Vascular Regenerative Capacity and the Obesity Paradox in Coronary Artery Disease

Objective: The underlying pathobiology of the paradoxical relationship between obesity and outcomes in coronary artery disease (CAD) is unclear. Our objective was to determine the association between obesity and circulating progenitor cell (CPC) counts—a measure of intrinsic regenerative capacity—in asymptomatic individuals and patients with CAD and its impact on the obesity paradox. Approach and Results: CPCs were enumerated by flow cytometry as CD45 med+ cells expressing CD34+, CD133+, and CXCR4+ epitopes in 672 asymptomatic individuals (50 years of age; 28% obese) and 1277 CAD patients (66 years of age; 39% obese). The association between obesity and CPCs was analyzed using linear regression models. The association between obesity and CPCs with cardiovascular death/myocardial infarction events over 3.5-year follow-up in CAD was studied using Cox models. Obesity was independently associated with 16% to 34% higher CPC counts (CD34+, CD34+/CD133+, and CD34+/CXCR4+) in asymptomatic individuals. This association was not attenuated by systemic inflammation, insulin resistance, or secretion but partly attenuated by cardiorespiratory fitness and body composition. In patients with CAD, obesity was associated with 8% to 12% higher CPC counts and 30% lower risk of adverse outcomes. Compared with nonobese patients, only obese patients with high CPC counts (CD34+ cells ≥median, 1806 cells/mL) were at a lower risk (hazard ratio, 0.52 [95% CI, 0.31–0.88]), whereas those with low counts (<median) were at a similar risk (hazard ratio, 0.75 [95% CI, 0.48–1.15]). Conclusions: Obesity is associated with higher CPC counts. The obesity paradox of improved outcomes with obesity in CAD is limited to patients with intact regenerative capacity who have CPC counts.

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The First Harmonic of Radial Pulse as an Early Predictor of Silent Coronary Artery Disease and Adverse Cardiac Events in Type 2 Diabetic Patients

Cardiology Research and Practice ◽

10.1155/2018/5128626 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Chi-Wei Chang ◽

Kuo-meng Liao ◽

Yi-Ting Chang ◽

Sheng-Hung Wang ◽

Ying-chun Chen ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Hazard Ratio ◽

Radial Pulse ◽

Cardiac Events ◽

Asymptomatic Patients ◽

Adverse Cardiac Events ◽

Silent Coronary Artery Disease ◽

Artery Disease ◽

Asymptomatic Individuals

Background. It has been reported that harmonics of radial pulse is related to coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). It is still unclear whether or not the first harmonics of the radial pulse spectrum is an early independent predictor of silent coronary artery disease (SCAD) and adverse cardiac events (ACE). Objectives. To measure the risk of SCAD in patients with T2DM and also to survey whether or not an increment of the first harmonic (C1) of the radial pulse increases ACE. Methods. 1968 asymptomatic individuals with T2DM underwent radial pulse wave measurement. First harmonic of the radial pressure wave, C1, was calculated. Next, the new occurrence of ACE and the new symptoms and signs of coronary artery disease were recorded. The follow-up period lasted for 14.7 ± 3.5 months. Results. Out of 1968 asymptomatic individuals with T2DM, ACE was detected in 239 (12%) of them during the follow-up period. The logrank test demonstrated that the cumulative incidence of ACE in patients with C1 above 0.96 was greater than that in those patients with C1 below 0.89 (P<0.01). By comparing the data of patients with C1 smaller than the first quartile and the patients with C1 greater than the third quartile, the hazard ratios were listed as follows: ACE (hazard ratio, 2.29; 95% CI, 1.55–3.37), heart failure (hazard ratio, 2.22; 95% CI, 1.21–4.09), myocardial infarction (hazard ratio, 2.44; 95% CI, 1.51–3.93), left ventricular dysfunction (Hazard ratio, 2.01; 95% CI, 0.86–4.70), and new symptoms and signs for coronary artery disease (hazard ratio, 2.03; 95% CI, 1.45–2.84). As C1 increased, the risk for composite ACE (P<0.001 for trend) and for coronary disease (P<0.001 for trend) also increased. The hazard ratio and trend for cardiovascular-cause mortality were not significant. Conclusions. This study showed that C1 of the radial pulse wave is correlated with cardiovascular events. Survival analysis showed that C1 value is an independent predictor of ACE and SCAD in asymptomatic patients with T2DM. Thus, screening for the first harmonic of the radial pulse may improve the risk stratification of cardiac events and SCAD in asymptomatic patients although they had no history of coronary artery disease or angina-related symptom.

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Sarcopenia predicts adverse outcomes in an elderly population with coronary artery disease: a systematic review and meta-analysis

BMC Geriatrics ◽

10.1186/s12877-021-02438-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qiqi Xue ◽

Jie Wu ◽

Yan Ren ◽

Jiaan Hu ◽

Ke Yang ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Meta Analysis ◽

Psoas Muscle ◽

Coronary Intervention ◽

Adverse Outcomes ◽

Cochrane Library ◽

Muscle Area ◽

Area Index ◽

Artery Disease

Abstract Background The development of sarcopenia is attributed to normal aging and factors like type 2 diabetes, obesity, inactivity, reduced testosterone levels, and malnutrition, which are factors of poor prognosis in patients with coronary artery disease (CAD). This study aimed to perform a meta-analysis to assess whether preoperative sarcopenia can be used to predict the outcomes after cardiac surgery in elderly patients with CAD. Methods PubMed, Embase, the Cochrane library, and Web of Science were searched for available papers published up to December 2020. The primary outcome was major adverse cardiovascular outcomes (MACE). The secondary outcomes were mortality and heart failure (HF)-related hospitalization. The random-effects model was used. Hazard ratios (HRs) with 95% confidence intervals (95%CIs) were estimated. Results Ten studies were included, with 3707 patients followed for 6 months to 4.5 ± 2.3 years. The sarcopenia population had a higher rate of MACE compared to the non-sarcopenia population (HR = 2.27, 95%CI: 1.58–3.27, P < 0.001; I2 = 60.0%, Pheterogeneity = 0.02). The association between sarcopenia and MACE was significant when using the psoas muscle area index (PMI) to define sarcopenia (HR = 2.86, 95%CI: 1.84–4.46, P < 0.001; I2 = 0%, Pheterogeneity = 0.604). Sarcopenia was not associated with higher late mortality (HR = 2.15, 95%CI: 0.89–5.22, P = 0.090; I2 = 91.0%, Pheterogeneity < 0.001), all-cause mortality (HR = 1.35, 95%CI: 0.14–12.84, P = 0.792; I2 = 90.5%, Pheterogeneity = 0.001), and death, HF-related hospitalization (HR = 1.37, 95%CI: 0.59–3.16, P = 0.459; I2 = 62.0%, Pheterogeneity = 0.105). The sensitivity analysis revealed no outlying study in the analysis of the association between sarcopenia and MACE after coronary intervention. Conclusion Sarcopenia is associated with poor MACE outcomes in patients with CAD. The results could help determine subpopulations of patients needing special monitoring after CAD surgery. The present study included several kinds of participants; although non-heterogeneity was found, interpretation should be cautious.

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Female disadvantage in risk of adverse outcomes after incident diabetic foot hospitalizations: A population cohort study

Current Diabetes Reviews ◽

10.2174/1573399817666210827121937 ◽

2021 ◽

Vol 17 ◽

Author(s):

Giuseppe Seghieri ◽

Laura Policardo ◽

Elisa Gualdani ◽

Paolo Francesconi

Keyword(s):

Coronary Artery Disease ◽

Renal Failure ◽

Coronary Artery ◽

Diabetic Foot ◽

Cardiovascular Events ◽

Arterial Disease ◽

Adverse Outcomes ◽

Excess Risk ◽

Lower Limbs ◽

Artery Disease

Background: Diabetic foot disease (DFD) is more prevalent among males and is associated with an excess-risk of cardiovascular events or mortality. Aims: This study explores the risk of next cardiovascular events, renal failure and all-cause mortality after incident DFD hospitalizations, separately in males and females to detect any gender difference in a cohort of 322,140 persons with diabetes retrospectively followed-up through administrative data-sources in Tuscany, Italy over years 2011-2018. Methods: The hazard ratio (HR) for incident adverse outcomes after first hospitalizations for DFD categorized as: major/minor amputations (No.=449;3.89%), lower limbs’ revascularizations (LLR: No.=2854;24.75%) and lower-extremity-arterial-disease (LEAD) with no procedures (LEAD-no proc: No.=6282;54.49%), was compared to risk of patients with background-DFD (ulcers, infections, Charcot-neuroarthropathy: No.=1,944;16.86%). Results: DFD incidence-rate was higher among males compared to females [1.57(95% CI:1.54-1.61) vs. 0.97(0.94-1.00)/100,000p-years]. After DFD the overall risk of coronary artery disease was significantly associated to male gender and that of stroke to female gender. LEAD-no proc and LLR were associated with risk of stroke risk only in females and with coronary artery disease at a significantly higher extent among women. Incident renal failure was not associated with any DFD category. Amputations and LEAD-no proc, significantly predicted mortality risk only in females while LLR reduced such risk in both genders. Females had a greater risk of composite outcome (death or cardiovascular events). When compared with background-DFD the risk was by 34% higher after amputations [HR: 1.34(1.04-1.72)] and by 10% higher after LEAD-no proc: [HR:1.10(1.03-1.18)] for LEAD-no proc, overall confirming that after incident DFD more strictly associated with vascular pathogenesis females are burdened by a greater excess-risk of adverse events. Conclusions: After incident DFD hospitalizations, females with DFD associated with amputations or with arterial disease are burdened by a greater excess risk of subsequent adverse cardiovascular events, compared with those with background DFD.

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Abstract 2870: In Women without Obstructive Coronary Artery Disease, Endothelial-Dependent and Non-Endothelial Dependent Coronary Reactivity Dysfunction are Associated with Different Types of Adverse Outcomes. The NHLBI Women’s Ischemia Syndrome Evaluation (WISE).

Circulation ◽

10.1161/circ.116.suppl_16.ii_639-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Scott Midwall ◽

R. David Anderson ◽

Delia Johnson ◽

Eileen Handberg ◽

Rhonda Cooper-Dehoff ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Adverse Events ◽

Obstructive Coronary Artery Disease ◽

Treatment Strategies ◽

Adverse Outcomes ◽

Flow Reserve ◽

Different Types ◽

Artery Disease ◽

Major Adverse Events

Backround: Altered coronary reactivity frequently occurs in women with chest discomfort both with and without obstructive coronary artery disease (CAD). Among those with obstructive CAD, the endothelial-dependent and non-endothelial dependent components of this altered reactivity have been associated with adverse outcomes. The clinical events among those with altered coronary reactivity but without obstructive CAD are not well defined. Methods: We evaluated 169 women with suspected myocardial ischemia who had no obstructive CAD at coronary angiography. Coronary reactivity was assessed by measuring flow reserve (CFR) with adenosine (endothelial-dependent) and change in vessel diameter (DIAM) following acetylcholine (non-endothelial dependent). Women were then followed for major adverse events (death, myocardial infarction, stroke, or hospitalization for heart failure) as well as hospitalization for recurrent angina by annual telephone contact over a median of 6.0 years. Results: Mean age was 54 ± 10 years, 15% were non-white, 37% had abnormal CFR (<2.32), and 47% had abnormal DIAM (no change or constriction). Of the women receiving both coronary reactivity tests, results were concordant in only 52%. Major events occurred in 16% (28/169) of which 5% (8/169) died. An additional 24% (41/169) were hospitalized for worsening angina. Major adverse events were predicted by abnormal CFR (27% vs 10%, p = 0.006) but not abnormal DIAM, while abnormal DIAM, but not CFR, predicted hospitalization for angina. Conclusion: Endothelial-dependent and non-dependent coronary dysfunction coexist in approximately one-half of women tested without angiographic evidence of CAD and appear to predict different types of adverse outcomes during follow-up. These results should foster developement of new diagnostic and treatment strategies targeting both endothelial and non-endothelial (e.g. vascular smooth muscle) dependent coronary dysfunction in women.

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The Obesity Paradox: Do Super Obese Patients Have Less Coronary Artery Disease?

Heart Lung and Circulation ◽

10.1016/j.hlc.2018.06.998 ◽

2018 ◽

Vol 27 ◽

pp. S483

Author(s):

S. Kyranis ◽

R. Markham ◽

M. Webber ◽

N. Aroney ◽

M. Savage ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Obesity Paradox ◽

Obese Patients ◽

Super Obese ◽

Artery Disease

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UPSTROKE TIME PER CARDIAC CYCLE IS ASSOCIATED WITH CARDIOVASCULAR PROGNOSIS IN TYPE 2 DIABETES

Endocrine Practice ◽

10.4158/ep-2019-0078 ◽

2019 ◽

Vol 25 (11) ◽

pp. 1109-1116 ◽

Cited By ~ 2

Author(s):

Li-Hsin Chang ◽

Chii-Min Hwu ◽

Chia-Huei Chu ◽

Justin G.S. Won ◽

Harn-Shen Chen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Confidence Interval ◽

Cardiac Cycle ◽

Hazard Ratio ◽

All Cause Mortality ◽

Composite Events ◽

Artery Disease

Objective: Upstroke time per cardiac cycle (UTCC) in the lower extremities has been found to be predictive of cardiovascular mortality in the general population. Therefore, the purpose of the study was to test the associations between increasing UTCC and outcomes in patients with type 2 diabetes. Methods: A total of 452 patients with type 2 diabetes (age, 67.5 ± 8.6 years; male, 54%) registered in a share-care program participated in the study at an outpatient clinic in Taipei Veterans General Hospital across a mean of 5.8 years. Primary outcomes were all-cause mortality hospitalization for coronary artery disease, stroke, revascularization, amputation, and diabetic foot syndrome. Secondary end-point outcome was all-cause mortality. Results: Increment of UTCC associations with primary and secondary outcomes were undertaken prior to baseline characteristic adjustments. A UTCC of 20.1% exhibited the greatest area under curve (AUC), sensitivity, and specificity balance to predict composite events in receiver operating curves (AUC, 0.63 [ P = .001]; sensitivity, 67.7%; specificity, 54.9%). Sixty-four composite events and 17 deaths were identified from medical records. UTCC ≥20.1% was associated with the occurrence of composite events and an increased risk of mortality. For composite events, an adjusted hazard ratio (HR) of 2.45 and 95% confidence interval (CI) of 1.38 to 4.35 ( P = .002) were calculated. For all-cause mortality, an adjusted HR of 1.91 and 95% CI of 0.33 to 10.99 ( P = .467) were calculated. Conclusion: Increasing UTCC was associated with cardiovascular outcomes in patients with type 2 diabetes. Therefore, UTCC is advocated as a noninvasive screening tool for ambulatory patients with type 2 diabetes. Abbreviations: CAD = coronary artery disease; CI = confidence interval; eGFR = estimated glomerular filtration rate; HR = hazard ratio; PAD = peripheral artery disease; UTCC = upstroke time per cardiac cycle

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