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IMPORTANCE OF THE GLYCOREGULATION IN THE CORONARY HEART DISEASE PATHOGENESIS IN DIABETES MELITUS
Boris ?in?i?,Stojan Radi?,Slobodan Anti?,Du?an Sokolovic
Acta Medica Medianae , 2001,
Abstract: Despite some research studies pointing to the importance of poorglycoregulation and the emergence of the coronary heart disease (CHD) in thepatients suffering from diabetes, the strength of relation between these twophenomena is still not clear enough.The aim of the paper is to examine the importance of the glycoregulationdisturbance fot the emergence of a coronary heart disease in insulin-independentpatients. The methods for estimating glycoregulation comprised: the determinationof a morning glycemia on an empty stomach, the determination of a daily glycemiaprofile by taking 5 capillary blood samples in a day and determining the mediumvalue of the daily profile.By comparing the glycemia profiles in the examined patients a statisticallyimportant difference among the medium glycemia values was found in each of theexamined groups. In the dyslipodemic patients with a CHD the glycemia values were considerably larger in ali the daily measurements and the medium daily profile ofglycemia (MBG) amounted to 9.77+2.47 mmol/1, while in the patients without anycoronary disease they amounted to 7.8+1.74 mmoI/L An important correlation wasfound between the triglyceride values and the morning glycemia (C=0.48) in thediabetes patients with the CHD, while in the diabetes patients without any CHD apositive correlation of the MBG values with cholesterol (C=0.54) and triglycerides(C=0.48) was found. A strong negative correlation in this group was shown for theHDL cholesterol (C=0.7). Ali this reveals a joint relation between hyperglycemia andlipid disturbances with a cumulative effect upon the emergence of the CHD in theNIDDM patients.
Importance of personality traits and psychosocial factors for the development of coronary heart disease  [PDF]
Jovanovi? Dragana,Jakovljevi? Branko,Paunovi? Katarina,Grubor Du?an
Vojnosanitetski Pregled , 2006, DOI: 10.2298/vsp0602153j
Abstract: Background/Aim. Numerous studies have provided clear and convincing evidence that psychosocial factors contribute to the pathogenesis and expression of coronary heart disease (CHD). These factors have been related to the following psychosocial domains: personality factors and character traits, depression, anxiety, social isolation and chronic life stress. The aim of this study was to estimate the influence of personality traits and psychosocial risk factors for the development of coronary heart disease. Methods. The investigation was conducted as observational cross-sectional (case-control) study. Based on medical records all subjects were divided into two groups: the group of patients with CHD (61 participants), and the control group of 41 healthy participants. All participants fulfilled the Eysenck Inventory Questionnaire, Paykel stress scale and Bortner scale of A-B self-estimation. Results. The participants with CHD were shown to have lower education than healthy participants, but were comparable by gender, age and place of residence. According to the Bortner scale, most participants with CHD expressed type A personality, whereas most healthy participants expressed types B and AB. The patients with CHD achieved higher scores on the Paykel stress scale of life events, and they had the higher level of neurotic and psychotic tendencies, as well as the lower level of extroversion compared to the healthy participants. Multivariate logistic regression model identified chronic stress (odds ratio 1.018; 95% confidence interval 1.007 1.028) as an important predictor for the occurrence of coronary heart disease, when adjusted for age, gender, nourishment and blood pressure. On the other side, the lower risk for the occurrence of CHD was observed among the participants who had the higher level of extroversion (odds ratio 0.859; 95% confidence interval 0.636 0.902). Conclusion. Chronic stress and introversion can be considered important risk factors for the development of coronary heart disease, independent of other predictors such as obesity and hypertension, supporting the biopsychosocial model of the occurrence of coronary heart disease.
The Role of Interleukin-1 Genotype in the Association between Coronary Heart Disease and Periodontitis in a Syrian Population  [PDF]
Lina Bashour,Razan Khattab,Elham Harfoush
ISRN Dentistry , 2013, DOI: 10.1155/2013/195678
Abstract: Objective. To determine whether differences exist between periodontitis subjects with and without Coronary Heart Disease (CHD) in a Syrian population in the distribution of IL-1 alleles at positions IL-1 +4845, IL-1 +3954, IL-1 ?511, and IL-1RN VNTR. Background. The role of Interleukin-1 genes in the association between periodontitis and CHD has been demonstrated in previous studies. No study has been carried out on the Syrian population to asses for such a role. Methods. 200 Syrian Arab periodontitis patients (184 males, 16 females; mean age 52.61) were divided into two groups: cases group 100 subjects with CHD (92 males, 8 females; mean age 52.06); controls group 100 subjects without CHD (92 males, 8 females; mean age 53.16). Probing depth (PD), clinical attachment loss (CAL), and alveolar bone loss (ABL) were performed for patients. Blood samples were collected for genotyping analysis of IL-1 +4845, IL-1 +3954, and IL-1 ?511 using PCR-RFLP technique and IL-1RN VNTR using normal PCR. Results. An association between both (CAL and ABL) and CHD was shown after adjustment for other confounders (OR: 7.659, ; OR: 3.645, , resp.). Also, an association between allele 2 of IL-1 +4845, IL-1 +3954, and IL-1 ?511 and ABL was shown. Allele 2 of IL-1 +4845 and IL-1 ?511 was associated with ABL among individuals with and without CHD. But after adjustment for other confounders, the association remained only between allele 2 of IL-11 +4845 and both CHD and severe ABL (OR: 0.189, ). Conclusion. Allele 2 of IL-11 +4845 may be considered a risk indicator for having both CHD and severe ABL in the investigated Syrian population. 1. Introduction Periodontitis is a chronic inflammatory disease of multifactorial etiology initiated by specific bacteria that activate host mechanisms which in turn destroy the bone and connective tissues that support the teeth [1]. In recent years, studies have demonstrated that periodontitis is associated with elevated levels of inflammatory cytokines [2], which have a substantial impact on numerous biological activities, and they take part in triggering inflammatory cascades and systems [3]. To illustrate, Interleukin-1 (IL-1) plays a prominent role in the inflammatory response in periodontal lesions. IL-1α and IL-1β upregulate prostaglandin E2 and matrix metalloproteinase and, together with these components, promote the loss of connective tissue and bone in periodontitis lesions [4]. Atherosclerosis is considered the most common cause of Coronary Heart Disease (CHD). It is a variable combination of changes of the intima of arteries that lead
Quantifying Policy Options for Reducing Future Coronary Heart Disease Mortality in England: A Modelling Study  [PDF]
Shaun Scholes, Madhavi Bajekal, Paul Norman, Martin O’Flaherty, Nathaniel Hawkins, Mika Kivim?ki, Simon Capewell, Rosalind Raine
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0069935
Abstract: Aims To estimate the number of coronary heart disease (CHD) deaths potentially preventable in England in 2020 comparing four risk factor change scenarios. Methods and Results Using 2007 as baseline, the IMPACTSEC model was extended to estimate the potential number of CHD deaths preventable in England in 2020 by age, gender and Index of Multiple Deprivation 2007 quintiles given four risk factor change scenarios: (a) assuming recent trends will continue; (b) assuming optimal but feasible levels already achieved elsewhere; (c) an intermediate point, halfway between current and optimal levels; and (d) assuming plateauing or worsening levels, the worst case scenario. These four scenarios were compared to the baseline scenario with both risk factors and CHD mortality rates remaining at 2007 levels. This would result in approximately 97,000 CHD deaths in 2020. Assuming recent trends will continue would avert approximately 22,640 deaths (95% uncertainty interval: 20,390-24,980). There would be some 39,720 (37,120-41,900) fewer deaths in 2020 with optimal risk factor levels and 22,330 fewer (19,850-24,300) in the intermediate scenario. In the worst case scenario, 16,170 additional deaths (13,880-18,420) would occur. If optimal risk factor levels were achieved, the gap in CHD rates between the most and least deprived areas would halve with falls in systolic blood pressure, physical inactivity and total cholesterol providing the largest contributions to mortality gains. Conclusions CHD mortality reductions of up to 45%, accompanied by significant reductions in area deprivation mortality disparities, would be possible by implementing optimal preventive policies.
Associations between Interleukin-1 Gene Polymorphisms and Coronary Heart Disease Risk: A Meta-Analysis  [PDF]
Liang Zhou, Jianguang Cai, Gang Liu, Yuan Wei, Hui Tang
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0045641
Abstract: Objective A great number of studies regarding the associations between IL-1B-511, IL-1B+3954 and IL-1RN VNTR polymorphisms within the IL-1gene cluster and coronary heart disease (CHD) have been published. However, results have been inconsistent. In this study, a meta-analysis was performed to investigate the associations. Methods Published literature from PubMed and Embase databases were searched for eligible publications. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random- or fixed- effect model. Results Thirteen studies (3,219 cases/2,445 controls) for IL-1B-511 polymorphism, nine studies (1,828 cases/1,818 controls) for IL-1B+3954 polymorphism and twelve studies (2,987 cases/ 2,208 controls) for IL-1RN VNTR polymorphism were included in this meta analysis. The results indicated that both IL-1B-511 and IL-1B+3954 polymorphisms were not associated with CHD risk (IL-1B-511 T vs. C: OR = 0.98, 95%CI 0.87–1.09; IL-1B+3954 T vs. C: OR = 1.06, 95%CI 0.95–1.19). Similarly, there was no association between IL-1RN VNTR polymorphism and CHD risk (*2 vs. L: OR = 1.00, 95%CI 0.85–1.17). Conclusions This meta-analysis suggested that there were no associations between IL-1 gene cluster polymorphisms and CHD.
Long-Term Interleukin-6 Levels and Subsequent Risk of Coronary Heart Disease: Two New Prospective Studies and a Systematic Review  [PDF]
John Danesh equal contributor ,Stephen Kaptoge equal contributor,Andrea G Mann,Nadeem Sarwar,Angela Wood,Sara B Angleman,Frances Wensley,Julian P. T Higgins,Lucy Lennon,Gudny Eiriksdottir,Ann Rumley,Peter H Whincup,Gordon D. O Lowe,Vilmundur Gudnason
PLOS Medicine , 2008, DOI: 10.1371/journal.pmed.0050078
Abstract: Background The relevance to coronary heart disease (CHD) of cytokines that govern inflammatory cascades, such as interleukin-6 (IL-6), may be underestimated because such mediators are short acting and prone to fluctuations. We evaluated associations of long-term circulating IL-6 levels with CHD risk (defined as nonfatal myocardial infarction [MI] or fatal CHD) in two population-based cohorts, involving serial measurements to enable correction for within-person variability. We updated a systematic review to put the new findings in context. Methods and Findings Measurements were made in samples obtained at baseline from 2,138 patients who had a first-ever nonfatal MI or died of CHD during follow-up, and from 4,267 controls in two cohorts comprising 24,230 participants. Correction for within-person variability was made using data from repeat measurements taken several years apart in several hundred participants. The year-to-year variability of IL-6 values within individuals was relatively high (regression dilution ratios of 0.41, 95% confidence interval [CI] 0.28–0.53, over 4 y, and 0.35, 95% CI 0.23–0.48, over 12 y). Ignoring this variability, we found an odds ratio for CHD, adjusted for several established risk factors, of 1.46 (95% CI 1.29–1.65) per 2 standard deviation (SD) increase of baseline IL-6 values, similar to that for baseline C-reactive protein. After correction for within-person variability, the odds ratio for CHD was 2.14 (95% CI 1.45–3.15) with long-term average (“usual”) IL-6, similar to those for some established risk factors. Increasing IL-6 levels were associated with progressively increasing CHD risk. An updated systematic review of electronic databases and other sources identified 15 relevant previous population-based prospective studies of IL-6 and clinical coronary outcomes (i.e., MI or coronary death). Including the two current studies, the 17 available prospective studies gave a combined odds ratio of 1.61 (95% CI 1.42–1.83) per 2 SD increase in baseline IL-6 (corresponding to an odds ratio of 3.34 [95% CI 2.45–4.56] per 2 SD increase in usual [long-term average] IL-6 levels). Conclusions Long-term IL-6 levels are associated with CHD risk about as strongly as are some major established risk factors, but causality remains uncertain. These findings highlight the potential relevance of IL-6–mediated pathways to CHD.
Investigation of the effect of Interleukin-1 receptor antagonist (IL-1ra) on markers of inflammation in non-ST elevation acute coronary syndromes (The MRC-ILA-HEART Study)
David C Crossman, Allison C Morton, Julian P Gunn, John P Greenwood, Alistair S Hall, Keith AA Fox, Andrew J Lucking, Marcus D Flather, Belinda Lees, Claire E Foley
Trials , 2008, DOI: 10.1186/1745-6215-9-8
Abstract: Three centres in the UK are planning to recruit 186 Non-ST elevation myocardial infarction patients to receive either interleukin-1 receptor antagonist (Anakinra) or matching placebo. Patients will receive a daily subcutaneous injection of either study drug or placebo over a 14 day period. The primary outcome is area under the curve of high sensitivity C-Reactive Protein (CRP) over the first 7 days.The MRC-ILA-HEART Study is a proof of concept clinical trial investigating the effects of IL-1ra upon markers of inflammation in patients with Non-ST elevation myocardial infarction. It is hoped this will provide new and exciting information in relation to an "anti-inflammatory" strategy for patients with acute coronary syndrome.ISRCTN89369318Acute coronary syndromes (ACS), caused by coronary atherosclerotic plaque destabilisation and interruption of coronary flow, are common, serious conditions that account for 15% of all deaths in the UK and are associated with considerable morbidity among survivors. ACS are classified by the presenting ECG: patients with persistent ST elevation myocardial infarction (STEMI) generally require early reperfusion [1], whereas those with non ST-elevation (NSTEMI) ACS require early risk stratification and revascularisation as necessary [2]. There remains, however, considerable risk in the non-ST elevation ACS patients: the average risk of death at 6 months is 6.2% with 19.3% re-attending hospital because of heart disease [3]. It is known that inflammatory processes are activated in ACS. This proposal is for a proof of concept clinical trial of a new and exciting anti-inflammatory strategy for the treatment of NSTEMI ACS based on pre-clinical investigations that we wish to translate to man.The past decade has seen a growth in treatment options available for ACS as a consequence of better understanding of the pathophysiology of this condition. At a biological level the process is driven by inflammatory mechanisms in the vessel wall where ather
Importance of HDL Cholesterol as Predictor of Coronary Heart Disease in Jordan Population: The Role of HDL-Subfractions in Reverse Cholesterol Transport  [PDF]
Mohammad A. Salahat,Husni S. Farah,Yahya S. Al-Degs
Pakistan Journal of Biological Sciences , 2002,
Abstract: The incidence of coronary heart disease (CHD) was assessed through cross-sectional study including 400 volunteer subjects aged between 16 and 65 years. An adequate incidence of atherosclerotic CHD was only found in male subjects greater than 40 years of age. The analysis and subsequent one year follow-up period was therefore confined to 200 male participants aged 40-65 years. In the follow-up period 65 participants developed atherosclerotic CHD only 20 definite non- fatal myocardial infraction (MI). Invariant analysis revealed a significant association between the incidence of atherosclerotic CHD and a high density lipoprotein cholesterol (P≤0.001) which remained after adjustment for other risk factors.
Polymorphisms of ?174G>C and ?572G>C in the Interleukin 6 (IL-6) Gene and Coronary Heart Disease Risk: A Meta-Analysis of 27 Research Studies  [PDF]
Guo-hua Zheng, Hai-ying Chen, Shang-Quan Xiong
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0034839
Abstract: Objective Elevated serum IL-6 level is a risk factor for coronary heart disease (CHD). The ?174G>C and ?572G>C polymorphisms in the IL-6 gene have previously been shown to modulate IL-6 levels. But the association between the ?174G>C and ?572G>C polymorphisms and the risk of CHD is still unclear. A meta-analysis of all eligible studies was carried out to clarify the role of IL-6 gene polymorphisms in CHD. Methods and Results PubMed, EMBASE, Vip, CNKI and CBM-disc were searched for eligible articles in English and Chinese that were published before October 2010. 27 studies involving 11580 patients with CHD and 17103 controls were included. A meta-analysis was performed for the included articles using the RevMan 5.0 and Stata 10.0 softwares. Overall, the ?174C allele was not significantly associated with CHD risk (ORs = 1.04, 95%CI = 0.98 to 1.10) when compared with the ?174G allele in the additive model, and meta-analysis under other genetic models (dominant, recessive, CC versus GG, and GC versus GG) also did not reveal any significant association. On the contrary, the ?572C allele was associated with a decreased risk of CHD when compared with the ?572G allele (ORs = 0.79, 95%CI = 0.68 to 0.93). Furthermore, analyses under the recessive model (ORs = 0.69, 95% = 0.59 to 0.80) and the allele contrast model (genotype of CC versus GG, ORs = 0.49, 95% = 0.35 to 0.70) yielded similar results. However, statistical significance was not found when the meta-analysis was restricted to studies focusing on European populations, studies with large sample size, and cohort studies by using subgroup analysis. Conclusions The ?174G>C polymorphism in the IL-6 gene is not significantly associated with increased risks of CHD. However, The ?572G>C polymorphism may contribute to CHD development. Future investigations with better study design and large number of subjects are needed.
Depression and Coronary Heart Disease  [PDF]
Karina W. Davidson
ISRN Cardiology , 2012, DOI: 10.5402/2012/743813
Abstract: There are exciting findings in the field of depression and coronary heart disease. Whether diagnosed or simply self-reported, depression continues to mark very high risk for a recurrent acute coronary syndrome or for death in patients with coronary heart disease. Many intriguing mechanisms have been posited to be implicated in the association between depression and heart disease, and randomized controlled trials of depression treatment are beginning to delineate the types of depression management strategies that may benefit the many coronary heart disease patients with depression. 1. Introduction Depression is quickly becoming the leading cause of years of life lived with disability worldwide [1] and has a particularly large impact on compromised health when comorbid with a chronic medical disorder [2]. More than 17 million American adults survived after an acute coronary syndrome (ACS), with 1.2 million new surviving cases added per year [3]. More than 2 out of every 5 of these patients have significant patient-reported depressive symptoms [4], and these symptoms will remain long after discharge [5]. Thus, as many as 7 million of Americans living with coronary heart disease (CHD) are also suffering with clinically significant depression, and we add half of a million new cases to this public health burden annually. As the comorbidity between these two conditions is high, and both predict increased occurrence of the other, a whole field has emerged to study the complex inter-relations of depression and ACS. For example, presence of a depressive disorder and/or minimally elevated depressive symptoms appears to be a robust risk and prognostic marker of CHD recurrence and all-cause mortality [4, 6, 7]. In this paper, the definition, measurement, epidemiology, mechanisms, screening, and treatment recommendations for depression comorbid with coronary heart disease will be presented, as will the controversies and future research directions in this interesting intersection between mental and physical disease. 2. Defining Depression Many researchers and much of the lay public assume that depression is a categorical disorder, and that those who suffer with symptoms typically associated with depression have a disease qualitatively different from everyday distress. Consequently, they consider that this cluster of symptoms should be viewed as one of a series of psychiatric illnesses, as described within the Diagnostic and Statistical Manual of Mental Disorders (DSM) [8]. However, there are others promoting continuous or dimensional views of these symptoms. Both
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