Effects of hypertriglyceridaemia on blood coagulation factor VII: a case control study of 110 cases

Abstract Background Spontaneous Coronary Artery Dissection (SCAD) is an important cause of acute coronary syndrome particularly in young-middle aged women. Revascularisation is challenging due to an underlying disrupted and friable coronary vessel wall leading to widely reported worse outcomes than for atherosclerotic coronary disease. Therefore, a conservative approach where possible is favoured however in some cases haemodynamic instability, ongoing ischaemia and reduced distal flow mandates consideration of revascularisation. Purpose To compare SCAD survivors managed with PCI or conservatively in terms of presentation characteristics, complications and long-term outcomes. Methodology and results 226 angiographically confirmed SCAD survivors (95% female,47±9.7yrs) who underwent PCI were compared in a case control study with two hundred and twenty-five angiographically confirmed SCAD survivors (92% female, 49±9.9yrs) who were conservatively managed. Patients were recruited from UK, Spanish and Dutch SCAD registries and both groups were well matched in terms of baseline demographics. Those treated with PCI were more likely to present with proximal SCAD (30.8% vs 7.6% P<0.01) and ST elevation myocardial infarction (STEMI) or cardiac arrest with reduced flow (32.3% vs 6.3% P<0.01). Intervention was performed with stents in 72.4%, plain old balloon angioplasty in 21.1% and wiring in 6.4% of cases and more often for multi-segment disease (40.8% vs 26.3% P<0.01). In cases with initial reduced flow undergoing PCI an improvement in flow was seen in 83%. Analysis of UK PCI cases (n=144) reveal complications in 56 (38.8%). However, when assessed for significance defined by a reduction in flow in a proximal/mid vessel, stent extension into left main stem, iatrogenic dissection requiring PCI and CABG as a consequence of PCI only 13 cases (9%) met criteria. Iatrogenic dissection accounts for the majority (76.9%). SCAD lesion length was associated with presence of complications (P=0.025). There was a non-significant trend towards major adverse cardiovascular events (MACE) occurring more frequently in those undergoing PCI (18% vs 11% P=0.067) driven by revascularisation (5% vs 1% P=0.036). Median follow up was 2.7 years. Conclusions PCI in SCAD is often performed in higher risk patients; in those presenting with reduced flow, the majority demonstrate improvement. Importantly whilst overall complication rates were similar to those widely reported, clinically significant complications were low. Multivariate modelling will reveal factors associated with complications to aid future decision making in this challenging patient group. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation

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Associations of Coagulation Factor X and XI with Incident Acute Coronary Syndrome and Stroke: A Nested Case‐Control Study

Journal of Thrombosis and Haemostasis ◽

10.1111/jth.15486 ◽

2021 ◽

Author(s):

Huiting Chen ◽

Miaoyan Shen ◽

Rundong Niu ◽

Xuanwen Mu ◽

Qin Jiang ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Case Control Study ◽

Coagulation Factor ◽

Case Control ◽

Factor X ◽

Coronary Syndrome ◽

Nested Case Control ◽

Control Study

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Association of smoking with coronary artery disease in Nepalese populations: a case control study

Toxicology Research ◽

10.1039/c9tx00083f ◽

2019 ◽

Vol 8 (5) ◽

pp. 677-685

Author(s):

Til Bahadur Basnet ◽

Cheng Xu ◽

Manthar Ali Mallah ◽

Wiwik Indayati ◽

Cheng Shi ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Risk Factor ◽

Coronary Artery ◽

Case Control Study ◽

Case Control ◽

Psychosocial Risk ◽

Psychosocial Risk Factor ◽

Artery Disease ◽

Control Study

Abstract There are well-known traditional risk factors for coronary artery disease (CAD). Among them, smoking is one of the most prominent and modifiable risk factors. This study aims to determine the magnitude of smoking as a risk factor for CAD in the Nepalese population. A hospital-based age- and sex-matched case–control study was carried out with a total of 612 respondents. Bivariate analysis showed that the risk of developing CAD in ex-smokers and current smokers was higher (odds ratio (OR): 1.81 (confidence interval (CI): 1.21–2.7) and OR: 5.2 (CI: 3.4–7.97)), with p-values less than 0.004 and <0.00001, respectively, compared to the risk in never smokers. From stratified socio-demographic, cardio-metabolic, behavioural and psychosocial risk factor analysis, smoking was found to be associated with CAD in almost all subgroups. In the subsequent multivariate analysis, adjustment for socio-demographic, cardio-metabolic and psychosocial risk factors showed a steady increase in risk. However, further adjustment for behavioural risk factors (alcohol use and physical activity) showed that the risk was attenuated by 59% in current smokers. After adjusting for the covariates, current smokers and ex-smokers had an increased risk of CAD (OR: 6.64, 95% CI: 3.64–12.12, p < 0.00001; OR: 1.89, 95% CI: 1.08–3.31, p < 0.012, respectively) compared with non-smokers. In conclusion, smoking was found to increase the risk of CAD in the Nepalese population.

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Association of Genetic Polymorphisms in Matrix Metalloproteinase-9 and Coronary Artery Disease in the Chinese Han Population: A Case–Control Study

Genetic Testing and Molecular Biomarkers ◽

10.1089/gtmb.2013.0109 ◽

2013 ◽

Vol 17 (9) ◽

pp. 707-712 ◽

Cited By ~ 13

Author(s):

Hai-di Wu ◽

Xiao Bai ◽

Dong-mei Chen ◽

Hong-yan Cao ◽

Ling Qin

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Matrix Metalloproteinase ◽

Case Control Study ◽

Case Control ◽

Chinese Han ◽

Han Population ◽

Artery Disease ◽

Metalloproteinase 9 ◽

Control Study

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Circulating Tissue Factor Procoagulant Activity and Thrombin Generation in Patients with Type 2 Diabetes: Effects of Insulin and Glucose

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2007-0933 ◽

2007 ◽

Vol 92 (11) ◽

pp. 4352-4358 ◽

Cited By ~ 83

Author(s):

Guenther Boden ◽

Vijender R. Vaidyula ◽

Carol Homko ◽

Peter Cheung ◽

A. Koneti Rao

Keyword(s):

Type 2 Diabetes ◽

Tissue Factor ◽

Blood Coagulation ◽

Coagulation Factor ◽

Procoagulant Activity ◽

Factor Vii ◽

Coagulation Factor Vii ◽

Glucose Levels ◽

Study Protocols

Abstract Context: Type 2 diabetes mellitus (T2DM) is a hypercoagulable state. Tissue factor (TF) is the principal initiator of blood coagulation. Objective: Our objective was to examine the effects of hyperglycemia and hyperinsulinemia on the TF pathway of blood coagulation in T2DM. Design: Three study protocols were used: 1) acute correction of hyperglycemia (with iv insulin) followed by 24 h of euglycemia, 2) 24 h of selective hyperinsulinemia, and 3) 24 h of combined hyperinsulinemia and hyperglycemia. Setting: The study took place at a clinical research center. Study Participants: Participants included 18 T2DM patients and 22 nondiabetic controls. Results: Basal TF-procoagulant activity (TF-PCA), monocyte TF mRNA, plasma coagulation factor VII (FVIIc), and thrombin-anti-thrombin complexes were higher in T2DM than in nondiabetic controls, indicating a chronic procoagulant state. Acutely normalizing hyperglycemia over 2–4 h resulted in a small (∼7%) but significant decline in TF-PCA with no further decline over 24 h. Raising insulin levels alone raised TF-PCA by 30%, whereas raising insulin and glucose levels together increased TF-PCA (by 80%), thrombin-anti-thrombin complexes, and prothrombin fragment 1.2. Plasma FVIIa and FVIIc declined with increases in TF-PCA. Conclusion: We conclude that the combination of hyperglycemia and hyperinsulinemia, common in poorly controlled patients with T2DM, contributes to a procoagulant state that may predispose these patients to acute cardiovascular events.

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Cognitive development of children with Kawasaki disease and the parenting stress of their caregivers in Taiwan: a case–control study

BMJ Open ◽

10.1136/bmjopen-2020-042996 ◽

2021 ◽

Vol 11 (6) ◽

pp. e042996

Author(s):

Liang-Jen Wang ◽

Zi-Yu Tsai ◽

Ling-Sai Chang ◽

Ho-Chang Kuo

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Parenting Stress ◽

Case Control Study ◽

Short Form ◽

Case Control ◽

Stress Index ◽

Secondary Outcome ◽

Healthy Children ◽

Control Study

ObjectiveKawasaki disease (KD) is an acute form of febrile vasculitis that occurs in early childhood. The multisystemic vasculitis common in patients with KD may influence blood perfusion in the brain, and thus caregivers of children with KD may feel stress with regard to caring for them. Intravenous immunoglobulin (IVIG) infusion is the standard treatment for acute KD, and the most serious complication of KD is coronary artery aneurysms (coronary artery lesion (CAL)). This study aimed to investigate the relationships between KD heterogeneity and the risk of patients’ cognitive impairment or caregivers’ parenting stress.DesignA case–control study with consecutive sampling.SettingA medical centre (Kaohsiung Chang Gung Memorial Hospital, Taiwan).ParticipantsThis study consisted of 176 patients with KD (mean age: 5.5 years, 60.8% boys) and 85 healthy children (mean age: 6.4 years, 54.1% boys).Primary and secondary outcome measuresBased on the children’s age, each patient with KD and control subject was administered an assessment using the Mullen Scales of Early Learning or the Wechsler Intelligence Scale, and parenting function of their caregivers was assessed using the Parenting Stress Index (PSI)-Short Form.ResultsWe observed no significant differences in any developmental index, cognitive function or parenting stress between patients with KD and controls. Among the children with KD, IVIG administration nor CAL was associated with children’s cognitive scores. However, the caregivers of patients who had CAL suffered from greater PSI total scores than those of patients without CAL. Furthermore, the caregivers who had education levels of a master’s degree or above showed less parenting stress than those who had an education level of college or lower.ConclusionCaregivers’ education is associated to parenting stress, and caregivers of patients with KD who developed CAL may feel stress about the unpredictable sequela caused by CAL for their children. Such caregivers may require support to fulfil their parenting roles.

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