Analysis of the Reactivity of Aspirin and Clopidogrel and Its Influencing Factors in Patients with Coronary Heart Disease at High Altitude

Objective. To evaluate the efficacy of dual-antiplatelet treatment (DAPT) in patients with coronary heart disease (CHD) at high altitude by using thrombelastogram (TEG) and to analyze the related biochemical factors affecting drug reactivity. Methods. Totally 118 CHD patients who admitted to the Qinghai People’s Hospital from September 2019 to September 2020 were enrolled in the group. Those people have lived in Qinghai for a long time. Seven days after DAPT, venous blood was collected on an empty stomach in the early morning of the next day; blood routine, coagulation function, and biochemical items were tested. Thrombelastogram (TEG) was used to draw curves to calculate platelet, coagulation and fibrinolysis functions, and drug inhibition rate. Patients were divided into the aspirin resistance (AR) group, clopidogrel resistance (CR) group, dual-antiplatelet drug resistance (DAR) group, and drug-sensitive group according to different inhibition rates. The drug efficacy was analyzed, and the clinical data, biochemical indexes, and TEG parameters of each group were compared to identify the risk factors of drug resistance. Results. Those 118 CHD patients at high altitude were incorporated into the study, ranging from 38 to 84 years of age, including 81 males (68.64%) and 37 females (31.36%). The platelet function and coagulation-fibrinolysis function were detected by TEG, and MATHROMBI, MAADP, and MAAA were higher than the reference range. There were 82 cases (69.49%) of drug resistance, 36 cases (32.53%) of drug sensitivity, 17 cases (14.41%) of AR alone, and 16 cases (12.71%) of CR alone. There was no significant difference in age, gender, BMI, oxygen saturation, TG, GFR, and history of diabetes and hypertension between ACS and CCS groups ( P > 0.05 ). PLT and FIB in the ACS group were higher than those in the CCS group, and the difference was statistically significant ( P < 0.05 ). In addition, MATHROMBIN, MAFIBRIN, E, A, A30, and coagulation composite index were also higher than those in the CCS group, with a statistically significant difference ( P < 0.05 ). Univariate analysis and logistic regression analysis suggested that age, HbA1c, FBG, and diabetes were the main factors of drug resistance. Conclusion. Antiplatelet drugs aspirin and clopidogrel resistance are associated with increased age, elevated HbA1c and FBG, and diabetes. Therefore, it is necessary to take reasonable treatment measures based on the actual situation of patients.

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Antiplatelet drug resistance in patients with coronary heart disease

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2012-6-71-77 ◽

2012 ◽

Vol 11 (6) ◽

pp. 71-77 ◽

Cited By ~ 1

Author(s):

V. A. Sulimov ◽

E. V. Moroz

Keyword(s):

Coronary Heart Disease ◽

Drug Resistance ◽

Heart Disease ◽

Aspirin Resistance ◽

Assessment Method ◽

Antiplatelet Drug ◽

Clinical Group ◽

Gold Standard Method ◽

Antiaggregant Therapy ◽

Antiplatelet Drug Resistance

Coronary angioplasty is an important component of coronary heart disease (CHD) management. There is a substantial evidence of the need for dual antiaggregant therapy (clopidogrel and aspirin) in this clinical group, both before and after the intervention. The development of thrombotic complications during antiaggregant therapy suggests the antiplatelet drug resistance. The prevalence of this condition varies from 5% to 45% for aspirin, and from 20% to 45% for clopidogrel, depending on the assessment method and the specific clinical group. For dual antiplatelet therapy, the resistance prevalence is 6-8%. Presently, the gold standard method of the platelet functional activity assessment is optical aggregometry. To assess the resistance to aspirin, arachidonic acid is used as an aggregation inductor, with the calculation of absolute aggregation levels. To assess the resistance to clopidogrel, ADP is used as an aggregation inductor, and the relative aggregation parameters are calculated. The development of aspirin resistance is influenced by biological, clinical, and genetic factors. The clopidogrel resistance is associated with certain medications, hyperglycemia, atherosclerosis, and CYP2C19*2 gene polymorphism. Identification of the patients resistant to antiplatelet drugs enables the clinicians to adjust the antiplatelet treatment reasonably early and to reduce the risk of cardiovascular events. The possible methods of overcoming antiplatelet drug resistance are to double the loading and maintenance doses of clopidogrel and to use new agents.

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The Role of Genetic Polymorphism and Other Factors on Clopidogrel Resistance (CR) in an Asian Population with Coronary Heart Disease (CHD)

Molecules ◽

10.3390/molecules26071987 ◽

2021 ◽

Vol 26 (7) ◽

pp. 1987

Author(s):

Mohammed Ahmed Akkaif ◽

Nur Aizati Athirah Daud ◽

Abubakar Sha’aban ◽

Mei Li Ng ◽

Muhamad Ali Sk Abdul Kader ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Genetic Polymorphism ◽

Racial Differences ◽

Personalised Medicine ◽

Asian Population ◽

Antiplatelet Drug ◽

Valuable Insight ◽

Platelet Activity ◽

Clopidogrel Resistance

Clopidogrel is a widely-used antiplatelet drug. It is important for the treatment and prevention of coronary heart disease. Clopidogrel can effectively reduce platelet activity and therefore reduce stent thrombosis. However, some patients still have ischemic events despite taking the clopidogrel due to the alteration in clopidogrel metabolism attributable to various genetic and non-genetic factors. This review aims to summarise the mechanisms and causes of clopidogrel resistance (CR) and potential strategies to overcome it. This review summarised the possible effects of genetic polymorphism on CR among the Asian population, especially CYP2C19 *2 / *3 / *17, where the prevalence rate among Asians was 23.00%, 4.61%, 15.18%, respectively. The review also studied the effects of other factors and appropriate strategies used to overcome CR. Generally, CR among the Asian population was estimated at 17.2–81.6%. Therefore, our overview provides valuable insight into the causes of RC. In conclusion, understanding the prevalence of drug metabolism-related genetic polymorphism, especially CYP2C19 alleles, will enhance clinical understanding of racial differences in drug reactions, contributing to the development of personalised medicine in Asia.

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Multimodal Diagnostics of Microrheologic Alterations in Blood of Coronary Heart Disease and Diabetic Patients

Diagnostics ◽

10.3390/diagnostics11010076 ◽

2021 ◽

Vol 11 (1) ◽

pp. 76

Author(s):

Anastasia Maslianitsyna ◽

Petr Ermolinskiy ◽

Andrei Lugovtsov ◽

Alexandra Pigurenko ◽

Maria Sasonko ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Red Blood Cells ◽

Blood Cells ◽

Optical Methods ◽

Diabetic Patients ◽

Aggregation Index ◽

Significant Difference

Coronary heart disease (CHD) has serious implications for human health and needs to be diagnosed as early as possible. In this article in vivo and in vitro optical methods are used to study blood properties related to the aggregation of red blood cells in patients with CHD and comorbidities such as type 2 diabetes mellitus (T2DM). The results show not only a significant difference of the aggregation in patients compared to healthy people, but also a correspondence between in vivo and in vitro parameters. Red blood cells aggregate in CHD patients faster and more numerously; in particular the aggregation index increases by 20 ± 7%. The presence of T2DM also significantly elevates aggregation in CHD patients. This work demonstrates multimodal diagnostics and monitoring of patients with socially significant pathologies.

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Effect of Tobacco on Lipoprotein Profile: A Comparative study among Smokers and Chewers

Research Journal of Pharmacy and Technology ◽

10.52711/0974-360x.2021.00865 ◽

2021 ◽

pp. 4973-4976

Author(s):

Roshan Kumar Jha ◽

Ranjit S. Ambad ◽

Priya Koundal ◽

Akansha Singh

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Total Cholesterol ◽

Sample Processing ◽

Exclusion Criteria ◽

Future Studies ◽

Area Of Interest ◽

Significant Difference ◽

The Difference

It has been proved that tobacco is one of the cholesterol dependent risk factors pathogenically, and in addition with other risk factors it may lead to coronary heart disease. Thus, a strong interaction exists between hypercholesterolemia and tobacco ingesting in the genesis of coronary heart disease. The aim of this study was to study the effect of tobacco smoking and chewing and compare its effect on lipoproteins. 60 subjects were included in the study, and were grouped into 3 three groups, tobacco smokers, tobacco chewers and tobacco non-abusers. Each group comprises 20 participants: selected on the basis of inclusion and exclusion criteria. Proper sampling and sample processing methods were employed to evaluate lipid profile. Total cholesterol and triglycerides levels were increased in smokers in comparison to non-smokers/non-chewers, and the differences were significant p<0.0001. HDL level was decreased in smokers as compared to non-smokers/non-chewers and the difference was statistically significant p<0.0001. Total cholesterol and LDL levels were increased in smokers in comparison to chewers. HDL level was decreased in chewers as compared to chewers. There was no significant association in any of the parameters. Present study observed increased and significant p<0.0001 differences in levels of total cholesterol and triglycerides while, HDL levels were decreased significantly p<0.0001, and also observed there was no significant difference among tobacco smokers and chewers. This may be a new area of interest for future studies.

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Effect of ageing on plasma lipoprotein(a) levels

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1258/0004563021901937 ◽

2002 ◽

Vol 39 (3) ◽

pp. 237-240 ◽

Cited By ~ 11

Author(s):

Harukuni Akita ◽

Miyao Matsubara ◽

Hitoshi Shibuya ◽

Hirotoshi Fuda ◽

Hitoshi Chiba

Keyword(s):

Molecular Weight ◽

Coronary Heart Disease ◽

Risk Factor ◽

Heart Disease ◽

The Elderly ◽

Low Molecular Weight ◽

Lipoprotein A ◽

Significant Difference ◽

The Mean ◽

Japanese Subjects

Background Lipoprotein(a) [Lp(a)] is a risk factor for atherosclerosis and increases with age. The purpose of this study was to determine the effect of ageing on Lp(a) for three different apo(a) phenotypes. Methods We measured plasma Lp(a) concentrations in 551 unrelated Japanese subjects (20-88 years of age). We performed statistical analyses separately for three apo(a) phenotypes: the low-molecular-weight (LMW) phenotype with the F, B or S1 isoform, the intermediate-molecular-weight (IMW) phenotype with the S2 isoform and the high-molecular-weight (HMW) phenotype with the S3 or S4 isoform. Results For each phenotype, the mean plasma Lp(a) concentration and the frequency of Lp(a) concentrations ≥ 250 mg/L increased with age. Further, a statistically significant difference was always found between the younger subjects (20-39 years of age) and the elderly (over 60 years). The frequency of coronary heart disease increased with age, particularly for the LMW and IMW phenotypes. Conclusions We conclude that ageing elevates plasma Lp(a) concentrations, which may have a role in the prevalence of coronary heart disease in the elderly, especially those with the LMW or IMW phenotypes.

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Association of Derived Neutrophil-To-Lymphocyte Ratio With Prognosis of Coronary Heart Disease After PCI

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.705862 ◽

2021 ◽

Vol 8 ◽

Author(s):

Gang-Qiong Liu ◽

Wen-Jing Zhang ◽

Jia-Hong Shangguan ◽

Xiao-Dan Zhu ◽

Wei Wang ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Cox Regression ◽

Univariate Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Major Adverse Cardiovascular Events ◽

Lymphocyte Ratio ◽

Coronary Syndrome ◽

The Third

Aims: The present study aimed to investigate the prognostic role of derived neutrophil-to-lymphocyte ratio (dNLR) in patients with coronary heart disease (CHD) after PCI.Methods: A total of 3,561 post-PCI patients with CHD were retrospectively enrolled in the CORFCHD-ZZ study from January 2013 to December 2017. The patients (3,462) were divided into three groups according to dNLR tertiles: the first tertile (dNLR < 1.36; n = 1,139), second tertile (1.36 ≥ dNLR < 1.96; n = 1,166), and third tertile(dNLR ≥ 1.96; n = 1,157). The mean follow-up time was 37.59 ± 22.24 months. The primary endpoint was defined as mortality (including all-cause death and cardiac death), and the secondary endpoint was major adverse cardiovascular events (MACEs) and major adverse cardiovascular and cerebrovascular events (MACCEs).Results: There were 2,644 patients with acute coronary syndrome (ACS) and 838 patients with chronic coronary syndrome (CCS) in the present study. In the total population, the all-cause mortality (ACM) and cardiac mortality (CM) incidence was significantly higher in the third tertile than in the first tertile [hazard risk (HR) = 1.8 (95% CI: 1.2–2.8), p = 0.006 and HR = 2.1 (95% CI: 1.23–3.8), p = 0.009, respectively]. Multivariate Cox regression analyses suggested that compared with the patients in the first tertile than those in the third tertile, the risk of ACM was increased 1.763 times (HR = 1.763, 95% CI: 1.133–2.743, p = 0.012), and the risk of CM was increased 1.763 times (HR = 1.961, 95% CI: 1.083–3.550, p = 0.026) in the higher dNLR group during the long-term follow-up. In both ACS patients and CCS patients, there were significant differences among the three groups in the incidence of ACM in univariate analysis. We also found that the incidence of CM was significantly different among the three groups in CCS patients in both univariate analysis (HR = 3.541, 95% CI: 1.154–10.863, p = 0.027) and multivariate analysis (HR = 3.136, 95% CI: 1.015–9.690, p = 0.047).Conclusion: The present study suggested that dNLR is an independent and novel predictor of mortality in CHD patients who underwent PCI.

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Relationship Between gamma-Glutamyltransferase (gamma-GT) with High Sensitive C-Reactive Protein (hs-CRP), Oxidized (Ox-LDL) and Glutathione Peroxidase (GPx) on Coronary Heart Disease (CHD) Patient

The Indonesian Biomedical Journal ◽

10.18585/inabj.v1i2.94 ◽

2009 ◽

Vol 1 (2) ◽

pp. 51 ◽

Cited By ~ 1

Author(s):

Marissa Arifin ◽

Marsetio Donosepoetro ◽

Sutomo Kasiman

Keyword(s):

Oxidative Stress ◽

Coronary Heart Disease ◽

Heart Disease ◽

Glutathione Peroxidase ◽

Medical Center ◽

Oxidized Ldl ◽

C Reactive Protein ◽

Reactive Protein ◽

Significant Difference ◽

Hs Crp

BACKGROUND: Recent clinical studies have suggested that γ-glutamyltransferase (γ-GT) can trigger oxidative stress within the plaque. This study aimed to investigate whether serum γ-GT might be as a risk factor of coronary heart disease (CHD), and measure the associations of serum γ-GT with high sensitive C-Reactive Protein (hs-CRP), Oxidized LDL (Ox-LDL) and Glutathione Peroxidase (GPx).METHODS: This study recruited 48 patients aged 30-70 year who underwent coronary angiography at Haji Adam Malik Medical Center at Medan between February and April 2008 and who presented at least one coronary stenosis of > 50% of the luminar diameter. The sample subjects were consecutively selected.RESULTS: γ-Glutamyltransferase was positively associated (r = 0.546) with hs-CRP as a marker of chronic inflammation after careful adjustment for other established risk factors in CHD patient. But, there was no significant difference between γ-GT in male and female patients. Further, there were no correlations between γ-GT and Ox-LDL and GPx. Ratio of γ-GT/GPx was measured as well, and it was associated with hs-CRP.CONCLUSIONS: Ratio of γ-GT/GPx was associated with inflammation process in coronary heart disease patients.KEYWORDS: γ-glutamyltransferase (γ-GT), inflammation, oxidative stress, coronary heart disease

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Therapeutic effect of nifedipine combined with enalapril on elderly patients with coronary heart disease complicated with hypertension

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v2i6.671 ◽

2018 ◽

Vol 2 (6) ◽

Author(s):

Xiaoye Wang

Keyword(s):

Blood Pressure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Elderly Patients ◽

Adverse Reactions ◽

Effective Rate ◽

Control Group ◽

Significant Difference ◽

Pre Treatment ◽

Experimental Group

ã€Abstractã€‘Objective: Toanalyze the efficacy of combined drug therapy for elderly patients with coronary heart disease and hypertension.METHODS:Sixty-six elderly patients with coronary heart disease and hypertension were enrolled from December 2017 to November 2018. They were randomly divided into two groups, 33 patients in each group. Patients in the experimental group received nifedipine. In combination with enalapril, patients enrolled in the control group received nifedipine monotherapy.RESULTS:Compared with the control group, the total effective rate, Serum Nitric Oxide (Serum NO) after treatment, CRP after treatment, HCY after treatment, and blood pressure after treatment were significantly improved (P<0.05). Serum NO and treatment before treatment in the 2 groups. There was no significant difference in pre-CRP, pre-treatment HCY, pre-treatment blood pressure, and adverse reactions during treatment (P>0.05).Conclusion: Theelderly patients with coronary heart disease and hypertension are treated with nifedipine and enalapril.

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