scholarly journals Gut microbiota in coronary artery disease: a friend or foe?

2020 ◽  
Vol 40 (5) ◽  
Author(s):  
Bo Zhang ◽  
Xinxin Wang ◽  
Ran Xia ◽  
Chunsheng Li
Keyword(s):  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Gut Microbiota ◽  
Cardiovascular Events ◽  
Beneficial Effects ◽  
Major Cardiovascular Events ◽  
Potential Biomarker ◽  
Increased Risk ◽  
Artery Disease ◽  
Harmful Effects

Abstract There is a growing interest in the role of gut microbiota in the pathophysiology of several diseases, including coronary artery diseases (CAD). Gut microorganisms may produce beneficial effects in myocardial ischemia either directly in the form of exogenous administration or indirectly by acting on fiber-rich food to produce important cardioprotective components. The harmful effects of gut microbiota in CAD are due to alteration in their composition with a significant decrease in Bacteroidetes and an increase in Firmicutes, Escherichia, Shigella, and Enterococcus. The altered microbiota may produce potentially toxic metabolites, including trimethylamine-N-oxide (TMAO). Indeed, the fasting plasma levels of TMAO are directly correlated to increased risk of major cardiovascular events in CAD patients, and it is proposed as a potential biomarker to predict the onset of major cardiovascular events. It is concluded that the change in the composition of gut microbiota in CAD patients may predispose to more harmful effects. However, exogenous delivery of probiotics may overcome the detrimental effects of myocardial ischemia.

Insulin resistance is associated with increased risk of major cardiovascular events in patients with preexisting coronary artery disease

2007 ◽  
Vol 153 (4) ◽  
pp. 559-565 ◽  
Author(s):  
Alexander Tenenbaum ◽  
Yehuda Adler ◽  
Valentina Boyko ◽  
Helena Tenenbaum ◽  
Enrique Z. Fisman ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Major Cardiovascular Events ◽  
Increased Risk ◽  
Artery Disease

Paediatric-onset coronary artery anomalies in pregnancy: a single-centre experience and systematic literature review

2017 ◽  
Vol 27 (8) ◽  
pp. 1529-1537 ◽  
Author(s):  
Michelle Keir ◽  
Catriona Bhagra ◽  
Debra Vatenmakher ◽  
Francisca Arancibia-Galilea ◽  
Katrijn Jansen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Coronary Anomalies ◽  
Coronary Artery Anomalies ◽  
Major Cardiovascular Events ◽  
Coronary Aneurysms ◽  
Increased Risk ◽  
In Pregnancy

AbstractObjectivesIndividuals with childhood-onset coronary artery anomalies are at increased risk of lifelong complications. Although pregnancy is thought to confer additional risk, a few data are available regarding outcomes in this group of women. We sought to define outcomes of pregnancy in this unique population.MethodsWe performed a retrospective survey of women with paediatric-onset coronary anomalies and pregnancy in our institution, combined with a systematic review of published cases. We defined paediatric-onset coronary artery anomalies as congenital coronary anomalies and inflammatory arteriopathies of childhood that cause coronary aneurysms. Major cardiovascular events were defined as pulmonary oedema, sustained arrhythmia requiring treatment, stroke, myocardial infarction, cardiac arrest, or death.ResultsA total of 25 surveys were mailed, and 20 were returned (80% response rate). We included 46 articles from the literature, which described cardiovascular outcomes in 82 women (138 pregnancies). These data were amalgamated for a total of 102 women and 194 pregnancies; 59% of women were known to have paediatric-onset coronary artery anomalies before pregnancy. In 23%, the anomaly was unmasked during or shortly after pregnancy. The remainder, 18%, was diagnosed later in life. Major cardiovascular events occurred in 14 women (14%) and included heart failure (n=5, 5%), myocardial infarction (n=7, 7%), maternal death (n=2, 2%), cardiac arrest secondary to ventricular fibrillation (n=1, 1%), and stroke (n=1, 1%). The majority of maternal events (13/14, 93%) occurred in women with no previous diagnosis of coronary disease.ConclusionsWomen with paediatric-onset coronary artery anomalies have a 14% risk of adverse cardiovascular events in pregnancy, indicating the need for careful assessment and close follow-up. Prospective, multicentre studies are required to better define risk and predictors of complications during pregnancy.

scholarly journals Type 2 diabetes and risk of major cardiovascular events in peripheral artery disease versus coronary artery disease patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C H Saely ◽  
A Vonbank ◽  
B Larcher ◽  
A Mader ◽  
M Maechler ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Peripheral Artery Disease ◽  
Cardiovascular Events ◽  
Peripheral Artery ◽  
Major Cardiovascular Events ◽  
Multivariate Adjustment ◽  
Artery Disease

Abstract   The prevalence of type 2 diabetes (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than CAD. The purpose of this study was to investigate how the incidence of major cardiovascular events compares between PAD and CAD patients when analyses are stratified by the presence of type 2 diabetes (T2DM). We prospectively recorded major cardiovascular events and death over 10.0±4.7 years in 923 patients with stable CAD, of whom 26.7% had T2DM and in 292 patients with PAD, of whom 42.1% had T2DM. Four groups were analyzed: CAD patients without diabetes (CAD/T2DM-; n=677), CAD patients with T2DM (CAD/T2DM+; n=246), PAD patients without diabetes (PAD/T2DM-; n=169) and PAD patients with T2DM (PAD/T2DM+; n=123). When compared to the incidence of MACE in CAD+/T2DM- patients (25.1%), it was significantly higher in CAD+/T2DM+ patients (35.4%; p<0.001), in PAD+/T2DM- patients (30.2%; p=0.022) and in PAD+/T2DM+ patients (47.2%; p<0.001). Patients with both PAD and T2DM in turn were at a higher risk than CAD+/T2DM+ or PAD+/T2DM- patients (p=0.001 and p<0.001, respectively). The incidence of MACE did not differ significantly between PAD+/T2DM- and CAD+/T2DM+ patients (p=0.413). Compared to patients with CAD, Cox regression analyses after multivariate adjustment showed an adjusted hazard ratio of 1.46 [1.14–1.87], p=0.002 for the presence of PAD. Conversely, T2DM increased the risk of MACE after multivariate adjustment in CAD and PAD patients (adjusted HR 1.58 [1.27–1.98], p<0.001). In conclusion, our data show that T2DM and the presence of PAD are mutually independent predictors of MACE. Patients with both PAD and T2DM are at an exceedingly high risk of MACE. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Alterations of Gut Microbiome and Serum Metabolome in Coronary Artery Disease Patients Complicated With Non-alcoholic Fatty Liver Disease Are Associated With Adverse Cardiovascular Outcomes

2022 ◽  
Vol 8 ◽  
Author(s):  
Xiaomin Hu ◽  
Ruilin Zhou ◽  
Hanyu Li ◽  
Xinyue Zhao ◽  
Yueshen Sun ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Liver Disease ◽  
Coronary Artery ◽  
Gut Microbiota ◽  
Clinical Outcomes ◽  
Gut Microbiome ◽  
Fatty Liver Disease ◽  
Cardiovascular Events ◽  
Cardiovascular Outcomes ◽  
Artery Disease

Rationale: Patients suffering from coronary artery disease (CAD) complicated with nonalcoholic fatty liver disease (NAFLD) present worse cardiovascular outcomes than CAD patients without NAFLD. The progression of CAD is recently reported to be associated with gut microbiota and microbe-derived metabolites. However, it remains unclear how the complication of NAFLD will affect gut microbiota and microbe-derived metabolites in CAD patients, and whether or not this interplay is related to the worse cardiovascular outcomes in CAD-NAFLD patients.Methods: We performed 16S rRNA sequencing and serum metabolomic analysis in 27 CAD patients with NAFLD, 81 CAD patients without NAFLD, and 24 matched healthy volunteers. Predicted functional profiling was achieved using PICRUSt2. The occurrence of cardiovascular events was assessed by a follow-up study. The association of alterations in the gut microbiome and metabolome with adverse cardiovascular events and clinical indicators was revealed by Spearman correlation analysis.Results: We discovered that the complication of NAFLD was associated with worse clinical outcomes in CAD patients and critical serum metabolome shifts. We identified 25 metabolite modules that were correlated with poor clinical outcome in CAD-NAFLD patients compared with non-NAFLD patients, represented by increased cardiac-toxic metabolites including prochloraz, brofaromine, aristolochic acid, triethanolamine, and reduced potentially beneficial metabolites including estradiol, chitotriose, palmitelaidic acid, and moxisylyte. In addition, the gut microbiome of individuals with CAD-NAFLD was changed and characterized by increased abundances of Oscillibacter ruminantium and Dialister invisus, and decreased abundances of Fusicatenibacter saccharivorans, Bacteroides ovatus and Prevotella copri. PICRUSt2 further confirmed an increase of potential pathogenic bacteria in CAD-NAFLD. Moreover, we found that variations of gut microbiota were critically correlated with changed circulating metabolites and clinical outcomes, which revealed that aberrant gut microbiota in CAD-NAFLD patients may sculpt a detrimental metabolome which results in adverse cardiovascular outcomes.Conclusions: Our findings suggest that CAD patients complicated with NAFLD result in worse clinical outcomes possibly by modulating the features of the gut microbiota and circulating metabolites. We introduce “liver-gut microbiota-heart axis” as a possible mechanism underlying this interrelationship. Our study provides new insights on the contribution of gut microbiota heterogeneity to CAD-NAFLD progression and suggests novel strategies for disease therapy.

372-P: Type 2 Diabetes and Risk of Major Cardiovascular Events in Peripheral Artery Disease vs. Coronary Artery Disease Patients

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 372-P
Author(s):  
CHRISTOPH H. SAELY ◽  
ALEXANDER VONBANK ◽  
BARBARA LARCHER ◽  
ARTHUR MADER ◽  
MAXIMILIAN MAECHLER ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Peripheral Artery Disease ◽  
Cardiovascular Events ◽  
Peripheral Artery ◽  
Major Cardiovascular Events ◽  
Artery Disease ◽  
P Type

Combination Use of Clopidogrel and Proton Pump Inhibitors Increases Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease

2016 ◽  
Vol 22 (2) ◽  
pp. 142-152 ◽  
Author(s):  
Qiang Niu ◽  
Zhongsu Wang ◽  
Yong Zhang ◽  
Jiangrong Wang ◽  
Pei Zhang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Combination Therapy ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Cardiovascular Events ◽  
Cochrane Library ◽  
Major Adverse Cardiovascular Events ◽  
Increased Risk ◽  
Artery Disease

Background: Published data indicated that combination use of clopidogrel and proton pump inhibitors (PPIs) may increase the incidence of major adverse cardiovascular events (MACEs). This has been a highly controversial topic for years. Design: The present study was performed to evaluate whether combination therapy of clopidogrel and PPIs is associated with increased risk of MACEs than with clopidogrel alone in patients with coronary artery disease. Methods: A systematic search of MEDLINE, EMBASE, and the Cochrane Library was conducted for studies recording the occurrence of MACEs in patients with exposure to concomitant use of clopidogrel and PPIs up to February 2015. Odds ratios (ORs) were combined using a random-effects model. Results: Patients receiving combination therapy with PPIs and clopidogrel were at significantly increased risk of MACEs (OR: 1.42; 95% confidence interval [CI]: 1.30-1.55). Adding a PPI to clopidogrel treatment was associated with a higher rate of MACE occurrence in rapid metabolizers (RMs, *1/*1) of CYP2C19 (OR: 1.42; 95% CI: 1.12-1.81), but there was no obviously increased rate (OR: 1.43; 95% CI: 0.89-2.28) in decreased metabolizers (with 1 or 2 loss-of-function allele). The increased risk of MACEs was similar in 4 classes of PPIs (omeprazole, lansoprazole, esomeprazole, and pantoprazole), but rabeprazole (OR: 1.03; 95% CI: 0.55-1.95) wasn’t. Conclusion: The combination use of clopidogrel and certain types of PPIs (omeprazole, lansoprazole, esomeprazole, pantoprazole) increases the risk of MACE in patients with coronary artery disease. Only in the RMs of CYP2C19, PPIs were associated with significantly increased MACE in patients coadministered with clopidogrel.

Ticagrelor in the management of coronary artery disease

2020 ◽  
Author(s):  
Krithika Loganath ◽  
Philip D Adamson ◽  
Alastair J Moss
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stable Coronary Artery Disease ◽  
Phase Iii ◽  
Major Cardiovascular Events ◽  
Increased Risk ◽  
Effective Inhibition ◽  
Phase Iii Trials ◽  
Artery Disease ◽  
Orally Active

Ticagrelor is a potent and orally active P2Y12 inhibitor. Ticagrelor has been extensively tested in Phase II and Phase III trials in patients with coronary artery disease. The pharmacokinetics and pharmacodynamics of Ticagrelor result in more rapid and effective inhibition of platelet activation compared with other P2Y12 inhibitors. This has resulted in a reduction in recurrent major cardiovascular events in initial randomized controls trials comparing Ticagrelor with clopidogrel. More recently, clinical trials have investigated the use of Ticagrelor in patients with stable coronary artery disease and a high residual risk of coronary thrombotic events. In patients with stable coronary artery disease, the potent antiplatelet effect of Ticagrelor is counterbalanced by an increased risk of major bleeding. Further research is ongoing to determine the optimal duration of Ticagrelor therapy.

scholarly journals Prognostic value of ST2 for MACEs and all-cause mortality in patients with coronary artery disease during a long-term follow up

2020 ◽  
Author(s):  
Man Li ◽  
Lei Duan ◽  
Yulun Cai ◽  
Benchuan Hao ◽  
Jianqiao Chen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Cox Regression ◽  
Major Adverse Cardiovascular Events ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Artery Disease

Abstract Background: Suppression of tumorigenesis-2 is implicated in the myocardial overload and it was long been recognized as an inflammation marker related to heart failure and acute coronary syndromes, but the data on prognostic value of suppression of tumorigenesis-2 on patients with coronary artery disease remains limited. The study ought to investigate the prognostic value of suppression of tumorigenesis-2 in patients with established coronary artery disease.Methods: In this prospective cohort study, a total of 3641 consecutive patients were included. The primary end point was major adverse cardiovascular events. Kaplan-Meier survival estimates indicated that the patients with higher levels of ST2 (ST2> 19 ng/ml) had a significantly increased risk of MACEs (log-rank p＜0.001) and all-cause death (log-rank p＜0.001). The secondary end point was all-cause death. The association between suppression of tumorigenesis-2 and outcomes was investigated using multivariable COX regression.Results: During a median follow up of 6.4 years, there were 775 patients had the occurrence of major adverse cardiovascular events and 275 patients died. Kaplan-Meier survival estimates indicated that the patients with higher levels of ST2 (ST2> 19 ng/ml) had a significantly increased risk of MACEs (log-rank p＜0.001) and all-cause death (log-rank p＜0.001). Multiple COX regression models showed that higher level of suppression of tumorigenesis-2 was an independent predictor in developing major adverse cardiovascular events (HR=1.36, 95% CI 1.17-1.56, p＜0.001) and all-cause death (HR=2.01, 95%CI 1.56-2.59, p＜0.001). The addition of suppression of tumorigenesis-2 to established risk factors significantly improved risk prediction of the composite outcome of major adverse cardiovascular events and all-cause death (c-statistic, net reclassification index, and integrated discrimination improvement, all p＜0.05).Conclusions: Higher level of suppression of tumorigenesis-2 is significantly associated with long-term all-cause death and major adverse cardiovascular events. Suppression of tumorigenesis-2 may provide incremental prognostic value beyond traditional risk factors.

scholarly journals PROGNOSTIC VALUE OF P-SELECTIN IN PATIENTS WITH STABLE ANGINA PECTORIS

2018 ◽  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Inflammatory Response ◽  
Stable Angina ◽  
Cardiovascular Events ◽  
Systemic Inflammatory Response ◽  
Increased Risk ◽  
Artery Disease

Coronary artery disease for many years is being the main cause of death in many developed countries. Currently, cardiovascular disease (CVD) plays the main role in the evolution of the total mortality in the world. Most deaths occur as a result of coronary heart disease (more than 300 thousand per year). It is known that chronic inflammation is a marker of global endothelial dysfunction and may be associated with the increased risk of cardiovascular events in patients with coronary artery disease. Nowadays, it is very promising in terms of assessing the prognosis and course of the disease to study P-selectin. The level of P-selectin in patients with stable angina is not associated with the level of hs-CRP, which creates the prerequisites for the personalization of therapeutic goals for reducing the systemic inflammatory response.2. In patients with high P-selectin (upper tertile), significantly more cardiovascular events are observed compared to patients with low P-selectin (lower tertile), which makes it possible to use the P-selectin level to estimate the prognosis in patients with stable angina.3. The data obtained in the study allow in the long term to use a new biomarker of inflammation of P-selectin to estimate the prognosis in patients with stable angina and to personalize therapy of patients with coronary heart disease aimed at reducing the «residual»cardiovascular risk associated with the activation of various mechanisms of the systemic inflammatory response.

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