficial effects on nitric oxide bioavailability induced by L-arginine.
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Age-dependence of lipid parameters in the general population and vegetarians.
Richter, V, Rassoul, F, Hentschel, B, Kothe, K, Krobara, M, Unger, R, Purschwitz, K, Rotzsch, W, Thiery, J, Muradian, K
Zeitschrift fur Gerontologie und Geriatrie. 2004;(3):207-13
Abstract
Age-dependent changes of lipid metabolism may arise both as a result of mechanisms of biological ageing and factors influencing age-dependent changes. To study possible influences of nutrition and life-style of vegetarians on age-dependence of lipid parameters, subjects of general population were compared with vegetarians. In the frame of population-based lipid screening projects in the city of Leipzig/Germany (Lipid Study Leipzig, LSL) 10 550 subjects (3,816 men and 6,734 women, age 18-99 years) of general population were compared with 417 vegetarians (vegans, lacto-vegetarians, lacto-ovo-vegetarians, 148 men and 269 women, age 18-93 years). Most of the vegetarians included in the study were members of the German Society of Vegetarians. The study program included capillary blood cholesterol measurements and the determination of high-density lipoprotein (HDL)-cholesterol, the measurement of other cardiovascular risk factors and the evaluation of dietary and life-style factors. Evaluation of cardiovascular risk profile within LSL was connected with individual consultation. The mean total cholesterol and non-HDL-cholesterol level and the total: HDL-cholesterol ratio showed the expected age-dependence, with maximum values within the decade 60-70 years. Vegetarians showed lower total and non-HDL-cholesterol levels in comparison with the general population. Furthermore, the age-dependent increase of these parameters is less pronounced under the conditions of vegetarian nutrition and life-style. Especially in young adulthood a significant difference is observed. Thus, the results of the present study reveal the role of nutritional and life-style factors that determine the lipid profile on a population basis and suggest that the known age-dependent rise of the level of atherogenic plasma lipoproteins is partly preventable.
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Plasma adiponectin concentration in relation to severity of coronary atherosclerosis and cardiovascular risk factors in middle-aged men.
Dunajska, K, Milewicz, A, Jedrzejuk, D, Szymczak, J, Kuliczkowski, W, Salomon, P, Bialy, D, Poczatek, K, Nowicki, P
Endocrine. 2004;(3):215-21
Abstract
UNLABELLED Adiponectin, an adipocyte-derived protein, seems to be a link between obesity, insulin resistance, and atherosclerosis. The present study investigated the association between adiponectin and coronary artery disease in middle-aged men. MATERIAL AND METHODS We examined 48 men (aged 40-60) with angiographically confirmed coronary atherosclerosis and 19 healthy men, matched by age, as a control group. Concentrations of glucose and lipids were estimated with enzymatic methods. Plasma level of adiponectin, total and free testosterone, estradiol, estrone, DHEA-S, and insulin were estimated with RIA commercial kits. RESULTS Men with coronary atherosclerosis had lower plasma adiponectin level than controls (16.2+/-9.2 vs 20.5+/-6.7 microg/mL; p<0.05). However, after including BMI and waist as covariate data in ANCOVA, the difference in adiponectin levels between men with CAD and controls lost statistical significance (respectively for BMI and waist: p=0.4 and p=0.7). Moreover, although not significant, adiponectin levels decreased as a function of the number of significantly narrowed coronary arteries. In a priori comparison the lowest adiponectin plasma concentration was in men with three-vessel coronary artery disease (14.3+/-9.8 microg/mL) and the high-est in controls (20.5+/-6.8 microg/mL; p=0.09). Adiponectin plasma level correlated negatively (p<0.05) with BMI, waist, percentage of total fat, fasting-insulin-resistance index (FIRI), total cholesterol and triglycerides, and positively with quantitative insulin sensitivity check index (QUICKI), HDL cholesterol, total testosterone, and total testosterone/estradiol ratio. CONCLUSIONS Our data suggest that low plasma adiponectin level is connected with insulin resistance syndrome and atherogenic lipid profile. It seems that adiponectin plays a role in pathogenesis of coronary atherosclerosis, especially in obese and insulin-resistant subjects.
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Changes in coronary plaque color and morphology by lipid-lowering therapy with atorvastatin: serial evaluation by coronary angioscopy.
Takano, M, Mizuno, K, Yokoyama, S, Seimiya, K, Ishibashi, F, Okamatsu, K, Uemura, R
Journal of the American College of Cardiology. 2003;(4):680-6
Abstract
OBJECTIVES Changes in coronary plaque color and morphology by statin therapy were evaluated using coronary angioscopy. BACKGROUND Coronary plaque stabilization by statin therapy has not been clarified in humans. METHODS Thirty-one patients with coronary artery disease were divided into either the comparison group (n = 16) or the atorvastatin group (n = 15). Before treatment and 12 months after, the color and complexity of 145 coronary plaques were determined according to angioscopic findings. The yellow score of the plaque was defined as 0 (white), 1 (light yellow), 2 (yellow), or 3 (dark yellow), and its disrupted score was defined as 0 (smooth surface) or 1 (irregular surface) and as 0 (without thrombus) or 1 (with thrombus). In each patient, the mean yellow score and mean disrupted score were calculated. RESULTS Mean low-density lipoprotein cholesterol (LDL-C) decreased by 45% in the atorvastatin group, whereas an increase of 9% was seen in the comparison group. The mean yellow score decreased from 2.03 to 1.13 in the atorvastatin group, whereas it increased from 1.67 to 1.99 in the comparison group. There was a good correlation between the change in the mean yellow score and the change in LDL-C levels (r = 0.81, p < 0.0001). The change in the mean yellow score and mean disrupted score differed significantly between the two groups (p = 0.002 and p = 0.03, respectively). CONCLUSIONS This is the first report clarifying detailed changes in coronary plaque by statin in humans. This study indicated that lipid-lowering therapy changes plaque color and morphology and should then lead to coronary plaque stabilization.
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Effect of exercise on upper and lower extremity endothelial function in patients with coronary artery disease.
Gokce, N, Vita, JA, Bader, DS, Sherman, DL, Hunter, LM, Holbrook, M, O'Malley, C, Keaney, JF, Balady, GJ
The American journal of cardiology. 2002;(2):124-7
Abstract
Aerobic exercise training improves endothelial vasomotor function in the coronary circulation of patients with coronary artery disease (CAD), an effect that has been attributed to local repetitive increases in shear stress on the endothelium. To study the effects of exercise on endothelial function in the peripheral circulation, we used vascular ultrasound to examine flow-mediated dilation and nitroglycerin-mediated dilation in the brachial and posterior tibial arteries of 58 subjects with CAD. Studies were performed at baseline and after 10 weeks in 40 subjects (aged 59 +/- 10 years) who participated in a supervised cardiac rehabilitation program that predominantly involved moderate intensity leg exercise (three 30-minute sessions/week), and 18 matched patients who did not exercise and maintained a sedentary lifestyle. Exercise was associated with a 29% increase in functional capacity (7.3 +/- 2.2 vs 9.4 +/- 2.7 METs, p <0.001), and significant improvement in endothelium-dependent, flow-mediated dilation in a conduit artery of the leg, but not the arm. Nitroglycerin-mediated dilation in the upper arm and lower extremity was unaffected. These findings suggest that exercise improves endothelial function in peripheral conduit arteries of patients with CAD and that the beneficial effect may be more marked in the vascular beds of the exercised limbs.