Clinical Approach to Diabetic Cardiomyopathy: A Review of Human Studies

Background: Diabetic Cardiomyopathy (DC) has been defined as a distinct entity characterized by the presence of diastolic or systolic cardiac dysfunction in a diabetic patient in the absence of other causes for Cardiomyopathy, such as coronary artery disease (CAD), hypertension (HTN), or valvular heart disease. Diabetes affects every organ in the body and cardiovascular disease accounts for two-thirds of the mortality in the diabetic population. Diabetes-related heart disease occurs in the form of coronary artery disease (CAD), cardiac autonomic neuropathy or DC. The prevalence of cardiac failure is high in the diabetic population and DC is a common, but underestimated cause of heart failure in diabetes. The strong association between diabetes and heart failure has fueled intense human and animal research aimed at identifying the mechanisms underlying diabetic myocardial disease. Despite significant progress made, the precise pathogenesis of diabetic Cardiomyopathy is yet to be clearly defined. Hyperglycemia, dyslipidemia and inflammation are thought to play key roles in the generation of reactive oxygen or nitrogen species which are in turn involved. Methods: We have reviewed the up-to-date scientific literature addressing these issues. Results: The myocardial interstitium undergoes alterations resulting in abnormal contractile function noted in DC. In the early stages of the disease, diastolic dysfunction is the only abnormality, but systolic dysfunction supervenes in the later stages with impaired left ventricular ejection fraction. Transmitral Doppler echocardiography is usually used to assess diastolic dysfunction, but tissue Doppler Imaging and Cardiac Magnetic Resonance Imaging are being increasingly used for early detection of DC. Diabetic patients with microvascular complications show the strongest association between diabetes and Cardiomyopathy, an association that parallels the duration and severity of hyperglycemia. Conclusion: The management of DC involves improvement in lifestyle, control of glucose and lipid abnormalities, together with treatment of hypertension and CAD, if present.

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Results of prospective multicenter study on heart failure on Campania Internal Medicine wards: the FASHION study

Italian Journal of Medicine ◽

10.4081/itjm.2017.705 ◽

2017 ◽

Vol 11 (2) ◽

pp. 184 ◽

Cited By ~ 1

Author(s):

Fernando Gallucci ◽

Ilaria Ronga ◽

Andrea Fontanella ◽

Generoso Uomo ◽

And the FASHION Study Group

Keyword(s):

Internal Medicine ◽

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Social Impact ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Campania Region ◽

Artery Disease

Heart failure (HF) is characterized by a high prevalence and hospitalization rate with considerable health and social impact; the knowledge of its epidemiological features remains the mainstay to assess adequacy of the health care needs. The aim of this study was to evaluate the prevalence of HF in Internal Medicine Units of the Campania region (Italy) and patients’ characteristics. We recruited all patients with HF admitted between April 1 and June 30, 2014, in 23 Units of Internal Medicine: 975 patients (19.5% of 5000 admissions), 518 women and 457 men, mean age 76.9±9.9 (range 34-100) with 741 (76%) older than 70 years. The mean age was higher in women than men; 35.8% of patients had atrial fibrillation, with higher prevalence in women than in men. Coronary artery disease represented the leading etiology while prevalence of non-ischemic heart failure was higher in women. New York Heart Association class was indicated in 926 patients. Left ventricular ejection fraction (LVEF) was measured in 503 patients; 18.4% of patients had a severely reduced LVEF<35%, mostly men (P=0.0001) and 67.4% presented a LVEF>40%. At least one hospital admission in the previous 12 months was registered in 39.6% of patients. One, two and more than two relevant comorbidities were present in 8.6%, 24.7% and 64.8% of patients, respectively. Arterial hypertension and coronary artery disease were more frequent in female. In conclusion, advanced age and clinical complexity were the main characteristics of HF patients hospitalized in the Internal Medicine Units in Campania. Gender differences also emerged from the analysis of demographic parameters and etiopathogenetic features. Some diagnostic and therapeutic aspects not in line with that recommended by the most recent HF international guidelines were registered.

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Circulating Levels of IL-13, TGF-β1, and Periostin as Potential Biomarker for Coronary Artery Disease with Acute Heart Failure

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/1690421 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Xuan Qiu ◽

Fengyi Ma ◽

Huanxin Zhang

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Serum Levels ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Enzyme Linked Immunosorbent Assay ◽

Ventricular Ejection Fraction ◽

Artery Disease ◽

Tgf Β1

Objective. Coronary artery disease (CAD) and associated comorbidities such as heart failure (HF) remain the leading cause of morbidity and mortality worldwide, attributed to, at least partially, the lack of biomarkers for efficient disease diagnosis. The study intended to explore potential biomarkers for predicting the presence of HF in CAD patients. Methods. According to the presence of HF, 83 CAD patients with HF were assigned to the AHF group and 52 CAD patients without HF to the CAD group. Additionally, healthy controls (n = 52) were those who had received physical examinations at the same period. The serum levels of IL-13, TGF-β1, and periostin were detected by the enzyme-linked immunosorbent assay (ELISA). Left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), left ventricle-end diastolic volume (LVEDV), and left ventricular mass index (LVMI) were detected 3 times by color Doppler ultrasound. The predictive values of IL-13, TGF-β1, and periostin methods were compared by receiver-operating characteristic (ROC) analysis and the area under the curve (AUC). Results. Increased levels of IL-13, TGF-β1, and periostin were noted in the AHF group than in the control and CAD groups ( p < 0.001 ); the CAD group showed higher levels of IL-13, TGF-β1, and periostin than the control group ( p < 0.001 ). Based on the NYHA classification, there were 33 cases with grade II, 28 cases with grade III, and 22 cases with grade IV among 83 CAD patients with HF. It was found that the serum levels of IL-13, TGF-β1, and periostin were higher in the AHF-IV group than in the AHF-III and AHF-II groups ( p < 0.001 ); these levels were also higher in the AHF-III group than in the AHF-II group ( p < 0.001 ). The periostin level was positively correlated with the levels of IL-13 (r = 0.458) and TGF-β1 (r = 0.569) in CAD patients with AHF. Besides, the serum levels of periostin (r = -0.425), IL-13 (r = -0.341), and TGF-β1 (r = -0.435) were negatively correlated with the LVEF of CAD patients with AHF, respectively. When IL-13, TGF-β1, and periostin levels were used to predict the presence of AHF in CAD patients in combination, the sensitivity and specificity were 75.9% and 90.38%, respectively, with the AUC of 0.906 (95% CI: 0.912–0.996). Conclusion. These data reveal that IL-13, TGF-β1, and periostin levels might be associated with the occurrence of AHF in CAD patients and their combination shows the predictive value for the presence of AHF in CAD patients.

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Influencing Cardiovascular Outcomes through Heart Rate Variability Modulation: A Systematic Review

Diagnostics ◽

10.3390/diagnostics11122198 ◽

2021 ◽

Vol 11 (12) ◽

pp. 2198

Author(s):

Alexandru Burlacu ◽

Crischentian Brinza ◽

Iolanda Valentina Popa ◽

Adrian Covic ◽

Mariana Floria

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Heart Rate ◽

Heart Rate Variability ◽

Coronary Artery ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Inverse Association ◽

Artery Disease ◽

The Impact

Psychological stress is a well-established risk factor for cardiovascular disease (CVD). Heart rate variability (HRV)-biofeedback could significantly reduce stress levels and improve autonomic nervous system function and cardiovascular endpoints. We aimed to systematically review the literature to investigate the impact of HRV modulation through HRV-biofeedback on clinical outcomes in patients with CVD. A literature search was performed in the following databases: MEDLINE (PubMed), Embase, and Cochrane from the inception until 1 October 2021. Patients in the HRV-biofeedback group had significantly lower rates of all-cause readmissions than patients who received psychological education (respectively, p = 0.028 and p = 0.001). Heart failure following HRV-biofeedback displayed an inverse association with stress and depression (respectively, p = 0.022 and p = 0.033). When stratified according to left ventricular ejection fraction (LVEF), patients with LVEF ≥ 31% showed improved values of the 6 min walk test after HRV-biofeedback interventions (p = 0.05). A reduction in systolic and diastolic blood pressure associated with HRV-biofeedback was observed (p < 0.01) in pre-hypertensive patients. HRV-biofeedback had beneficial effects on different cardiovascular diseases documented in clinical trials, such as arterial hypertension, heart failure, and coronary artery disease. A standard breathing protocol should be applied in future studies to obtain equivalent results and outcomes. However, data regarding mortality in patients with coronary artery disease are scarce and need further research.

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Symptomatic and Asymptomatic Patients in the Polish Atrial Fibrillation (POL-AF) Registry

Journal of Clinical Medicine ◽

10.3390/jcm10051091 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1091

Author(s):

Marek Kiliszek ◽

Beata Uziębło-Życzkowska ◽

Iwona Gorczyca ◽

Małgorzata Maciorowska ◽

Olga Jelonek ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Ejection Fraction ◽

Thromboembolic Event ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Asymptomatic Patients ◽

Artery Disease

Background: Atrial fibrillation (AF) can cause severe symptoms, but it is frequently asymptomatic. We aimed to compare the clinical features of patients with asymptomatic and symptomatic AF. Methods: A prospective, observational, multicenter study was performed (the Polish Atrial Fibrillation (POL-AF) registry). Consecutive hospitalized AF patients over 18 years of age were enrolled at ten centers. The data were collected for two weeks during each month of 2019. Results: A total of 2785 patients were analyzed, of whom 1360 were asymptomatic (48.8%). Asymptomatic patients were more frequently observed to have coronary artery disease (57.5% vs. 49.1%, p < 0.0001), heart failure with preserved ejection fraction (39.8% vs. 26.5%, p < 0.0001), a previous thromboembolic event (18.2% vs. 13.1%, p = 0.0002), and paroxysmal AF (52.3% vs. 45.2%, p = 0.0002). In multivariate analysis, history of electrical cardioversion, paroxysmal AF, heart failure, coronary artery disease, previous thromboembolic event, and higher left ventricular ejection fraction were predictors of a lack of AF symptoms. First-diagnosed AF was a predictor of AF symptoms. Conclusions: In comparison to symptomatic patients, more of those hospitalized with asymptomatic AF had been previously diagnosed with this arrhythmia and other cardiovascular diseases. However, they presented with better left ventricular function and were more frequently treated with cardiovascular medicines.

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Coronary heart disease

ESC CardioMed ◽

10.1093/med/9780198784906.003.0089 ◽

2018 ◽

pp. 441-445

Author(s):

Thomas H. Marwick

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Stress Echocardiography ◽

Suspected Coronary Artery Disease ◽

Dobutamine Stress ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Acute Setting ◽

Artery Disease

Echocardiography is a vital part of the assessment of patients with known or suspected coronary artery disease. In the acute setting, the absence of wall motion abnormalities in a patient with ongoing chest pain is reassuring, and echocardiography provides a means of excluding alternative diagnoses. In patients with a complicated course, the technique provides the ability to evaluate left ventricular ejection fraction and haemodynamics in heart failure, the pericardium, evidence of disturbances of myocardial or valvular structure, and function (relevant to the mechanical complications of infarction). Cardiac imaging is indispensable in the management of heart failure, and echocardiography is the most widely used test for this purpose. However, no single test satisfies all imaging requirements in heart failure. In the non-acute setting, stress echocardiography is helpful for the recognition and prognostic evaluation of coronary artery disease, and in stable chronic disease, dobutamine stress echocardiography can be used to recognize myocardial viability. The challenges to echocardiography in all of these settings pertain to adequate training, the need for quantification of regional function, and the need to limit the use of this test to situations where it will influence management.

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Secondary prevention and outcomes in outpatients with coronary artery disease, atrial fibrillation or heart failure: a focus on disease overlap

Open Heart ◽

10.1136/openhrt-2019-001165 ◽

2020 ◽

Vol 7 (1) ◽

pp. e001165 ◽

Cited By ~ 2

Author(s):

Nicolas Lamblin ◽

Sandro Ninni ◽

Olivier Tricot ◽

Thibaud Meurice ◽

Gilles Lemesle ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Secondary Prevention ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Chronic Coronary Artery Disease ◽

Ventricular Ejection Fraction ◽

Artery Disease

ObjectiveTo assess secondary prevention and outcomes in patients with chronic coronary artery disease (CAD), atrial fibrillation (AF) and heart failure (HF), focusing on disease overlap.MethodsWe analysed the data of 10 517 outpatients with a diagnosis of CAD, AF and/or HF included in a prospective cohort study. Follow-up (median 3.2 years) was achieved in 10 478 (99.6%) patients. Seven mutually exclusive patient groups were formed: CAD alone (n=4303), AF alone (n=2604), CAD+AF (n=700), HF alone (n=513), HF+CAD (n=728), HF+AF (n=1087) and HF+CAD+AF (n=582).ResultsPatients with disease overlaps represented 29.4% of the total population. The level of secondary prevention was high in all subgroups and in accordance with European class I – level A guidelines. Among patients with CAD, 99% received an antithrombotic and 91% received a statin. Among patients with AF, 81.7% were treated with an anticoagulant if indicated. Among HF patients with left ventricular ejection fraction <40%, 90.9% received a renin-angiotensin system antagonist and 91% a beta-blocker. Three-year all cause/cardiovascular mortality rates were: 6.4%/2%, 9.7%/3.3%, 15.6%/6.7%, 19.2%/9.4%, 24.3%/13.6%, 28%/15.7% and 35.4%/24.8%, for patients with CAD alone, AF alone, CAD+AF, HF alone, HF+CAD, HF+AF and HF+CAD+AF, respectively. In all groups with HF, observed all-cause mortality was higher (p<0.0001) than expected mortality for age-matched, gender-matched and geography-matched persons. In contrast, observed mortality was lower than expected for patients with CAD alone and AF alone (p<0.0001).ConclusionsIn a context of adequate secondary prevention, overlap between diseases is a frequent and high-risk situation with incremental increases in mortality. These patients deserve specific attention.

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Effects of liraglutide on diastolic function parameters in patients with type 2 diabetes and coronary artery disease: a randomized crossover study

Cardiovascular Diabetology ◽

10.1186/s12933-020-01205-2 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Preman Kumarathurai ◽

Ahmad Sajadieh ◽

Christian Anholm ◽

Ole P. Kristiansen ◽

Steen B. Haugaard ◽

...

Keyword(s):

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Diastolic Dysfunction ◽

Diastolic Function ◽

Left Ventricular ◽

Trial Registration ◽

Left Ventricular Ejection ◽

Artery Disease

Abstract Background Diastolic dysfunction is highly prevalent in patients with type 2 diabetes mellitus (T2DM) and is associated with overweight, glucose dysregulation and coronary artery disease (CAD). The GLP-1 receptor agonist, liraglutide, has shown to induce weight loss and improve metabolic factors, thus modulating factors associated with diastolic dysfunction. We have previously reported the effects of liraglutide on systolic function, and in this current study we explore the effects of liraglutide on diastolic function parameters in patients with stable CAD, preserved left ventricular ejection fraction (LVEF), and newly diagnosed T2DM. Methods Thirty subjects were randomized to liraglutide or placebo intervention for 12 + 12-weeks in this double-blind cross-over study. 2D-echocardiography using tissue velocity imaging was used for assessment of diastolic function parameters. Early diastolic filling velocity (E), late atrial filling velocity (A), E-wave deceleration time (EDT) and E/A ratio was assessed from the pulse wave (PW)-Doppler velocity recording of the mitral inflow. Peak early diastolic annular velocities (e′) was measured from color tissue doppler images. Results Liraglutide, when compared to placebo, induced a significant reduction in average e′ and lateral e′ velocities (– 0.57 cm/s [– 1.05 to − 0.08] and –0.74 cm/s [–1.32 to –0.15], respectively). Adjusted for the concomitant increase in HR (+ 6.16 bpm [0.79 to 11.54], the changes were not significant. No significant changes in other diastolic function parameters were observed. Conclusions Liraglutide therapy did not improve any diastolic function parameters in subjects with T2DM, CAD, and preserved LVEF. Instead, a deterioration in e’ was observed, which was associated to an increase in heart rate induced by liraglutide therapy. Trial registration Clinical Trial Registration: http://www.clinicaltrials.gov (unique identifier: NCT01595789) (first submitted May 8, 2012)

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Abstract 17584: Pulmonary Artery Systolic Pressure Independently Predicts All-Cause Mortality in Patients with Coronary Artery Disease Irrespective of a Diagnosis of Heart Failure

Circulation ◽

10.1161/circ.130.suppl_2.17584 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Nima Ghasemzadeh ◽

Raghda Alanbari ◽

Salim Hayek ◽

Mosab Awad ◽

Mohamed Khayata ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Left Ventricular Ejection Fraction ◽

Systolic Pressure ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Pulmonary Artery Systolic Pressure ◽

Ventricular Ejection Fraction ◽

Artery Disease

Background: Elevated pulmonary artery systolic pressure (PASP) is associated with a worse outcome in heart failure (HF), but the prognostic role of PASP in patients with coronary artery disease (CAD) remains unknown. Methods: 863 patients with known or suspected CAD (age: 64±13 years, 62% male) enrolled in the Emory Cardiovascular Biobank were followed for a median 455 days for all-cause death. Transthoracic echocardiographic parameters included measurement of left ventricular ejection fraction (LVEF, range: 5-80%) and diastolic function parameters. Youden’s index from the receiver operating curve analysis was used to determine the best discriminatory cutoff for PASP (cutoff=43 mmHg). Cox regression was performed to determine independent predictors of mortality. Results: 88 (10%) subjects died during follow-up. PASP correlated with left ventricular ejection fraction (LVEF, N=644, r=-0.20, p<0.0001), C-reactive protein (CRP, N=539, r=0.12, p=0.004), and mitral valve inflow E/A ratio (N=359, r=0.32, p<0.0001), mitral valve deceleration time (N=260, r=-0.16, p=0.007),and left atrial size (LAs, N=694, r=0.25, p<0.0001). High PASP predicted incident mortality in a model adjusted for age, gender, diabetes, hypertension, dyslipidemia, smoking, glomerular filtration rate, CRP, heart failure, Gensini angiographic severity score, as well as aspirin, statin, beta-blocker, and angiotensin converting enzyme-inhibitor use (HR: 3.3, p=0.000001). The association of PASP with death was independent of LVEF (HR=3.2, p=0.00002). Thus, high PASP also predicted mortality in subjects with LVEF>50% and no history of HF (HR: 4.7, p=0.004). In separate models, this association was also independent of LAs and E/A. Conclusion: High PASP >43 mmHg is an independent predictor of mortality in patients with CAD even in those with preserved LVEF without HF. Whether high PASP predicts future development of HF and hospitalization for HF exacerbation needs to be investigated.

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The independent reduction in mortality associated with guideline-directed medical therapy in patients with coronary artery disease and heart failure with reduced ejection fraction

European Heart Journal - Quality of Care and Clinical Outcomes ◽

10.1093/ehjqcco/qcaa032 ◽

2020 ◽

Cited By ~ 1

Author(s):

Natasha K Wolfe ◽

Joshua D Mitchell ◽

David L Brown

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Ejection Fraction ◽

Medical Therapy ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Antiplatelet Drug ◽

Reduced Ejection Fraction ◽

Artery Disease

Abstract Aims Guideline-directed medical therapy (GDMT) is underutilized in patients with coronary artery disease (CAD). However, there are no studies evaluating the impact of GDMT adherence on mortality among patients with CAD and heart failure with reduced ejection fraction (HFrEF). We sought to investigate the association of GDMT adherence with long-term mortality in patients with CAD and HFrEF. Methods and results Surgical Treatment for Ischaemic Heart Failure (STICH) was a trial of patients with an left ventricular ejection fraction ≤35% and CAD amenable to coronary artery bypass graft surgery (CABG) who were randomized to CABG plus medical therapy (N = 610) or medical therapy alone (N = 602). Median follow-up time was 9.8 years. We defined GDMT for the treatment of CAD and HFrEF as the combination of at least one antiplatelet drug, a statin, a beta-blocker, and an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The primary outcome was all-cause mortality. Assessment of the independent association between GDMT and mortality was performed using multivariable Cox regression with GDMT as a time-dependent covariate. In the CABG arm, 63.6% of patients were on GDMT throughout the study period compared to 66.5% of patients in the medical therapy arm (P = 0.3). GDMT was independently associated with a significant reduction in mortality (hazard ratio 0.65, 95% confidence interval 0.56–0.76; P < 0.001). Conclusion GDMT is associated with reduced mortality in patients with CAD and HFrEF independent of revascularization with CABG. Strategies to improve GDMT adherence in this population are needed to maximize survival.

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Association of C1q/TNF-related protein-9 (CTRP9) level with obstructive sleep apnea in patients with coronary artery disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.2887 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

X Wang ◽

Z Li ◽

Y Du ◽

L Jia ◽

J Fan ◽

...

Keyword(s):

Coronary Artery Disease ◽

Obstructive Sleep Apnea ◽

Coronary Artery ◽

Sleep Apnea ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Funding Source ◽

Related Protein ◽

Obstructive Sleep ◽

Artery Disease

Abstract Background Obstructive sleep apnea (OSA) is closely related to the incidence and progression of coronary artery disease (CAD), but the mechanisms linking OSA and CAD are unclear. C1q/TNF-related protein-9 (CTRP9) is a novel adipokine that protects the heart against ischemic injury and ameliorates cardiac remodeling. Purpose We aimed to ascertain the clinical relevance of CTRP9 with OSA prevalence in patients with CAD. Methods From August 2016 to March 2019, consecutive eligible patients with CAD (n=154; angina pectoris, n=88; acute myocardial infarction [AMI], n=66) underwent cardiorespiratory polygraphy during hospitalization. OSA was defined as an apnea-hypopnea index (AHI) ≥15 events h–1. Plasma CTRP9 concentrations were measured by ELISA method. Results OSA was present in 89 patients (57.8%). CTRP9 levels were significantly decreased in the OSA group than in the non-OSA group (4.7 [4.1–5.2] ng/mL vs. 4.9 [4.4–6.0] ng/mL, P=0.003). The difference between groups was only observed in patients with AMI (3.0 [2.3–4.9] vs. 4.5 [3.2–7.9], P=0.009), but not in patients with AP (5.0 [4.7–5.3] ng/mL vs. 5.1 [4.7–5.9] ng/mL, P=0.571) (Figure 1). Correlation analysis showed that CTRP9 levels were negatively correlated with AHI (r=−0.238, P=0.003) and oxygen desaturation index (r=−0.234, P=0.004), and positively correlated with left ventricular ejection fraction (r=0.251, P=0.004) in all subjects. Multivariate analysis showed that male gender (OR 3.099, 95% CI 1.029–9.330, P=0.044), body mass index (OR 1.148, 95% CI 1.040–1.268, P=0.006), and CTRP9 levels (OR 0.726, 95% CI 0.592–0.890, P=0.002) were independently associated with the prevalence of OSA. Conclusions Plasma CTRP9 levels were independently related to the prevalence of OSA in patients with CAD, suggesting that CTRP9 might play a role in the pathogenesis of CAD exacerbated by OSA. Figure 1. CTRP9 levels in OSA and non-OAS groups Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China

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