scholarly journals Frequency-Domain Characteristics Response to Passive Exercise in Patients With Coronary Artery Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaodong Zhang ◽  
Yahui Zhang
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Frequency Domain ◽  
Frequency Characteristics ◽  
Energy Ratio ◽  
Control Group ◽  
Velocity Spectrum ◽  
Passive Exercise ◽  
Artery Disease ◽  
Opposite Response

Purpose: The enhanced external counterpulsation (EECP), a kind of passive exercise, is a novel non-invasive therapy used to improve peripheral perfusion in patients with coronary artery disease (CAD). However, whether frequency-domain characteristics of peripheral hemodynamics may benefit from passive exercise needs to be verified.Methods: We recruited 21 patients with CAD and 21 healthy controls in this study. Ultrasonic blood flow velocity spectrum in left carotid (LC) and right carotid (RC) common arteries, and right brachial (RB) and right femoral (RF) arteries was monitored using an ultrasonic Doppler. Frequency-domain characteristics before, during, and after passive exercise were extracted from ultrasonic spectrum images. The first and second peak amplitudes/frequencies (y1, y2, x1, x2) and power spectral energy ratio (PSER) in the 0–2.05 Hz/0.87 Hz (p5, p6) were calculated by fast Fourier transform and power spectrum density analysis.Results: For the amplitude and frequency characteristics of the spectrum, y1 in the LC of patients with CAD was significantly decreased during exercise (p = 0.036), whereas, y2 was significantly decreased immediately after passive exercise (p = 0.038). Besides those, y1 only in the RC and RB of controls was significantly decreased during exercise. Immediately after exercise, y2 in the LC of control was significantly lower than at the baseline (p = 0.014). For the energy ratio characteristics of the spectrum, there was an opposite response in the two groups that p6 was significantly reduced and elevated in the LC of controls and in the RB of patients with CAD during exercise (both p < 0.05).Conclusions: Passive exercise reduces amplitude and frequency characteristics of carotid arteries, while there was an opposite response of energy ratio characteristics in the LC and RB arteries to passive exercise between CAD patients and controls. Additionally, energy ratio characteristics of spectrum in the brachial artery were markedly elevated in CAD patients during passive exercise. Moreover, passive exercise only reduces amplitude characteristics of LC artery in the control group.

scholarly journals Optimizing diagnosis of obstructive coronary artery disease by CT angiography: RCT's final results and 12-months follow-up

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.P Dias Ferreira Reis ◽  
R Ramos ◽  
P Modas Daniel ◽  
S Aguiar Rosa ◽  
L Almeida Morais ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Functional Test ◽  
Control Group ◽  
Diagnostic Strategy ◽  
Coronary Syndrome ◽  
Tertiary Center ◽  
Safety Endpoint ◽  
Artery Disease ◽  
Primary Safety Endpoint

Abstract Aim In patients (pts) with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) may improve pt selection for invasive coronary angiography (ICA) as alternative to functional testing. However. the role of CTA in symptomatic pts after abnormal functional test (FT) is incompletely defined. Methods and results This randomized clinical trial conducted in single academic tertiary center selected 218 symptomatic pts with mild to moderately abnormal FT referred to ICA to receive either the originally intended ICA (n=103) or CTA (n=115). CTA interpretation and subsequent care decisions were made by the clinical team. Pts with high risk features on FT, previous acute coronary syndrome, previously documented CAD, chronic kidney disease (GFR<60ml/min/1.73m2) or persistent atrial fibrillation were excluded. The primary endpoint was the percentage of ICA with no significant obstructive CAD (no stenosis ≥50%) in each group. Diagnostic (DY) and revascularization (RY) yields of ICA in either group were also assessed. Pts were followed up for at least 1 year for the primary safety endpoint of all cause death/ nonfatal myocardial infarction/ stroke. Unplanned revascularization (UP) and symptomatic status (SS) were also evaluated. Pts averaged 68±9 years of age, 60% were male, 29% were diabetic. Nuclear perfusion stress test was used in 33.9% in CTA group and 31.1% in control group (p=0.655). Mean post (functional) test probability of obstructive CAD was 34%. Overall prevalence of obstructive CAD was 32.1%. In the CTA group, ICA was cancelled by referring physicians in 83 of the pts (72.2%) after receiving CTA results. For those undergoing ICA, non-obstructive CAD was found in 5 pts (15.6%) in the CTA-guided arm and 60 (58.3%) in the usual care arm (p<0.001 Mean cumulative radiation exposure related to diagnostic work up was similar in both groups (6±14 vs 5±14mSv, p=0.152). Both DY (84.4% vs 41.7, p<0.001) and RY (71.9% vs 38.8%, p=0.001) yields were significantly higher for CTA-guided ICA as compared to standard FT-guided ICA. The rate of the primary safety endpoint was similar between both groups (1.9% vs 0%, p=0.244), as well as the rates of UP (0.9% vs 0.9%, p=1.000) and SS (persistent angina: 29.6% vs 24.8%, p=0.425). Conclusions In pts with suspected CAD and mild to moderately abnormal ischemia test, a diagnostic strategy including CTA as gatekeeper is safe, effective and significantly improves diagnostic and revascularization yields of ICA. Funding Acknowledgement Type of funding source: None

scholarly journals A serial optical frequency-domain imaging study of early and late vascular responses to bioresorbable-polymer sirolimus-eluting stents for the treatment of acute myocardial infarction and stable coronary artery disease patients: results of the MECHANISM-ULTIMASTER study

2021 ◽  
Author(s):  
Tomonori Itoh ◽  
◽  
Hiromasa Otake ◽  
Takumi Kimura ◽  
Yoshiro Tsukiyama ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Frequency Domain ◽  
Stable Coronary Artery Disease ◽  
Imaging Study ◽  
Optical Frequency ◽  
Bioresorbable Polymer ◽  
Artery Disease

AbstractThe purpose of this study was to assess early and late vascular healing in response to bioresorbable-polymer sirolimus-eluting stents (BP-SESs) for the treatment of patients with ST-elevation myocardial infarction (STEMI) and stable coronary artery disease (CAD). A total of 106 patients with STEMI and 101 patients with stable-CAD were enrolled. Optical frequency-domain images were acquired at baseline, at 1- or 3-month follow-up, and at 12-month follow-up. In the STEMI and CAD cohorts, the percentage of uncovered struts (%US) was significantly and remarkably decreased during early two points and at 12-month (the STEMI cohort: 1-month: 18.75 ± 0.78%, 3-month: 10.19 ± 0.77%, 12-month: 1.80 ± 0.72%; p < 0.001, the CAD cohort: 1-month: 9.44 ± 0.78%, 3-month: 7.78 ± 0.78%, 12-month: 1.07 ± 0.73%; p < 0.001 respectively). The average peri-strut low-intensity area (PLIA) score in the STEMI cohort was significantly decreased during follow-up period (1.90 ± 1.14, 1.18 ± 1.25, and 1.01 ± 0.72; p ≤ 0.001), whereas the one in the CAD cohort was not significantly changed (0.89 ± 1.24, 0.67 ± 1.07, and 0.64 ± 0.72; p = 0.59). In comparison with both groups, differences of %US and PLIA score at early two points were almost disappeared or close at 12 months. The strut-coverage and healing processes in the early phase after BP-SES implantation were significantly improved in both cohorts, especially markedly in STEMI patients. At 1 year, qualitatively and quantitatively consistent neointimal coverage was achieved in both pathogenetic groups.

scholarly journals Assessment of structural and functional myocardial characteristics in patients with chronic coronary artery disease and various glycemic status

2021 ◽  
Vol 20 (7) ◽  
pp. 3077
Author(s):  
M. A. Kokozheva ◽  
B. U. Mardanov ◽  
E. A. Poddubskaya ◽  
V. A. Kutsenko ◽  
M. A. Umetov ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Exercise Tolerance ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Control Group ◽  
Glycemic Status ◽  
Artery Disease

Aim. To study the structural and functional myocardial characteristics in patients with exertional angina and type 2 diabetes in comparison with those without diabetes to identify combined hemodynamic changes.Material and methods. Patients were divided into two groups depen - ding on the glycemic status. The first group consisted of 49 patients (mean age, 57,9±1,04 years; male/female, 35/14) with coronary artery disease (CAD) and type 2 diabetes, while the second one (control)  — 51 patients (60,2±0,9 years, 34/17) with CAD and without diabetes. Patients were surveyed using a standard questionnaire that included socio-demographic parameters, behavioral risk factors, clinical status, medications received, and comorbidities. Diagnostic investigations were carried out, including resting electrocardiography, transthoracic echocardiography and cycle ergometry.Results. Among patients with CAD and type 2 diabetes, hypertension occurred 20% more often compared with the control group  — 98 vs 78% (p<0,004). According to the electrocardiography, the combination of diabetes and CAD was characterized by various arrhythmias, which were recorded 2,8 times more often than in the group without diabetes. According to echocardiography, signs of left ventricular hypertrophy, systolic and diastolic dysfunction prevailed in people with diabetes. Mean pulmonary artery pressure in patients with diabetes were higher than in patients without carbohydrate metabolism disorders (p<0,004). According to the stress test, exercise tolerance in experimental group patients was lower than in patients in the control group.Conclusion. The combination of chronic CAD and type 2 diabetes is cha - racterized by a more common combination with hypertension, impaired central and intracardiac hemodynamics, as well as left ventricular hypertrophy. In people with diabetes, impaired systolic and diastolic myocardial function is combined with reduced exercise tolerance.

scholarly journals Patients with New-Onset Tumor of Severe Coronary Artery Disease May be at a Higher Risk of Arrhythmia

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Palisha Alimu ◽  
Dezhi Yang ◽  
Huatao Zhou ◽  
Yan Wu ◽  
Huiping Guo
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Disease Patient ◽  
Control Group ◽  
Severe Coronary Artery Disease ◽  
Tumor Treatment ◽  
Severe Coronary Artery ◽  
The Difference ◽  
Artery Disease ◽  
New Onset

Background. Arrhythmia is one of the causes of death in severe coronary artery disease patients who also suffered from cancer. Our research aims to compare the incidence of arrhythmia between severe coronary artery disease patient with and without new-onset tumor. Methodology. We enrolled 79 patients (December 2019–December 2020) with severe coronary artery disease in this study, and 40 of them were complicated with new-onset tumor. The details of all subjects were thoroughly obtained; the laboratory tests were implemented including creatinine before coronary angiography. The appraisal of the severity of coronary artery disease was applied by Gensini score. The cardiac inspection includes UCG, 12-lead ECG, and Holter monitor. Results. Among them, there were 40 patients in the experimental group and 39 patients in the control group. The difference at the baseline between the two sets of figures was not statistically significant ( P > 0.05 ). The incidence of arrhythmia between the two groups was statistically significant ( P < 0.05 ). Conclusions. The incidence of arrhythmia in severe coronary artery disease patients who were complicated with new-onset tumor was higher than that in patients with severe coronary artery disease alone, and attention should be paid to arrhythmia before tumor treatment.

scholarly journals Composition of the Oral Microbiome in Patients with Coronary Artery Disease

2020 ◽  
Author(s):  
Thangam Menon ◽  
Supraja Kalyanaraman ◽  
Seethalakshmi Srinivasan
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Bacterial Flora ◽  
Human Microbiome ◽  
Oral Microbiome ◽  
Metagenomic Analysis ◽  
Control Group ◽  
Oral Microbiota ◽  
Normal Human ◽  
Artery Disease

Introduction: Distinct microbial communities reside in the oral cavity and the composition of the oral microbiota has important implications for human health and disease. Identification of bacterial flora of the microbiome is done by metagenomic analysis of 16S ribosomal RNA sequences. Aim: The aim of this study was to characterise the human microbiome in patients with Coronary Artery Disease (CAD) in comparison with the normal human microbiome. Materials and Methods: A pilot study was carried out in tertiary hospital, Chennai. Oral mouthwash samples collected from nine patients with CAD were selected, with one control group. They were studied by metagenomic analysis of V3-V4 region of 16SrRNA gene sequences.. Sequencing of the variable V3 and V4 regions was done using Illumina platform. Results: The six major phyla, Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria, Spirochaetes, and Fusobacteriacontained 99% of the taxa in all the samples analysed. Conclusion: Diversity of the microbiome in patients with CAD was similar to the normal human microbiome.

scholarly journals Impact of Calcium Channel Blockers on Aspirin Reactivity in Patients With Coronary Artery Disease

2021 ◽  
Author(s):  
Afek Kodesh ◽  
Eli Lev ◽  
Dorit Leshem-Lev ◽  
Alejandro Solodky ◽  
Ran Kornowski ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Platelet Reactivity ◽  
Aspirin Resistance ◽  
Control Group ◽  
Channel Blockers ◽  
Artery Disease ◽  
Stable Cad

Abstract Purpose: Calcium channel blockers (CCBs) do not reduce the risk of initial or recurrent myocardial infarction (MI) in patients diagnosed with stable coronary artery disease (CAD). The aim of this current study was to evaluate the association between CCBs and aspirin resistance in patients with CAD. Methods: Patients with stable CAD who were regularly taking aspirin (75-100 mg qd) for at least one month prior to enrollment in the study were included. The VerifyNow system was used for platelet function testing with high on-aspirin platelet reactivity (HAPR) defined as aspirin reaction units (ARU) >550. We compared patients treated with CCBs versus control group. Results: 503 patients with CAD were included in this study, 88 were treated with CCBs; Mean age (67.9±9.7 in the CCB group vs 66.5±11.4 in the control group, p=0.288), gender (77.3 male vs. 82.9%, p=0.214) and rates of diabetes mellitus (34.7 vs. 36.9%, p=.121) were similar. Rates of hypertension were higher in the CCB group (83.9 vs. 63.5%, p<0.01), but rates of past MI were lower (47.1 vs. 59.7%, p=0.039). The mean ARU was 465.4P70.0 for patients treated with CCBs versus 445.2u60.0 in controls (p=0.006). Similarly, 15.9% of CCB patients demonstrated HAPR compared to 7.0% (p=0.006). In a multivariate analysis, the administration of CCBs was independently associated with HAPR (OR- 1.72, 95% CI 1.04 – 8.91, p=0.047). Conclusions: Usage of CCBs is positively correlated with aspirin resistance. These findings may suggest an adverse pharmacologic effect of CCBs among patients with stable CAD treated with aspirin.

scholarly journals Effects of exercise training on sleep apnoea in patients with coronary artery disease: a randomised trial

2016 ◽  
Vol 48 (1) ◽  
pp. 142-150 ◽  
Author(s):  
Monique Mendelson ◽  
Owen D. Lyons ◽  
Azadeh Yadollahi ◽  
Toru Inami ◽  
Paul Oh ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Exercise Training ◽  
Randomised Trial ◽  
Exercise Group ◽  
Sleep Apnoea ◽  
Control Group ◽  
Fluid Shift ◽  
Obstructive Sleep ◽  
Artery Disease

Overnight fluid shift from the legs to the neck and lungs may contribute to the pathogenesis of obstructive sleep apnoea (OSA) and central sleep apnoea (CSA). We hypothesised that exercise training will decrease the severity of OSA and CSA in patients with coronary artery disease (CAD) by decreasing daytime leg fluid accumulation and overnight rostral fluid shift.Patients with CAD and OSA or CSA (apnoea–hypopnoea index >15 events per h) were randomised to 4 weeks of aerobic exercise training or to a control group. Polysomnography, with measurement of leg, thoracic and neck fluid volumes and upper-airway cross-sectional area (UA-XSA) before and after sleep, was performed at baseline and follow-up.17 patients per group completed the study. Apnoea–hypopnoea index decreased significantly more in the exercise group than in the control group (31.1±12.9 to 20.5±9.4versus28.1±13.5 to 27.0±15.1 events per h, p=0.047), in association with a greater reduction in the overnight change in leg fluid volume (579±222 to 466±163versus453±164 to 434±141 mL, p=0.04) and by a significantly greater increase in the overnight change in UA-XSA in the exercise group (p=0.04).In patients with CAD and sleep apnoea, exercise training decreases sleep apnoea severityviaattenuation of overnight fluid shift and an increase in UA-XSA.

Abstract 150: Association Between Serum Ghrelin Levels and Coronary Artery Disease: a Meta-analysis

2015 ◽  
Vol 117 (suppl_1) ◽  
Author(s):  
Pradyumna Agasthi ◽  
Sivakanth Aloor ◽  
Avantika Chenna ◽  
Anekwe Onwuanyi
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Meta Analysis ◽  
Control Group ◽  
Cross Sectional ◽  
Median Serum ◽  
Artery Disease ◽  
Differentiation And Proliferation ◽  
And Control ◽  
Serum Gh

Background: Ghrelin (GH) is a gastrointestinal endocrine peptide regulating multiple biological processes including adipogenesis, glucose metabolism, cell differentiation and proliferation. Recent studies demonstrated that GH inhibits pro-atherogenic changes in vessel wall via inhibition of nuclear factor - B activity, a transcriptional factor mediating production pro-inflammatory cytokines and adhesion molecule expression in the endothelium. The aim of the current study is to conduct a meta-analysis to evaluate the relationship between serum GH levels and coronary artery disease (CAD). Methods: We searched MEDLINE, CINHAL and COCHRANE databases for studies reporting serum GH levels in the CAD and non CAD study population. We included case controls, cohort and cross-sectional studies. We calculated the weighted standardized mean difference (SMD) in serum GH levels between the CAD and control groups. Results: Our search strategy yielded 285 articles and we included 10 studies enrolling 1855 participants. The median age of the CAD group was 62 yrs. (IQR 60 - 63) compared to 61 yrs. (IQR 58 - 65) in the control group. The median body mass index in the CAD group was 28 kg/m2 (IQR 27.9 - 28) compared to 27 kg/m2 (IQR 26 - 27) in the control group. The unweighted median serum GH levels in the CAD group were 0.66 ng/ml (IQR 0.3 - 1.6) compared to 0.76 ng/ml (IQR 0.38 - 4.9) in the control group. The SMD of GH level was -0.44 (95% CI -0.56,-0.31) p<0.001 comparing those in the CAD group and control group. Conclusion: Serum GH levels are significantly and inversely associated with CAD. Current findings warrant the need to further investigate the role of GH in the pathogenesis of CAD.

Intracoronary imaging assessment of atherosclerosis in vasomotor dysfunction and phenotypes of non-obstructive coronary artery disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Pellegrini ◽  
R Konst ◽  
S Elias-Smale ◽  
R.J Van Geuns ◽  
N Van Royen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stable Angina ◽  
Normal Population ◽  
Obstructive Coronary Artery Disease ◽  
Macrophage Infiltration ◽  
Control Group ◽  
Coronary Microvascular Dysfunction ◽  
Artery Disease ◽  
Vasomotor Dysfunction

Abstract Background A consistent portion of patients with stable angina is affected by coronary vasomotor dysfunction, in the form of epicardial vasospasm (VSA) or coronary microvascular dysfunction (CMD). Although available data suggest a worse prognosis compared to normal population, anatomical background and associations with atherosclerosis are still uncertain. Purpose To define specific morphological features in patients with stable angina and coronary vasomotor dysfunction. Methods We enrolled all patients referred to our laboratory in the first half of 2019 for coronary reactivity testing (CRT) for stable angina and suspected vasomotor dysfunction. After confirming non-obstructive coronary artery disease by angiography, CRT consisted of acetylcholine test and physiology assessment with resting and hyperemic indexes. In addition, optical coherence tomography (OCT) was performed. All tests were performed in the left anterior descending artery. Patients were divided in 3 groups: VSA, CMD and control group (no CMD/VSA), according to international COVADIS consensus documents. Two independent reviewers assessed the OCTs to identify markers of atherosclerosis. Results We enrolled 48 patients. Mean age was 55.19±7.71 years. 46 (96%) were females. 3 patients were removed due to mixed VSA and CMD, resulting in 45 subjects eligible for analysis: 17 had VSA, 22 CMD and 6 were controls. Baseline characteristics, resting and hyperemic indexes were similar in the groups, except for the index of microvascular resistance (IMR), being higher in CMD group. Moving from control group, to CMD, to VSA, OCT suggested a trend of increasing prevalence of fibroatheromas (0% in controls, 36% in CMD, 47% in VSA, p 0.12), thin-cap fibroatheromas (0% vs 18% vs 29%, respectively, p 0.29) and neovascularisation (17% vs 23% vs 47%, p 0.19). On the other hand, macrophage infiltration was higher in CMD group (55% in CMD, vs 47% in VSA, vs 33% in controls, p 0.64). Plaques covered 43% of the vessel in VSA group (34% being lipid-rich), 35% in CMD (lipid: 36%) and 30% in controls (p 0.69; 17% lipid). Lipid pools showed a different distribution across the groups. Control group had small pools (mean/max lipid arc 56/65°, length: 5.5 mm), CMD showed intermediate width (arc 82/106°), but long extension (11.5 mm), while VSA had large pools (94/127°, p 0.05/0.08), with intermediate length (7 mm, p 0.58). Lipid index (mean arc x lipid length) was similar in VSA (632) and CMD (642), but lower in control group (203, p 0.35). Conclusions This study hints at atherosclerosis as an underlying pathophysiology in VSA and CMD. A trend to increasing burden, both in terms of extension and vulnerability, was observed across patients with normal arteries, CMD and VSA. Peculiar patterns of atherosclerosis may be associated with specific phenotypes of vasomotor dysfunction, with larger lipid pools and neovascularization being associated with VSA and macrophage infiltration being more common in CMD. Funding Acknowledgement Type of funding source: None

scholarly journals IMMUNOLOGICAL STUDY OF CORONARY ARTERY DISEASE ASSOCIATED WITH DIABETES MELLITUS TYPE II IN IRAQI PATIENTS

2018 ◽  
Vol 11 (12) ◽  
pp. 269
Author(s):  
Mundher Jabbar Al-okhedi ◽  
Mohammed Qais Al-ani ◽  
Marrib N Rasheed
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Serum Levels ◽  
Control Group ◽  
Immunological Study ◽  
Increased Risk ◽  
Artery Disease

Objective: The objective of this study was to investigate the association between proinflammatory cytokines in special, the interleukin-6 (IL-6), and insulin-like growth factor (IGF-1) levels in coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM).Methods: This study was conducted from November 2017 to March 2018 in Anbar, Iraq. We studied a total of 90 individuals (46 men and 44 women) aged between 20 and 87 years. The samples were divided into four groups: CAD patients (n=23), T2DM patients (n=23), coronary artery disease and type 2 diabetes together in the same patient (n=23), and control group (n=21). The concentrations of IL-6 and IGF-1 were determined using a commercially available enzyme-linked immune sorbent assay.Results: The results of the present study showed that there were elevated serum levels of IL-6 and low levels of IGF-1 in all the tested groups, compared with the control. The difference was statistically significant at p<0.05. The results showed a positively correlated between IL-6 and IGF-1 in the CAD group and T2DM group, while it was a negative correlation between serum levels of IL-6 and IGF-1 in the T2DM+CAD group.Conclusion: Elevated levels serum of IL-6 predicts the development of CAD and T2DM. These data support a possible role for inflammation in diabetogenesis and complication of the cardiovascular disease. There is an inverse relationship between the levels serum of IGF-1 and increased risk of CAD and development of T2DM.

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