Endometriosis and New-Onset Coronary Artery Disease in Taiwan: A Nationwide Population-Based Study

Endometriosis (EM) with chronic inflammation may accelerate the progression of atherosclerosis. Currently, no large or randomized clinical studies have assessed the incidence of cardiovascular events in patients with endometriosis in Asia to investigate whether incident EM is associated with a higher risk of new-onset coronary artery disease (CAD). In this study of a nationwide cohort in Taiwan, we identified 13,988 patients with newly diagnosed EM from 1 January, 2000, through 31 December, 2012. EM and non-EM groups were matched by propensity score at a ratio of 1:1. Of a total 27,976 participants, 358 developed CAD. The incidence rate in the EM group was higher than that in the non-EM group (1.8 per 1,000 person-years vs. 1.3 per 1,000 person-years) during the follow-up period. The adjusted hazard ratio (aHR) of CAD for the EM group was 1.52 with a 95% confidence interval (1.23–1.87, p < 0.001) after adjusting for demographic characteristics, comorbidities, surgical procedures, frequency of outpatient visits, and medications. Stratified analysis revealed that, among four age groups (20–39, 40–49, 50–54, and above 55 years), the 20–39 years sub-group was associated with a higher risk of CAD (aHR, 1.73; 95% CI, 1.16–2.59, p = 0.008). Several sensitivity analyses were conducted for cross-validation, and it showed consistent positive findings. In conclusion, this cohort study revealed that patients with symptomatic EM in Taiwan were associated with increased risk of subsequent CAD than patients without medical records of EM. Further prospective studies are needed to confirm this causal relationship.

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Prognostic value of serum soluble ST2 in stable coronary artery disease: a prospective observational study

Scientific Reports ◽

10.1038/s41598-021-94714-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hack-Lyoung Kim ◽

Jung Pyo Lee ◽

Nathan Wong ◽

Woo-Hyun Lim ◽

Jae-Bin Seo ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stable Coronary Artery Disease ◽

Stable Condition ◽

Baseline Serum ◽

Soluble St2 ◽

Increased Risk ◽

Artery Disease ◽

Stable Cad

AbstractThe role of ST2 in stable coronary artery disease (CAD) has not yet been well defined. This study was performed to investigate baseline serum soluble ST2 (sST2) level can predict clinical outcomes in patients with stable CAD. A total of 388 consecutive patients with suspected CAD (65 years and 63.7% male) in stable condition referred for elective invasive coronary angiography (ICA) was prospectively recruited. Major adverse cardiovascular event (MACE), including cardiac death, non-fatal myocardial infarction, coronary revascularization (90 days after ICA), and ischemic stroke during clinical follow-up was assessed. Most of the patients (88.0%) had significant CAD (stenosis ≥ 50%). During median follow-up of 834 days, there was 29 case of MACE (7.5%). The serum sST2 level was significantly higher in patients with MACE than those without (47.3 versus 30.6 ng/ml, P < 0.001). In multiple Cox regression model, higher sST2 level (≥ 26.8 ng/ml) was an independent predictor of MACE even after controlling potential confounders (hazard ratio, 13.7; 95% confidence interval 1.80–104.60; P = 0.011). The elevated level of baseline sST2 is associated with an increased risk of adverse clinical events in stable CAD patients. Studies with larger sample size are needed to confirm our findings.

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Abstract P050: Association Between Glycemic Control and Short-term Mortality Varies Across the Spectrum of Coronary Artery Disease

Circulation ◽

10.1161/circ.135.suppl_1.p050 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Sridharan Raghavan ◽

Wenhui G Liu ◽

P. Michael Ho ◽

Mary E Plomondon ◽

Anna E Baron ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Glycemic Control ◽

Diabetes Management ◽

Significant Risk ◽

Short Term ◽

Increased Risk ◽

Short Term Mortality ◽

Artery Disease

Background: Diabetes is a significant risk factor for cardiovascular disease, but optimal glycemic control strategies remain unclear. In particular, trials of intensive glycemic control have highlighted a tension between increased mortality risk and macrovascular benefits. In this study we aimed to assess whether the burden of coronary artery disease (CAD) modifies the association between glycemic control and short-term mortality. Methods: We studied veterans with diabetes who underwent elective cardiac catheterization between 2005 and 2013 in a retrospective analysis of data from the VA Clinical Assessment, Reporting, and Tracking (CART) Program. Primary exposures were time-varying HbA1c over two years of follow-up after index catheterization, categorized as <6%, 6-6.49%, 6.5-6.99%, 7-7.99%, 8-8.99%, and >=9%, and burden of CAD, categorized as no CAD, non-obstructive CAD, or obstructive CAD. Primary outcome was two-year all-cause mortality. A total of 17394 participants had, on average, five HbA1c measurements over two years of follow-up. We used multivariable Cox proportional hazards regression to estimate the association between HbA1c and mortality, adjusting for demographic and clinical covariates and CAD burden, and including a term for interaction between HbA1c and CAD burden. Results: In adjusted models with 6.5 ≤ HbA1c ≤ 6.99% as the reference category, HbA1c < 6% was associated with increased risk of mortality (HR 1.55 [1.25, 1.92]), whereas HbA1c categories above 7% were not. We observed significant interaction between glycemic control and CAD burden (interaction p=0.0005); the increased risk of short-term mortality at HbA1c < 6% was limited to individuals with non-obstructive and obstructive CAD (Figure 1). Conclusions: HbA1c below 6% was associated with increased risk of short-term mortality, but only in individuals with CAD. CAD burden may thus inform individualized diabetes management strategies, specifically treatment de-escalation in individuals with any angiographically-defined CAD.

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Abstract P238: Culturally-Competent Heart Health Coaching Improves Lipids in South Asians

Circulation ◽

10.1161/circ.127.suppl_12.ap238 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Powell O Jose ◽

Kristin M Azar ◽

Jennifer Kang ◽

Marshall Baek ◽

Latha P Palaniappan ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Total Cholesterol ◽

South Asians ◽

Health Coaching ◽

Culturally Competent ◽

Heart Health ◽

Increased Risk ◽

Artery Disease

Background: Health coaching programs, delivered by trained non-medical and medical personnel, and focused on diet and lifestyle counseling, have proven beneficial in both primary and secondary prevention of cardiovascular disease. These coaching programs, however, have not been tested or validated in South Asians, who have unique dietary and lifestyle habits, and greatly increased risk of coronary artery disease. Methods: We examined lipid values in participants who were invited to enroll in the Heart Health Coaching Program at the South Asian Heart Center at El Camino Hospital in Mountain View, California. Trained volunteer coaches contacted interested participants throughout the year by phone and email to deliver culturally-competent health education on diet, physical activity, and stress reduction. Participants were categorized, based on their level of participation, into three groups: those who did not enroll in the coaching program (non-coached, N=33), those who received some coaching (partially coached, N=145), and those who completed one full year of the program (fully coached, N=558). Fasting lipid measurements were obtained with mean differences being calculated from their baseline and last available follow-up lab test. Paired t-test was used for comparison of baseline and follow-up lab tests within each group. Multivariate age-adjusted analyses incorporated MANOVA to detect for differences between groups. Results: There were no significant differences in mean age(43, 42 and 43), mean BMI(25.8, 26.5 and 26.2), or baseline lipid values across the three groups (fully-coached, partially coached, and non-coached respectively). There were significant improvements in total cholesterol(TC) (-5.5±28.4mg/dl), LDL(-4.1±24.3), HDL (1.9±6.4), triglycerides(-16.1±67.3), and TC/HDL ratio(-0.31±0.83) in the fully coached group (p<0.001 for all). The partially coached group demonstrated reductions in total cholesterol(-5.2±27.8, p=0.03), LDL(-8.1±28.0mg/dl, p<0.001), and TC/HDL ratio (-0.42±1.01, p<0.001) with a trend towards increased HDL (4.9±31.3, p=0.06). Non-coached participants did not have any statistically significant differences for any lipid measurement. Coached participants were more likely to improve lipid values than partially coached and non-coached participants (p<0.001). Conclusions: Our results suggest the benefit of a volunteer culturally-competent coaching program for South Asians in improving their lipid profile. Benefit was obtained even for partially coached participants. Non-medically trained health coaches may be an effective method to deliver culturally appropriate cardiovascular health messages for South Asians at risk for developing coronary artery disease.

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Abstract P85: Are Myocardial Bridges Associated With Increased Risk of Death or Myocardial Infarction?

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap85 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Mouaz H Al-Mallah ◽

Kamal Kassem ◽

Owais Khawaja ◽

Thomas Song ◽

Chad Poopat ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Prognostic Value ◽

Cox Regression ◽

Study Cohort ◽

Risk Of Death ◽

Increased Risk ◽

Artery Disease

Background: Myocardial bridging (MB) is frequently seen on coronary CT angiography (CCTA). However, there has been conflicting data on the prognostic value of MB. The aim of this analysis is to determine the prognostic value of MB in patients without obstructive coronary artery disease (CAD) (<50 diameter stenosis). Methods: We included patients with no known prior coronary artery disease (CAD) who underwent CCTA for various clincial reasons. Patients with obstructive CAD on CCTA were excluded. The study cohort was followed for all cause mortality or myocardial infarction (MI) (median follow-up 1.7 years). Group comparisons were made between patients with patients with or without MB. Results: A total of 715 patients were included in this analysis of which 68 patients had MB (10%). 73% of the bridges were in the mid LAD and 22% had bridging in the distal LAD. 48% of the study cohort had normal coronaries, while 52% had evidence of non obstructive CAD. There were no differences in the baseline characteristics, symptomatic status or prevalence of non obstructive CAD between the two groups (all p>0.5). After a median follow-up duration of 1.7 years, 23 patients died and 10 patients experienced myocardial infarction. There were no statistically significant differences in the rate of death/MI between the two groups (figure). Using multivariable Cox regression, the presence of MB was not associated with increased risk for death/MI (Adjusted HR 0.4, 95% confidence interval 0.1 -2.8, p=0.34) Conclusions: In patients with non-obstructive CAD, MB is not associated with increased risk for all cause death or MI.

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Abstract P224: The Haptoglobin (Hp) Genotype Predicts Coronary Artery Disease (CAD) During 25 Years of Follow-up in Type 1 Diabetes: Potential Pole of Impaired HDL Cholesterol Efflux Capacity

Circulation ◽

10.1161/circ.131.suppl_1.p224 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Tina Costacou ◽

Jay W Heinecke ◽

Tomas Vaisar ◽

Trevor J Orchard

Keyword(s):

Coronary Artery Disease ◽

Type 1 Diabetes ◽

Coronary Artery ◽

Pilot Study ◽

Cholesterol Efflux ◽

P Value ◽

Increased Risk ◽

Artery Disease

Background: The Hp 2-2 genotype has been associated with increased cardiovascular risk in type 2 diabetes, potentially relating to dysfunctional HDL mediated cholesterol efflux. We have shown that the Hp 2 allele predicts the development of both coronary artery disease (CAD) and kidney dysfunction also in childhood onset type 1 diabetes over 18 years of follow-up in the Epidemiology of Diabetes Complications (EDC) study. We now present results on the Hp-CAD association after an additional 7 year follow-up and Hp’s relation to impaired sterol efflux capacity, a proposed cardioprotective effect of HDL. Methods: Participants free of CAD at baseline and with Hp determined were studied (n=565; mean age, 27 and duration, 19 years; 11.5% Hp 1-1, 42.5% Hp 2-2). CAD was defined as EDC physician diagnosed angina, ischemic ECG changes (MC 1.3, 4.1-4.3, 5.1-5.3, 7.1), confirmed MI (MC 1.1, 1.2 or validated medical records), stenosis >50%, revascularization or CAD death. In a pilot study, serum HDL sterol efflux was assessed in Mifepristone stimulated ABCA1-BHK cells among 20 individuals (6 Hp 1-1; 7 Hp 2-1; 7 Hp 2-2) attending the 25 year exam. Results: During follow-up, 186 (32.9%) developed CAD. Incidence increased with the number of Hp 2 alleles (24.6% in Hp 1-1, 31.1% in Hp 2-1 and 37.1% in Hp 2-2, p-trend=0.04; Fig. 1). Multivariably, Hp 2-2 significantly increased risk by almost 80% (HR=1.79, 1.03-3.09). The risk associated with Hp 2-1 did not reach significance (HR=1.46, 0.85-2.53). In the pilot study, serum HDL sterol efflux was lower in Hp 2 allele carriers: 14.0% in Hp 1-1, 12.5% in Hp 2-1, 12.4% in Hp 2-2, p-trend=0.06, p-value Hp 1-1 vs Hp 2-1/2-2 =0.04. Conclusion: These results extend our previous findings of increased CAD risk associated with the Hp 2 allele in type 1 diabetes and further suggest that this allele associates with impaired sterol efflux capacity. These results support the hypothesis that sterol efflux explains the increased Hp 2 risk for CAD and should be confirmed prospectively. Figure 1. CAD-free survival curves by Hp genotype

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Endometriosis Is Associated with an Increased Risk of Coronary Artery Disease in Asian Women

Journal of Clinical Medicine ◽

10.3390/jcm10184173 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4173

Author(s):

Pei-Chen Li ◽

Yu-Cih Yang ◽

Jen-Hung Wang ◽

Shinn-Zong Lin ◽

Dah-Ching Ding

Keyword(s):

Coronary Artery Disease ◽

Health Insurance ◽

Coronary Artery ◽

Large Scale ◽

Population Based ◽

Chronic Inflammatory Disease ◽

Asian Women ◽

National Health Insurance System ◽

Increased Risk ◽

Artery Disease

Endometriosis is a common systemic chronic inflammatory disease. Inflammation is the key mechanism responsible for the development of endothelial dysfunction and atherosclerosis. We aimed to investigate the risk of coronary artery disease (CAD) among Asian women with endometriosis. This retrospective population-based cohort study included patients with endometriosis diagnosed from 2000 to 2012 and registered in the Longitudinal Health Insurance Database, Taiwan. The comparison cohort (those without endometriosis) were selected (1:4) by matching the age frequency and the index year. We followed up the patients until the diagnosis of CAD (ICD-9-CM codes: 410–414, A270, and A279), withdrawal from the National Health Insurance system, death, or the end of the study. We used a multivariable-adjusted Cox proportional hazard model for evaluating the risk of CAD. We included 19,454 patients with endometriosis and 77,816 women as a comparison group. The mean age of the women at the diagnosis of endometriosis was 37.4 years. A total of 3245 women developed CAD in both groups during a median follow-up of 7 years. The incidence of CAD was higher in women with endometriosis than in those without (5.96 vs. 4.38 per 10,000 person-years; adjusted hazard ratio [95% confidence interval], 1.34 [1.22–1.47]). In conclusion, Asian women with endometriosis had a significantly higher risk of CAD. Further large-scale studies are needed to elucidate the cause-effect relationship between endometriosis and CAD.

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Investigation of Renalase gene rs2576178 polymorphism in patients with coronary artery disease

Bioscience Reports ◽

10.1042/bsr20180839 ◽

2018 ◽

Vol 38 (5) ◽

Cited By ~ 3

Author(s):

Ning Hu ◽

Jun Wang ◽

Pengfei Hu ◽

Zhongmei Li

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Laser Desorption ◽

Laser Desorption Ionization ◽

Ethnic Populations ◽

Increased Risk ◽

Artery Disease ◽

Stage Renal Disease ◽

End Stage ◽

Stratified Analysis

Renalase gene rs2576178 polymorphism has been demonstrated to be a risk factor of ischemic stroke, essential hypertension, and end-stage renal disease, but the association Renalase with risk of coronary artery disease (CAD) has been less reported. Therefore, we detected Renalase rs2576178 polymorphism in 449 CAD patients and 507 healthy controls using matrix-assisted laser-desorption ionization (MALDI)/time of flight (TOF)-mass spectrometry (MS). It was found that GG genotype or G allele of rs2576178 polymorphism was associated with the risk of CAD. Stratified analysis indicated that Renalase polymorphism significantly increased the risk of CAD in females, smokers, and alcoholics. However, there was no significant association between different genotypes of rs2576178 polymorphism and clinical parameters. In summary, Renalase rs2576178 polymorphism is associated with increased risk of CAD, but this finding should be confirmed by larger studies with more diverse ethnic populations.

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Serum Parathyroid Hormone and Risk of Coronary Artery Disease: Exploring Causality Using Mendelian Randomization

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2019-01063 ◽

2019 ◽

Vol 104 (11) ◽

pp. 5595-5600 ◽

Cited By ~ 1

Author(s):

Håkan Melhus ◽

Karl Michaëlsson ◽

Susanna C Larsson

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Parathyroid Hormone ◽

Coronary Artery ◽

Mendelian Randomization ◽

Sensitivity Analyses ◽

Nucleotide Polymorphisms ◽

Serum Parathyroid Hormone ◽

Increased Risk ◽

Artery Disease

Abstract Context Elevated circulating parathyroid hormone concentrations have been associated with increased risk of cardiovascular disease in observational studies, but whether the association is causal is unknown. Objective We used the Mendelian randomization design to test whether genetically increased serum parathyroid hormone (S-PTH) concentrations are associated with coronary artery disease (CAD). Design, Setting, and Participants Five single-nucleotide polymorphisms robustly associated with S-PTH concentrations were used as instrumental variables to estimate the association of genetically higher S-PTH concentrations with CAD. Summary statistics data for CAD were obtained from a genetic consortium with data from 184,305 individuals (60,801 CAD cases and 123,504 noncases). Main Outcome Measure OR of CAD per genetically predicted one SD increase of S-PTH concentrations. Results Genetically higher S-PTH concentration was not associated with CAD as a whole or myocardial infarction specifically (∼70% of total cases). The ORs per genetically predicted one SD increase in S-PTH concentration were 1.01 (95% CI: 0.93 to 1.09; P = 0.88) for CAD and 1.02 (95% CI: 0.94 to 1.10; P = 0.64) for myocardial infarction. The lack of association remained in various sensitivity analyses. Conclusion Genetic predisposition to higher S-PTH concentrations does not appear to be an independent risk factor for CAD.

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Impact of left ventricular function on clinical outcomes among patients with coronary artery disease

European Journal of Preventive Cardiology ◽

10.1177/2047487319841939 ◽

2019 ◽

Vol 26 (12) ◽

pp. 1273-1284 ◽

Cited By ~ 4

Author(s):

George CM Siontis ◽

Mattia Branca ◽

Patrick Serruys ◽

Sigmund Silber ◽

Lorenz Räber ◽

...

Keyword(s):

Coronary Artery Disease ◽

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Cardiac Death ◽

Coronary Intervention ◽

Increased Risk ◽

Percutaneous Coronary ◽

All Cause Mortality ◽

Artery Disease

Aims To investigate the clinical relevance of contemporary cut-offs of left ventricular ejection fraction (LVEF) including an intermediate phenotype with mid-range reduced ejection fraction among patients with coronary artery disease undergoing percutaneous coronary intervention. Methods and results Patient-level data were summarized from five randomized clinical trials in which 6198 patients underwent clinically indicated percutaneous coronary intervention in different clinical settings. We assessed all-cause mortality as primary endpoint at five-year follow-up. According to the proposed LVEF cut-offs, 3816 patients were included in the preserved LVEF group (LVEF ≥ 50%), 1793 in the mid-range reduced LVEF group (LVEF 40–49%) and 589 patients in the reduced LVEF group (LVEF < 40%). Patients in the reduced LVEF group were at increased risk for the primary outcome of all-cause mortality compared with both, preserved and mid-range LVEF throughout five years of follow-up (adjusted hazard ratio 2.39 (95% confidence interval 1.75–3.28, p < 0.001) and 1.68 (95% confidence interval 1.34–2.10, p < 0.001), respectively). The risk of cardiac death and the composite endpoint of cardiac death, myocardial infarction, or stroke were higher for patients in the reduced LVEF group compared with the preserved and mid-range reduced LVEF groups, but also for the mid-range LVEF compared with preserved LVEF group (adjusted p < 0.05 for all comparisons) throughout five years. Irrespective of clinical presentation at baseline (stable coronary artery disease or acute coronary syndrome), patients with reduced or mid-range LVEF were at increased risk of all-cause mortality and cardiac death up to five years compared with the other group (adjusted p < 0.05 for all comparisons). Conclusion Patients with reduced LVEF <40% or mid-range LVEF 40–49% in the context of coronary artery disease undergoing clinically indicated percutaneous coronary intervention are at increased risk of all-cause mortality, cardiac death and the composite of cardiac death, stroke and myocardial infarction throughout five years of follow-up. The recently proposed LVEF cut-offs contribute to the differentiation and risk stratification of patients with ischaemic heart disease.

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