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1.
Effect of Atorvastatin Therapy on the Level of CD34+CD133+CD309+ Endothelial Progenitor Cells in Patients with Coronary Heart Disease.
Ansheles, AA, Rvacheva, AV, Sergienko, IV
Bulletin of experimental biology and medicine. 2017;(1):133-136
Abstract
In 58 patients with coronary heart disease, the count of CD34+CD133+CD309+ endothelial progenitor cells in the blood was determined and the dynamics of the content of endothelial progenitor cells, angiogenic growth factors, and lipid parameters over 3 months of atorvastatin therapy was analyzed. Atorvastatin was administered in daily doses of 10 mg (26 patients) and 40 mg (32 patients). Control group comprised 15 healthy volunteers. In patients with coronary heart disease, the count of endothelial progenitor cells was lower by 4 times, the level of VEGF was higher by 52%, and the level of endostatin was lower by 13% than in healthy volunteers. Atorvastatin therapy significantly reduced the levels of VEGF (by 11%), C-reactive protein (by 26%), total cholesterol (by 30%), LDL cholesterol (by 35%), and triglycerides (by 18%); the levels of endostatin, MCP-1, and HDL cholesterol remained unchanged. The count of endothelial progenitor cells increased significantly by 72% irrespectively on the statin dose, but the changes were more pronounced in patients with lower initial endothelial progenitor cell counts and in patients with more drastic decrease in LDL cholesterol.
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2.
[Community nursing intervention in population with high-risk coronary heart disease in Hengyang].
Huang, Y, Chen, J, Zeng, Y, Liu, D, He, G
Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences. 2014;(10):1061-6
Abstract
OBJECTIVE To explore the effect of community nursing intervention on awareness regarding primary prevention knowledge, self-management, and risk factors for coronary heart disease (CHD) in Hengyang City, Hunan Province. METHODS A total of 120 individuals at high risk of CHD were recruited and divided into a control group and an intervention group. The intervention group was given the health knowledge lecture and individual community nursing intervention. The control group was given the routine management. Before and after the intervention, all of the recruiters were evaluated by the awareness on primary prevention knowledge, self-management and risk factors for CHD. RESULTS Before the intervention, there was no significant difference in the demographic data, the cognitive levels regarding primary prevention knowledge, the self-management and the risk factors for CHD between the 2 groups (P>0.05). After the intervention, the cognitive levels regarding primary prevention knowledge, the self-management and the risk factors for CHD between the 2 groups changed. In the intervention group, the cognitive level was significantly increased (P<0.05); the self management score was improved; the systolic blood pressure, BMI, and the levels of fasting glucose, TC and low density lipoprotein-cholesterol were significantly decreased and the level of high density lipoprotein-cholesterol was significantly increased (P<0.05). There was no significant difference in the above-mentioned parameters between before and after intervention in the control group (P>0.05). CONCLUSION The cognitive levels regarding primary prevention knowledge and self-management for CHD can be improved effectively by community nursing intervention in high-risk population of CHD, and the risk factors for CHD can also be reduced.
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3.
[Interleukin-6-597G/A and -572C/G polymorphisms and risk of coronary heart disease].
Fu, HX, Li, GS, Li, Y, Xu, JL, Zhang, JY
Zhonghua xin xue guan bing za zhi. 2006;(6):519-22
Abstract
OBJECTIVE To explore the relationship between interleukin-6 (IL-6) gene polymorphisms and the risk of coronary heart disease (CHD). METHODS IL-6/-597G/A and -572C/G polymorphisms were genotyped in 245 CHD patients and 260 healthy adults by PCR-RFLP. Serum IL-6 level was examined by ELISA. Logistic regression was performed to observe the relationship between IL-6/-572C/G polymorphism and other risk factors of CHD. RESULTS IL-6/-597G/A genotype was similar between the two groups. The frequencies of IL-6/-572C/G genotype and G allele were more frequent in patients with CHD than that in controls (P < 0.01). Compared with CC genotype, the relative risk for CHD in people with CG and GG genotypes was 1.46 (95% CI: 1.01 - 2.10, P < 0.05) and 5.19 (95% CI: 1.69 - 15.89, P < 0.01), respectively. The serum levels of IL-6 were similar between carriers of the IL-6/-572G allele and patients with CC genotype (P > 0.05). IL-6/-572 C/G is related to total cholesterol (OR 1.76, 95% CI: 1.05 - 3.16, P < 0.05) and triglyceride (OR = 2.51, 95% CI: 1.04 - 6.45, P < 0.05), respectively. CONCLUSION IL-6/-597G/A polymorphism was not associated with susceptibility to CHD, but IL-6-572C/G polymorphism may be a possible genetic susceptibility factor for CHD in Chinese Hans population.
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4.
Statin initiation following coronary artery bypass grafting: outcome of a hospital discharge protocol.
Khanderia, U, Townsend, KA, Eagle, K, Prager, R
Chest. 2005;(2):455-63
Abstract
STUDY OBJECTIVES To evaluate the outcome of a hospital discharge statin drug therapy initiation protocol following coronary artery bypass graft (CABG) surgery. Our goal was to measure the percentage of patients receiving statin drugs at hospital discharge and at a post-hospital discharge assessment following the implementation of the statin drug therapy initiation protocol. We also evaluated low-density lipoprotein cholesterol (LDL-C) goal attainment (ie, < 100 mg/dL), safety monitoring, and tolerability of the statin drug. DESIGN Single-center, observational study with a historical control group. SETTING University-affiliated health system with a comprehensive heart care program that included a 14-bed cardiac surgery ICU. Approximately 400 CABG procedures are performed annually. PATIENTS Patients who underwent CABG surgery were eligible for inclusion in the study. The exclusion criteria were as follows: contraindications to statin therapy; refusal to take a statin drug; refusal to give informed consent; and age < 18 years. INTERVENTION A protocol was implemented to recommend treatment with a statin drug at hospital discharge in all post-CABG surgery patients if the presurgical LDL-C level was > 100 mg/dL or the patient was receiving a statin prior to hospital admission. The protocol also included a presurgical assessment of lipoprotein levels and hepatic function. All cardiac surgery staff were educated regarding the specifics of the protocol. RESULTS A total of 403 patients were included in the study. The historical control group (202 subjects) and the intervention group (201 subjects) were similar with respect to gender, age, and baseline lipoprotein levels. The follow-up assessment interval was approximately 6 months in both groups. Overall, patients were more likely to receive a statin at hospital discharge in the intervention group compared to the control group (relative risk [RR], 1.6; 95% confidence interval [CI], 1.3 to 2.0). Attainment of the goal for LDL-C level was similar between the intervention and control groups in the overall sample. Patients who were not at their LDL-C goal at baseline were more likely to have a follow-up LDL-C level of < 100 mg/dL in the intervention group (RR, 1.9; 95% CI, 1.0 to 3.5). The rate of liver function assessment was similar in the control and intervention groups. No patients in either group experienced elevations of alanine aminotransferase levels that were more than three times the upper limit of normal, and no cases of muscle toxicity were noted. CONCLUSION The initiation of therapy with a statin drug at hospital discharge following CABG surgery was associated with increased utilization rates. The LDL-C goal attainment improved in patients who were not at their goal prior to surgery. However, the persistence of medication use declined within 6 months. Statin therapy initiation was well-tolerated in this cohort of patients.
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5.
[Study on the relationship between aspirin resistance and incidence of myonecrosis after non-emergent percutaneous coronary intervention].
Zhang, Y, Liang, J, Zhou, YJ, Yuan, H, Zhang, YZ, Dong, L
Zhonghua xin xue guan bing za zhi. 2005;(8):695-9
Abstract
OBJECTIVE To investigate the occurrence of aspirin resistance in coronary heart disease (CHD) patients and its influence on myonecrosis among patients undergoing non-emergent percutaneous coronary intervention (PCI). METHODS 256 CHD patients who have been on aspirin (100 mg/d) for at least 7 days were recruited based on aspirin responsiveness determination. All the patients were divided into two groups: aspirin-resistant group and aspirin-sensitive group. For all patients scheduled for non-emergent PCI, a loading dose of 300 mg of clopidogrel was given at least 12 h before PCI and a 75 mg maintenance dose was given every morning before and after PCI. The incidence of myonecrosis was evaluated by the levels of creatine kinase-myocardial band (CK-MB) and troponin I (TnI) before and after PCI. RESULTS Aspirin resistance was found in 67 (26.2%) patients and 189 (73.8%) patients were aspirin-sensitive. There was a significantly higher proportion of female subjects in the aspirin-resistant group. The incidence of any CK-MB elevation was 38 (56.7%) in aspirin-resistant group and 42 (22.2%) in aspirin-sensitive group (P < 0.01). The elevation of TnI was observed in 41 (61.2%) of the aspirin-resistant group and in 67 (35.4%) of the aspirin-sensitive group (P < 0.05). Multivariate analysis revealed that aspirin resistance was an independent predictor for CK-MB elevation after PCI (OR = 2.5; 95% CI 1.5 to 6.5; P < 0.05). CONCLUSION Aspirin resistance exists in some CHD patients, which increases the risk of myonecrosis following non-emergent PCI.
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6.
Angioscopic evaluation of stabilizing effects of an antilipemic agent, bezafibrate, on coronary plaques in patients with coronary artery disease: a multicenter prospective study.
Ohsawa, H, Uchida, Y, Fujimori, Y, Hirose, J, Noike, H, Tokuhiro, K, Kawamura, K, Kanai, M, Sakuragawa, H, Hitsumoto, T, et al
Japanese heart journal. 2002;(4):319-31
Abstract
To evaluate the stabilizing effects of an antilipemic agent, bezafibrate, on coronary plaques, we carried out a prospective angioscopic and angiographic open trial. From April 1997 to December 1998, 24 patients underwent coronary angioscopy of plaques in non-targeted vessels during coronary interventions and then again 6 months later. The patients were divided into control (10 patients, 14 plaques) and bezafibrate (14 patients, 21 plaques) groups. Oral administration of bezafibrate (400 mg/day) was started immediately after the intervention and was continued for 6 months. The vulnerability score was determined based on the angioscopic characteristics of plaques and compared before and 6 months later. Six months later, the vulnerability score was reduced (from 1.6 to 0.8; P<0.05) in the bezafibrate group and unchanged (from 1.4 to 1.3; NS) in the control group. In the bezafibrate group, the changes in the vulnerability score were not correlated with those in % stenosis or minimal lumen diameter. The plasma total cholesterol level (T-C) was unchanged, triglyceride level (TG) was decreased, and high density lipoprotein cholesterol level (HDL-C) was increased in the bezafibrate group, but were unchanged in the control group. In the bezafibrate group, T-C and TG were decreased and HDL-C was increased in patients with a reduced vulnerability score but were unchanged in those with an unchanged score. These results indicate that 6 month administration of bezafibrate stabilizes coronary plaques and that the stabilization is not correlated with angiographic changes.
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7.
Beneficial clinical effects of perhexiline in patients with stable angina pectoris and acute coronary syndromes are associated with potentiation of platelet responsiveness to nitric oxide.
Willoughby, SR, Stewart, S, Chirkov, YY, Kennedy, JA, Holmes, AS, Horowitz, JD
European heart journal. 2002;(24):1946-54
Abstract
AIMS: To examine whether the prophylactic antianginal agent perhexiline potentiates platelet responsiveness to nitric oxide (NO) in patients with stable angina pectoris (SAP) and acute coronary syndromes (ACS: unstable angina pectoris or non-Q-wave myocardial infarction). METHODS AND RESULTS Blood samples were obtained from patients before and after initiation of treatment with perhexiline. ADP-induced platelet aggregation and its inhibition by the NO donor sodium nitroprusside (SNP) were determined via impedance aggregometry in whole blood (WB) and platelet-rich plasma (PRP). Intraplatelet cGMP content was assayed by RIA, and superoxide (O(2)(-)) level by lucigenin-derived chemiluminescence. In patients with ACS not receiving perhexiline (n=12), platelet responsiveness to SNP did not vary significantly over the first 3 days post admission to hospital. Therapy with perhexiline for 3 days was associated with increases in SNP-induced inhibition of aggregation from 29+/-2% to 43+/-4% (n=50,P <0.001) in WB and from 20+/-5% to 42+/-7% (n=12, P<0.01) in PRP. Resolution of symptomatic ischaemia (n=39) was associated with significantly greater (P<0.01) increases than non-resolution (n=11). Similar increases in SNP responsiveness (P<0.001) occurred following institution of perhexiline therapy in patients with SAP (n=30), associated with a 85% decrease in anginal frequency. Treatment with perhexiline potentiated the cGMP-elevating effects of SNP in platelets (n=9,P =0.03). Although perhexiline did not alter whole blood O(2)(-) concentration ex vivo, it inhibited (P<0.01) O(2)(-) release from neutrophils in vitro. CONCLUSION Perhexiline potentiates platelet responsiveness to NO both in SAP and ACS patients; in the latter group this improvement was predictive of resolution of ischaemic symptoms. The predominant mechanism of perhexiline effect is an increase in platelet cGMP responsiveness. Perhexiline also may reduce the potential for NO clearance by neutrophil-derived O(2)(-).
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8.
Men at increased risk of coronary heart disease are not different from age- and weight-matched healthy controls in their postprandial triglyceride, nonesterified fatty acid, or incretin responses to sucrose.
Brynes, AE, Edwards, CM, Ghatei, MA, Bloom, SR, Frost, GS
Metabolism: clinical and experimental. 2002;(2):195-200
Abstract
Short-term studies suggest that extreme sucrose consumption has a detrimental effect on triglycerides (TG) in hypertriglyceridemic people. There is currently no consensus on the short-term inclusion of a moderate intake of sucrose in middle-aged men at increased risk of coronary heart disease (CHD). It is also unknown whether gut hormones that are released in response to carbohydrate ingestion modulate any of the effects of sucrose. The aim of this study was to further elucidate whether men at increased risk of CHD have an exaggerated response to sucrose compared with age- and weight-matched controls over an acute postprandial period. Twenty middle-aged men were recruited and separated into control (total cholesterol < 5.5 mmol/L) and increased risk of CHD (> 5.5 mmol/L) groups. We measured postprandial TG, nonesterified fatty acids (NEFA), insulin, glucose, glucagon-like peptide-1 (GLP-1), and gastric inhibitory polypeptide (GIP) concentrations in response to a meal containing 75 g glucose or 75 g sucrose with a moderate fat load. The increased risk group had significantly higher Framingham risk assessment (12% v 4%), TG (2.4 +/- 1.5 v 1.1 +/- 0.4 mmol/L), low-density lipoprotein-cholesterol (LDL-C) (4.4 +/- 0.5 v 2.7 +/- 0.4 mmol/L), and lower high-density lipoprotein-cholesterol (HDL-C) (1.2 +/- 0.2 v 1.5 +/- 0.2 mmol/L) (P <.05 for all). There was no significant difference in the incremental area under the curve (IAUC, 0 to 360 minutes) for TG, NEFA, glucose, GLP-1, or GIP in response to glucose or sucrose within or between the groups. Absolute total area under the curve (not IAUC) for TG was significantly higher in the increased risk group for both glucose and sucrose, respectively (P =.01). A total of 75 g of sucrose given as part of a single meal appears to make little difference in the postprandial TG and NEFA response in men with or without risk of CHD compared with glucose. Although long-term data is needed, this begs the question whether a moderate intake of sucrose has been overemphasized as a detrimental dietary message in middle-aged men.
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9.
Off-pump coronary revascularization attenuates transient renal damage compared with on-pump coronary revascularization.
Loef, BG, Epema, AH, Navis, G, Ebels, T, van Oeveren, W, Henning, RH
Chest. 2002;(4):1190-4
Abstract
STUDY OBJECTIVES Cardiopulmonary bypass (CPB) represents a specific risk factor for renal damage during coronary revascularization. The purpose of this study was to compare the perioperative renal damage in patients undergoing on-pump and off-pump coronary surgery. DESIGN AND PATIENTS The progress and extent of renal damage was prospectively studied in two groups of patients undergoing cardiac surgery without concomitant morbidity, undergoing elective coronary revascularization with (n = 12) and without (n = 10) CPB. Markers of glomerular function (creatinine clearance) and damage (microalbuminuria), and markers of tubular function (fractional excretion of sodium [FENa] and free water clearance) and damage (N-acetyl-beta-D glucosaminidase [NAG]) were evaluated. Measuring plasma concentrations of free hemoglobin assessed hemolysis. Plasma and urinary specimens were obtained at the following points: (1) baseline; (2) heparinization; (3) the end of CPB or completing graft for off-pump surgery; (4) skin closure; (5) the sixth hour in the ICU; and (6) the second postoperative day. Free water and creatinine clearances, FENa, and the urinary excretion of microalbumin and NAG were calculated for the corresponding time intervals. SETTING University hospital. RESULTS We found that off-pump coronary revascularization induced significantly less changes in microalbuminuria, FENa, free water clearance, NAG, and free hemoglobin as compared with operations with CPB. Markers returned to baseline within 2 days after the operation, and there was no clinical or laboratory evidence of overt renal dysfunction in both groups. CONCLUSION Off-pump coronary surgery attenuates transient renal injury compared with traditional on-pump coronary artery bypass grafting.
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10.
Effects of preventive group education on the resistance of LDL against oxidation and risk factors for coronary heart disease in bypass surgery patients.
Palomäki, A, Miilunpalo, S, Holm, P, Mäkinen, E, Malminiem, K
Annals of medicine. 2002;(4):272-83
Abstract
BACKGROUND Comprehensive preventive education for heart patients is effective in reducing cardiac events. However, very demanding counselling protocols cannot easily be implemented as an integral part of clinical practice in hospitals. AIM: To evaluate whether recurrent preventive group education for coronary artery bypass grafting patients affects the resistance of LDL against oxidation and the classical risk factors for coronary heart disease. METHODS A prospective, controlled study with one-year follow-up was carried out in Southern Finland. Coronary artery bypass patients were allocated late (> or = 18 months) after the operation in the intervention and control groups. RESULTS Seventy two patients (65 men and 7 women) completed the study. Twelve-hour group education on healthy life-style had a significant (25%, P = 0.01) but transient positive effect on the resistance of LDL against oxidation. There was a trend towards increased physical activity in the intervention group. The impact of education on patients' weight was also more consistent (1.2 kg at 12 months, P < 0.05), whereas long-term effects on fibrinogen and serum lipids were small. CONCLUSIONS Repeated group education applied as an economically feasible part of specialist care had only small positive effects on patients' risk factors. There was a significant, but transient, increase in the resistance of LDL against oxidation. However, effective lipid lowering drug treatment is indicated for most coronary artery bypass patients rather than repeated health education alone.