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Coronary Artery Disease: HELP
Articles from Africa
Based on 270 articles published since 2008

These are the 270 published articles about Coronary Artery Disease that originated from Africa during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11
1 Editorial Pulse pressure and selection of the optimal coronary artery disease management strategy in patients with type 2 diabetes. 2018

Mahfouz, Essam M. ·Professor of Cardiology, Mansoura University, Egypt. Electronic address: emahfouz@mans.edu.eg. ·Int J Cardiol · Pubmed #30190157.

ABSTRACT: -- No abstract --

2 Review Amiodarone-Induced Thyroid Dysfunction: A Clinical Update. 2018

Elnaggar, Mohamed Nabil / Jbeili, Kahtan / Nik-Hussin, Nik / Kozhippally, Mohandas / Pappachan, Joseph M. ·Department of Endocrinology, Diabetes & Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, United Kingdom, LA1 4RP. · Internal Medicine Department, Faculty of Medicine, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt. · Department of Radiology and Nuclear Imaging Services, University Hospitals of Morecambe Bay NHS Foundation Trust, United Kingdom, LA1 4RP. · Department of Medicine, Good Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, United Kingdom, B75 7RR. ·Exp Clin Endocrinol Diabetes · Pubmed #29558786.

ABSTRACT: Amiodarone is one of the most commonly prescribed antiarrhythmic agents in clinical practice owing to its efficacy, even with high toxicity profile. The high iodine content and the prolonged biological half-life of the drug can result in thyroid dysfunction in a high proportion of patients treated with amiodarone even after cessation of amiodarone. Both hypothyroidism and hyperthyroidism are common side effects that mandate regular monitoring of patients with thyroid function tests. Amiodarone-induced hypothyroidism (AIH) is diagnosed and managed in the same way as a usual case of hypothyroidism. However, differential diagnosis and clinical management of amiodarone-induced thyrotoxicosis (AIT) subtypes can be challenging. With the aid of a case snippet, we update the current evidence for the diagnostic work up and management of patients with amiodarone-induced thyroid dysfunction in this article.

3 Review Coronary Artery Calcium Scoring in Young Adults: Evidence and Challenges. 2018

Saad, Marwan / Pothineni, Naga Venkata / Thomas, Joseph / Parikh, Richa / Kovelamudi, Swathi / Elsayed, Dina / Nairooz, Ramez / Feit, Frederick. ·Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA. mssaad@uams.edu. · Division of Cardiology, Ain Shams University, Cairo, Egypt. mssaad@uams.edu. · Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA. · Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA. · Division of Biomedical Informatics, Graduate School, University of Arkansas for Medical Sciences, Little Rock, AR, USA. · Division of Cardiovascular Medicine, University of South California, Los Angeles, CA, USA. · Division of Cardiovascular Medicine, New York University School of Medicine, New York, NY, USA. ·Curr Cardiol Rep · Pubmed #29435665.

ABSTRACT: PURPOSE OF REVIEW: This review aims to summarize the evidence and challenges of coronary artery calcium (CAC) scoring as a screening tool for coronary artery disease (CAD) in young adults. RECENT FINDINGS: Several cohort studies have highlighted the value of CAC scoring in CAD risk assessment in young adults. The largest study to date is the Coronary Artery Risk Development in Young Adults (CARDIA) study. The study examined patients at 18-30 years of age and demonstrated that the presence of any degree of CAC was associated with a higher risk of coronary events compared to zero CAC, with an incremental increase in the risk of events with higher scores. However, it is important to note that 70% of patients screened had CAC = 0 at the age of 56. Despite the evidence that higher CAC score cutoff used in guidelines for predicting cardiovascular risk may be "falsely reassuring," however, mass screening of young adults using CAC score may be challenging. The development of prediction tools and scoring systems to identify patients at higher risk of developing CAC based on known CAD risk factors may help reduce the number needed to screen to detect patients with positive CAC.

4 Review Treatment of coronary bifurcation lesions: current knowledge and future perspectives. 2018

Elwany, Mostafa / Palma, Gaetano Di / Cortese, Bernardo. ·Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milano, Italy. · Faculty of Medicine, University of Alexandria, Alexandria, Egypt. · Department of Cardiothoracic Sciences, Second University of Napoli, Naples, Italy. · Cardiac Department, Fondazione G Monasterio CNR-Regione Toscana, Pisa, Massa, Italy. ·Future Cardiol · Pubmed #29372810.

ABSTRACT: Coronary lesions at bifurcation sites are frequent and still remain a challenging subset for the interventional cardiologist. Although in the last years the provisional stenting technique has shown more consistent results, coronary bifurcation interventions still share a worse procedural success rate and increased rates of mid- and long-term cardiac events. Most of the dedicated devices proposed in the last few years have failed to show improved results when compared with standard devices. The broader use of imaging techniques, such as intravascular ultrasound and optical coherence tomography, lead to a better understanding of the real anatomy of bifurcations and has shown to be a great tool for percutaneous coronary intervention optimization. Preliminary results come from drug-coated balloons and bioresorbable vascular scaffolds, especially for the 'leave nothing behind' concept, particularly interesting in this setting of lesions.

5 Review Reversible myocardial perfusion defects in patients not suffering from obstructive epicardial coronary artery disease as assessed by coronary angiography. 2018

van de Wiele, Christophe / Rimbu, Adriana / Belhocine, Tarik / de Spiegeleer, Bart / Sathekge, Mike / Maes, Alex. ·Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium - cvdwiele@hotmail.com. · Department of Radiology and Nuclear Medicine, University Ghent, Ghent, Belgium - cvdwiele@hotmail.com. · Centre André Dutreix, NUCLERIDIS, Dunkerque, France - cvdwiele@hotmail.com. · Centre André Dutreix, NUCLERIDIS, Dunkerque, France. · Biomedical Imaging Research Center (BIRC), Western University, London, Ontario, Canada. · Department of Pharmaceutical Analysis, University of Ghent, Ghent, Belgium. · Department of Nuclear Medicine, University of Pretoria, Pretoria, South-Africa. · Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium. · Department of Morphology and Medical Imaging, University Hospital Leuven, Leuven, Belgium. ·Q J Nucl Med Mol Imaging · Pubmed #27007665.

ABSTRACT: In approximately 10-30% of patients presenting with angina complaints, normal or non-obstructive coronary arteries are found on angiography. In this review paper, available literature on the underlying pathophysiological substrate explaining these discrepancies is reviewed. Both histological studies as well as studies using intravascular ultrasound e.g. the PROSPECT trial, show that epicardial coronary vessel significant lumen stenosis may be delayed until a plaque occupies 40% of the internal elastic lamina area. Limited available data suggest that these angiographically undetectable plaques are associated with an abnormal vasodilation capacity of the coronary circulation and may results in reversible perfusion defects on myocardial perfusion imaging (MPI). Organic non-atherosclerotic causes of epicardial coronary artery disease such as anomalous coronary arteries that course between the aorta and pulmonary artery, myocardial bridging and coronary vasospasm may also contribute to MPI results suggesting the presence of ischemia in the presence of normal coronary arteries on coronary angiography. Additional causes of reversible perfusion defects on MPI in the presence of a normal coronary angiogram are intraventricular conduction disturbances. The existence of reversible perfusion defects in the anteroseptal region in most of the patients suffering from left bundle branch block (LBBB) on MPI following physical exercise as stressor is well documented. As the observed reduced septal uptake of both 201Tl and 99mTc-sestamibi/tetrofosmin in LBBB reflects coronary autoregulation in response to lower oxygen demands, not surprisingly, dipyridamole which uniformly exploits flow reserve, has proven more accurate for the diagnosis of coronary artery disease (CAD) in patients suffering from LBBB. Although patients with a permanent ventricular pacemaker have a similar conduction abnormality as patients presenting with a LBBB, most of the defects found on MPI imaging in this patient population (in up to 78% of patients with a normal coronary angiogram that area continuously paced) are localized in the inferoposterior (71%), apical (50%) and inferoseptal (28%) wall; coronary flow velocities in the left anterior descending (LAD) and dominant coronary artery and coronary flow reserve are also significantly lower when compared to a control group. Contrary to what is seen in LBBB patients, dipyridamole stress does not significantly reduce the incidence of abnormalities found but limits the defects to the inferior wall. Furthermore, the frequency of abnormalities found on MPI increases over time with right ventricular outflow tract pacing. Previous histologic studies have shown that microvessel disease is often accompanied by a slow-flow phenomenon reflecting decreased resting flow velocity. Thus, not surprisingly, MPI reversible abnormalities in the presence of a normal coronary angiogram have been reported in a wide variety of diseases characterized by microvessel disease such as diabetes, systemic lupus erythematosus, Behçet's disease and metabolic syndrome. In these patients, low adiponectin and high lipoprotein(a) levels are found which are known to be associated with endothelial dysfunction, atherosclerosis and coronary artery disease. Furthermore, in these patients, limited available data suggest that reversible perfusion defects on MPI confer a significantly poorer prognosis both in terms of hard event rate (MI and cardiac death) and total event rate (MI, cardiac death or late revascularization). It is thus suggested that MPI could discriminate patients with a more severe prognosis. Finally, physical training in patients with primary microvascular angina appears to be associated with reduction of myocardial perfusion abnormalities.

6 Review Optimal percutaneous coronary intervention in patients with ST-elevation myocardial infarction and multivessel disease: An updated, large-scale systematic review and meta-analysis. 2017

Nguyen, An Vu / Thanh, Le Van / Kamel, Mohamed Gomaa / Abdelrahman, Sara Attia Mahmoud / El-Mekawy, Mohamed / Mokhtar, Mohamed Ashraf / Ali, Aya Ashraf / Hoang, Nam Nguyen Nho / Vuong, Nguyen Lam / Abd-Elhay, Fatma Abd-Elshahed / Omer, Omer Abdelbagi / Mohamed, Ahmed Abdou / Hirayama, Kenji / Huy, Nguyen Tien. ·Pham Ngoc Thach University of Medicine, Ho Chi Minh City, 70000, Viet Nam. · University of Medicine and Pharmacy, Ho Chi Minh City, 70000, Viet Nam. · Faculty of Medicine, Minia University, Minia 61519, Egypt. · Faculty of Medicine, Alexandria University, Beheira 22762, Egypt. · Faculty of Medicine, Cairo University, Cairo 13719, Egypt. · Faculty of Medicine, Sohag University, Sohag 82738, Egypt. · Faculty of Medicine, Gezira University, 20, Wad Madani, Sudan. · Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan. · Evidence Based Medicine Research Group & Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Viet Nam; Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan. Electronic address: nguyentienhuy@tdt.edu.vn. ·Int J Cardiol · Pubmed #28647440.

ABSTRACT: BACKGROUND: Our study aimed to compare three different percutaneous coronary intervention (PCI) approaches: culprit-only (COR) and complete (CR) revascularization - categorizing into immediate (ICR) or staged (SCR). METHODS: We searched 13 databases for randomized controlled trials. Articles were included if they compared at least two strategies. To have more studies in each analysis, an adjusted analysis was performed using person-years to incorporate follow-up durations and obtain pooled rate ratios (RR), with their corresponding 95% confidence interval. RESULTS: Thirteen trials were included with a population of 2830 patients. COR significantly increased major adverse cardiac event (MACE) (adjusted RR 1.67, 95% CI: 1.27-2.19) and repeat revascularization (2.12, 1.67-2.69), which was driven by repeat PCI, without any difference in all-cause mortality and myocardial infarction (MI) compared to CR. When categorizing CR into SCR and ICR, the trend repeated with COR increased MACE (1.99, 1.53-2.6 for ICR), cardiovascular mortality (2.06, 1.07-3.96 for ICR), MI for ICR (1.72, 1.04-2.86), repeat revascularization and repeat PCI for both ICR and SCR. Non-cardiovascular mortality, stroke, nephropathy, re-hospitalization, stent thrombosis and bleeding were similar among all approaches. CONCLUSIONS: In MVD-STEMI patients, CR is better than COR in terms of MACE, cardiovascular mortality, repeat revascularization with no difference in safety outcomes. There was a trend towards to a reduction of cardiovascular mortality and MI in ICR compared to SCR when each matched with COR; even though there is no statistically significant difference between ICR and SCR when compared together.

7 Review Effect of ivabradine on cardiovascular outcomes in patients with stable angina: meta-analysis of randomized clinical trials. 2017

Mengesha, Hayelom Gebrekirstos / Weldearegawi, Berhe / Petrucka, Pammala / Bekele, Tadese / Otieno, Mala George / Hailu, Abraha. ·College of Health Science, Adigrat University, Adigrat, Ethiopia. hayetgeb@gmail.com. · College of Health Science, School of Public Health, Mekelle University, Mekelle, Ethiopia. · College of Nursing; Adjunct Nelson Mandela African Institute of Science and Technology, University of Saskatchewan, Saskatoon, Canada. · College of Health Science, Department of Pharmacy, Haramaya University, Harar, Ethiopia. · College of Health Science, Department of Medical Biochemistry, Mekelle University, Mekelle, Ethiopia. · College of Health Science, Department of Internal Medicine, Mekelle University, Mekelle, Ethiopia. ·BMC Cardiovasc Disord · Pubmed #28454527.

ABSTRACT: BACKGROUND: Although there are established drugs for treatment of cardiovascular diseases, due to adverse effects these drugs may not be clinically applicable to all patients. Recent trends have seen the emergence of drugs which act on funny current channels to induce selective heart rate reduction. Ivabradine is one such drug developed for coronary artery disease and heart failure. There is inconsistent evidence about the effect of this selective inhibitor in reduction of cardiovascular related mortality and morbidity. Such an inconsistency warrants the need for a meta-analysis to consider the effectiveness and efficacy of Ivabradine in the treatment of coronary artery disease and heart failure. METHODS: Randomized controlled trials with a minimum follow-up period of one year were searched in Pub Med/Medline, Embase, Cochrane Central Register of Controlled Trials published between 1980 and 2016.Each eligible study was assessed for risk of bias by using the Cochrane Risk of Bias Assessment tool. The outcomes assessed in this study included: all cause mortality, cardiovascular-related mortality, hospitalization for new or worsening heart failure, and adverse events. Subgroup analysis and publication bias were assessed. We used Mantel-Haenszel method for random-effects. Analysis was done using RevMan5.1™.This study was registered in PROSPERO as [PROSPERO 2016:CRD42016035597]. RESULT: Three trials with a total of 36,577 participants met the meta-analysis criteria. Pooled analysis showed that ivabradine is not effective in reducing cardiovascular deaths (OR: 1.02; CI:0.91-1.15,P = 0.74), all-cause mortality (OR:1.00; CI:0.91-1.10,P = 0.98), coronary revascularization (OR: 0.93, CI: 0.77-1.11, P = 0.41) and hospital admission for worsening of heart failure (OR: 0.94, CI: 0.71-1.25, P = 0.69). However, the drug was found to significantly increase adverse events: phosphenes (OR:7.77, CI: 4.4-14.6,P < 0.00001), blurred vision (OR:3.07,CI:2.18-4.32,P < 0.00001), symptomatic bradycardia (OR: 6.23, CI: 4.2-9.26, P < 0.00001), and atrial fibrillation (OR: 1.35, CI: 1.19-1.53, P < 0.0001). Subgroup analysis by duration of follow up on cardiovascular outcomes found that there is no difference in effect of ivabradine depending on the duration of follow up. There was no publication bias in reporting of included studies. CONCLUSION: This meta-analysis suggests that ivabradine is not effective in reducing cardiovascular-related morbidity and mortality unless used for specific conditions. On the contrary, the use of this drug was strongly associated with the onset of untoward and new adverse events. This finding strongly supports previous findings and further informs the rational and evidence-informed clinical use of ivabradine.

8 Review Aspirin Use Prior to Coronary Artery Bypass Grafting Surgery: a Systematic Review. 2017

Elbadawi, Ayman / Saad, Marwan / Nairooz, Ramez. ·Department of Medicine, Rochester General Hospital, Rochester, NY, USA. · Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt. · Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205,, USA. · Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205,, USA. ramez.nairooz@gmail.com. ·Curr Cardiol Rep · Pubmed #28213669.

ABSTRACT: PURPOSE OF REVIEW: Aspirin use before coronary artery bypass graft (CABG) surgery has been a puzzling question for years. Controversy existed regarding the overall benefits vs. risk of pre-operative aspirin use and was translated to conflicting guidelines from major societies. RECENT FINDINGS: Observational studies have suggested a reduced mortality with pre-operative aspirin use. A meta-analysis of randomized controlled trials showed increased risk of post-operative bleeding with aspirin, with no associated increased mortality risk. A recent large randomized controlled trial did not find a significant difference in bleeding risk or post-operative mortality with pre-CABG aspirin use. The results of available studies showed a beneficial effect with pre-CABG aspirin use by decreasing thrombotic complications and perioperative myocardial infarction, with an associated adverse risk of bleeding that did not affect mortality rates. Given overall benefit-risk assessment, we are in favor of pre-operative aspirin use in CABG patients.

9 Review Should blood pressure goal be individualized in hypertensive patients? 2017

Yannoutsos, Alexandra / Kheder-Elfekih, Rania / Halimi, Jean-Michel / Safar, Michel E / Blacher, Jacques. ·Unité Hypertension Artérielle, Prévention et Thérapeutique Cardiovasculaires, Centre de Diagnostic et de Thérapeutique, Université Paris Descartes, Hôpital Hôtel-Dieu, Paris, France. · Service de Néphrologie, Hôpital La Rabta, Tunis, Tunisia. · Service de Néphrologie-Iimmunologie Clinique, Université François-Rabelais, CHU de Tours, Hôpital Bretonneau, Tours EA 4245, France. · Unité Hypertension Artérielle, Prévention et Thérapeutique Cardiovasculaires, Centre de Diagnostic et de Thérapeutique, Université Paris Descartes, Hôpital Hôtel-Dieu, Paris, France. Electronic address: jacques.blacher@aphp.fr. ·Pharmacol Res · Pubmed #27919826.

ABSTRACT: The aim of the present review is to consider the clinical relevance of individualized blood pressure (BP) goal under treatment in hypertensive patients according to their age, comorbidities or established cardiovascular (CV) disease. Evidence from large-scale randomized trials to support a lower BP goal, as initially recommended by guidelines in high-risk hypertensive patients, were lacking. Recently, the randomized intervention SPRINT trial studied two treatment targets for systolic BP (120mm Hg versus 140mm Hg in the intensive and standard treatment group, respectively) among high-risk hypertensive patients, without diabetes and without a history of prior stroke. The trial was stopped prematurely owing to a significantly lower rate of the primary composite outcome and all-cause mortality in the intensive treatment group. Several practical questions have to be considered. First, using an automated measurement system at an office visit during the SPRINT protocol, while the patient was seated alone after 5min of quiet rest, may likely have resulted in lower BP values than would normally be obtained with the routine BP measurement. A target systolic of 120mm Hg in SRPINT trial may be thus equated to a target systolic BP of 130mm Hg in the real-world office setting. Second, careful and repeated examinations of SPRINT participants may have led to fewer adverse events (more frequent in the intensive treatment group) than that expected in the real-world setting. The safety profile of this intensive treatment approach should therefore remain a matter of concern in clinical practice, especially in elderly patients, in diabetic patients or with established CV or renal disease. Orthostatic hypotension should alert the clinician to withhold up titration. Third, beyond the question of BP goal, choice of antihypertensive medication and effective 24-h BP control are important to consider in the context of BP-lowering strategy. In particular, ambulatory BP measurements and during nighttime should be considered for an individualized hypertension care.

10 Review Meta-Analysis of the Duration of Dual Antiplatelet Therapy in Patients Treated With Second-Generation Drug-Eluting Stents. 2016

D'Ascenzo, Fabrizio / Moretti, Claudio / Bianco, Matteo / Bernardi, Alessandro / Taha, Salma / Cerrato, Enrico / Omedè, Pierluigi / Montefusco, Antonio / Frangieh, Antonio H / Lee, Cheol W / Campo, Gianluca / Chieffo, Alaide / Quadri, Giorgio / Pavani, Marco / Zoccai, Giuseppe B / Gaita, Fiorenzo / Park, Seung-Jung / Colombo, Antonio / Templin, Christian / Lüscher, Thomas F / Stone, Gregg W. ·Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy. Electronic address: meshmeshaya11@yahoo.com. · Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy. · Division of Cardiology, A.O.U San Luigi Gonzaga Hospital, Orbassano, Turin, Italy. · Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy; Division of Cardiology, Assuit University Hospital, Assuit, Egypt. · University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland. · Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. · Cardiology Department, Cardiovascular Institute, Azienda Ospedaliera Universitaria S.Anna, Ferrara, Italy; Cardiology Department, LTTA Center, Ferrara, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milán, Italia. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. · Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York. ·Am J Cardiol · Pubmed #27134057.

ABSTRACT: The purpose of the study was to evaluate the optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention, especially in the era of second-generation drug-eluting stents (DES). The work was conducted from November 2014 to April 2015. All randomized controlled trials comparing short (<12 months) versus long (≥12 months) DAPT in patients treated with second-generation DES were analyzed. Sensitivity analyses were performed for length of DAPT and type of DES. All-cause death was the primary end point, whereas cardiovascular death, myocardial infarction (MI), stent thrombosis (ST), and major bleeding were secondary end points. Results were pooled and compared with random-effect models and meta-regression analysis. Eight randomized controlled trials with 18,810 randomized patients were included. The studies compared 3 versus 12 months of DAPT (2 trials), 6 versus 12 months (3 trials), 6 versus 24 months (1 trial), 12 versus 24 months (1 trial), and 12 versus 30 months (1 trial). Comparing short versus long DAPT, there were no significant differences in all-cause death (odds ratio [OR] 0.87; 95% confidence interval [CI] 0.66 to 1.44), cardiovascular death (OR 0.95; 95% CI 0.65 to 1.37), and ST (OR 1.20; 95% CI 0.79 to 1.83), and no differences were present when considering everolimus-eluting and fast-release zotarolimus-eluting stents separately. Shorter DAPT was inferior to longer DAPT in preventing MI (OR 1.35; 95% CI 1.03 to 1.77). Conversely, major bleeding was reduced by shorter DAPT (OR 0.60; 95% CI 0.42 to 0.96). Baseline features did not influence these results in meta-regression analysis. In conclusion, DAPT for ≤6 months is reasonable for patients treated with everolimus-eluting and fast-release zotarolimus-eluting stents, with the benefit of less major bleeding at the cost of increased MI, with similar survival and ST rates. An individualized patient approach to DAPT duration should take into account the competing risks of bleeding and ischemic complications after present-generation DES.

11 Review Management of Coronary Artery Disease in South Asian Populations: Why and How to Prevent and Treat Differently. 2016

Ahmed, Emad / El-Menyar, Ayman. ·Department of Adult Cardiology and Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar Department of Cardiology, National Heart Institute, Cairo, Egypt. · Department of Clinical Medicine, Weill Cornell Medical School, Qatar Clinical Research, Trauma Section, Hamad Medical Corporation (HMC), Qatar Internal Medicine, Cardiology Section, Ahmed Maher Teaching Hospital, Egypt aymanco65@yahoo.com. ·Angiology · Pubmed #25969568.

ABSTRACT: The South Asian (SA) population constitutes one of the largest ethnic groups in the world. Several studies that compared host and migrant populations around the world indicate that SAs have a higher risk of developing cardiovascular disease (CVD) than their native-born counterparts. Herein, we review the literature to address the role of the screening tools, scoring systems, and guidelines for primary, secondary, and tertiary prevention in these populations. Management based on screening for the CVD risk factors in a high-risk population such as SAs can improve health care outcomes. There are many scoring tools for calculating 10-year CVD risk; however, each scoring system has its limitations in this particular ethnicity. Further work is needed to establish a unique scoring and guidelines in SAs.

12 Review Cardiovascular remodelling in coronary artery disease and heart failure. 2014

Heusch, Gerd / Libby, Peter / Gersh, Bernard / Yellon, Derek / Böhm, Michael / Lopaschuk, Gary / Opie, Lionel. ·Institut für Pathophysiologie, Universitätsklinikum Essen, Essen, Germany. · Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. · Division of Cardiovascular Diseases, Mayo Clinic, and Mayo Clinic College of Medicine, Rochester, MN, USA. · The Hatter Cardiovascular Institute, University College London, London, UK. · Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. · Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada. · Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa. Electronic address: lionel.opie@uct.ac.za. ·Lancet · Pubmed #24831770.

ABSTRACT: Remodelling is a response of the myocardium and vasculature to a range of potentially noxious haemodynamic, metabolic, and inflammatory stimuli. Remodelling is initially functional, compensatory, and adaptive but, when sustained, progresses to structural changes that become self-perpetuating and pathogenic. Remodelling involves responses not only of the cardiomyocytes, endothelium, and vascular smooth muscle cells, but also of interstitial cells and matrix. In this Review we characterise the remodelling processes in atherosclerosis, vascular and myocardial ischaemia-reperfusion injury, and heart failure, and we draw attention to potential avenues for innovative therapeutic approaches, including conditioning and metabolic strategies.

13 Review HIV and the heart: the impact of antiretroviral therapy: a global perspective. 2013

Thienemann, Friedrich / Sliwa, Karen / Rockstroh, Jürgen Kurt. ·Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Wolfson Pavilion, Room S3.03 Level 3, Anzio Road, Observatory, Cape Town 7925, South Africa. ·Eur Heart J · Pubmed #24126882.

ABSTRACT: From a global perspective, cardiovascular disease (CVD) in human immunodeficiency virus (HIV) may result from cardiac involvement upon presentation of opportunistic infections in the presence of advanced immunosuppression, be a consequence of HIV-induced immune activation or derive from antiretroviral therapy-associated dyslipidaemia and insulin resistance. Indeed, in developed countries with unlimited access to antiretroviral therapy CVD has become one of the major causes of death in HIV. Therefore, cardiovascular risk reduction and lifestyle modifications are essential and careful selection of the antiretroviral drugs according to underlying cardiovascular risk factors of great importance. In developing countries with delayed roll-out of antiretroviral therapy pericardial disease (often related to TB), HIV-associated cardiomyopathy, and HIV-associated pulmonary hypertension are the most common cardiac manifestations in HIV. In Africa, the epicentre of the HIV epidemic, dynamic socio-economic and lifestyle factors characteristic of epidemiological transition appear to have positioned the urban African community at the cross-roads between historically prevalent and 'new' forms of CVD, such as coronary artery disease. In this context, cardiovascular risk assessment of HIV-infected patients will become a critical element of care in developing countries similar to the developed world, and access to antiretroviral therapy with little or no impact on lipid and glucose metabolism of importance to reduce CVD in HIV.

14 Review Uncoupling protein 2 -866G/A and uncoupling protein 3 -55C/T polymorphisms in young South African Indian coronary artery disease patients. 2013

Phulukdaree, Alisa / Moodley, Devapregasan / Khan, Sajidah / Chuturgoon, Anil A. ·Discipline of Medical Biochemistry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, 4013 Durban, South Africa. ·Gene · Pubmed #23639961.

ABSTRACT: BACKGROUND: Uncoupling proteins (UCPs) 2 and 3 play an important role in the regulation of oxidative stress which contributes to chronic inflammation. Promoter polymorphisms of these genes have been linked to chronic diseases including heart disease and type II diabetes mellitus in several populations. This is the first investigation of the UCP2 -866G/A rs659366 and UCP3 -55C/T rs1800849 polymorphisms in young South African (SA) Indians with coronary artery disease (CAD). METHODS: A total of 300 subjects were recruited into this study of which 100 were SA Indian males with CAD, 100 age- (range 24-45 years), gender- and race-matched controls and 100 age-matched black SA males. The frequency of the UCP2 -866G/A and UPC3 -55C/T genotypes was assessed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). RESULTS: The heterozygous UCP2 -866G/A and homozygous UCP3 -55C/C genotypes occurred at highest frequency in CAD patients (60% and 64%, respectively) compared to SA Indian controls (52% and 63%) and SA Black controls (50% and 58%). The UCP2 -886G/A (OR=1.110; 95% CI=0.7438-1.655; p=0.6835) and UCP3 -55C/T (OR=0.788; 95% CI=0.482-1.289; p=0.382) polymorphisms did not influence the risk of CAD. The rare homozygous UCP3 -55T/T genotype was associated with highest fasting glucose (11.87 ± 3.7 mmol/L vs. C/C:6.11 ± 0.27 mmol/L and C/T:6.48 ± 0.57 mmol/L, p=0.0025), HbA1c (10.05 ± 2.57% vs. C/C:6.44 ± 0.21% and C/T:6.76 ± 0.35%, p=0.0006) and triglycerides (6.47 ± 1.7 mmol/L vs. C/C:2.33 ± 0.17 mmol/L and C/T:2.06 ± 0.25 mmol/L, p<0.0001) in CAD patients. CONCLUSION: The frequency of the UCP2 -866G/A and UCP3 -55C/T polymorphisms was similar in our SA Indian and SA Black groups. The presence of the UCP2 -866G/A and UCP3 -55C/T polymorphisms does not influence the risk of CAD in young South African Indian CAD patients.

15 Review Cardiac manifestations of HIV infection: an African perspective. 2009

Ntsekhe, Mpiko / Mayosi, Bongani M. ·Division of Cardiology at Groote Schuur Hospital, Cape Town, South Africa. mpiko.ntsekhe@uct.ac.za ·Nat Clin Pract Cardiovasc Med · Pubmed #19104517.

ABSTRACT: The pericardium, myocardium, coronary arteries and pulmonary arteries are the main targets for cardiac disease in people who are infected with HIV. Geography and access to highly active anti-retroviral therapy (HAART) have a major influence on which of these targets is affected. In sub-Saharan Africa, where tuberculosis is endemic and access to HAART is limited, the dominant forms of HIV-associated heart disease are pericardial tuberculosis and cardiomyopathy. However, in industrialized countries, where tuberculosis is rare and HAART is widely available, coronary artery disease is the main cause of death and disability in these patients. Observational data suggest that HAART, by preserving immune function, reduces the incidence of myopericardial disease and pulmonary hypertension. The result has been that, although optimal strategies to reduce vascular disease in this population continue to be sought and debated in industrialized nations, the focus of prevention and treatment strategies for HIV-related heart disease in developing countries has been to support the active campaigns to get universal access to HAART in the first place. Herein, we review the cardiac manifestations of HIV in sub-Saharan Africa.

16 Review Cardiac multi-detector CT: its unique contribution to cardiology practice. 2009

Zidan, Mamdouh / Nicoll, Rachel / Schmermund, Axel / Henein, Michael. ·Diagnostic Imaging Department, Alexandria Faculty of Medicine, Alexandria, Egypt. ·Int J Cardiol · Pubmed #18804875.

ABSTRACT: Medical practice is moving fast towards non-invasive and non-surgical disease management. While significant progress has been made with coronary artery disease prevention, MDCT stands as an ideal non-invasive tool for its progression. It accurately assesses both arterial lumen and wall disease. Although the main concern of current cardiology practice is the coronary stenotic disease, arterial wall calcification itself may significantly contribute to patients' symptoms. Thus, in addition to the beneficial use of MDCT in patients with mild to moderate risk for coronary disease, the unique information it provides on wall disease may assist the management of symptomatic patients with no flow-limiting lesions.

17 Review [Coronary artery fistula: case report and review of the literature]. 2009

Jerbi, S / Tarmiz, A / Fradi, S / Brahem, A / Beltaïfa, M / Mlika, S / Romdhani, N / Limayem, F / Ennabli, K. ·Service de chirurgie cardiovasculaire et thoracique, CHU Sahloul, route Ceinture, cité Sahloul, 4054 Sousse, Tunisie. jerbisofiane@yahoo.fr ·Ann Cardiol Angeiol (Paris) · Pubmed #18656849.

ABSTRACT: The coronary fistula is a rare abnormality making communicate a coronary artery with a cardiac cavity or a great vessel, so bypassing the myocardial capillary network. The majority of these fistulas are congenital but can nevertheless arise after a cardiac surgery. The right coronary artery and the left anterior descending coronary artery are mostly concerned. The circumflex coronary artery is rarely involved. The most frequent site of drainage is the right ventricle. We report the case of a 2-year-old child, brought by his parents for dyspnoea of effort. The diagnosis of coronary fistula was confirmed by the coronary angiography which showed an aneurysmal circumflex artery, draining into the right ventricle. The intervention was led under cardiopulmonary bypass. We proceeded to the longitudinal opening of the aneurysm then to the blindness of the fistula. The postoperative course was simple.

18 Review Electrocardiographic left ventricular hypertrophy with strain pattern: prevalence, mechanisms and prognostic implications. 2008

Ogah, O S / Oladapo, O O / Adebiyi, A A / Adebayo, A K / Aje, A / Ojji, D B / Salako, B L / Falase, A O. ·Department of Medicine, Federal Medical Centre, Idi-Aba, Abeokuta, Ogun State, Nigeria. ·Cardiovasc J Afr · Pubmed #18320088.

ABSTRACT: BACKGROUND: Electrocardiographic left ventricular hypertrophy with strain pattern has been documented as a marker for left ventricular hypertrophy. Its presence on the ECG of hypertensive patients is associated with a poor prognosis. This review was undertaken to report the prevalence, mechanism and prognostic implications of this ECG abnormality. MATERIALS AND METHODS: We conducted a comprehensive search of electronic databases to identify studies relating to the title of this review. The search criteria were related to the title. Two of the reviewers independently screened the searches. RESULTS: Results were described qualitatively. The data were not pooled because there were no randomised studies on the topic. The prevalence of ECG strain pattern ranged from 2.1 to 36%. The highest prevalence was reported before the era of good antihypertensive therapy. The sensitivity as a measure of left ventricular hypertrophy ranged from 3.8 to 50%, while the specificity was in the range of 89.8 to 100%. Strain pattern was associated with adverse cardiovascular risk factors as well as increased all-cause and CV morbidity and mortality. ST-segment depression and T-wave inversion on the ECG was recognised as the strongest marker of morbidity and mortality when ECG-LVH criteria were utilised for risk stratification in hypertensive subjects. CONCLUSION: Electrocardiographic strain pattern identifies cardiac patients at higher risk of cardiovascular-related as well as all-cause morbidity and mortality.

19 Clinical Trial The Effect of ACE I/D Polymorphisms Alone and With Concomitant Risk Factors on Coronary Artery Disease. 2018

Amara, Ahmed / Mrad, Meriem / Sayeh, Aicha / Lahideb, Dhaker / Layouni, Samy / Haggui, Abdeddayem / Fekih-Mrissa, Najiba / Haouala, Habib / Nsiri, Brahim. ·1 Laboratoire de Biologie Moléculaire, Service d'Hématologie, Hôpital Militaire de Tunis, Montfleury, Tunisie. · 2 Faculté des Sciences de Tunis, Université Tunis el Manar, Tunis, Tunisie. · 3 Service de Cardiologie, Hôpital Militaire de Tunis, Montfleury, Tunisie. · 4 Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie. · 5 Faculté de Pharmacie, Université de Monastir, Monastir, Tunisie. · 6 Académie Militaire Fondouk Jédid, Nabeul, Tunisie. ·Clin Appl Thromb Hemost · Pubmed #27895197.

ABSTRACT: BACKGROUND: Coronary artery disease (CAD), also known as atherosclerotic heart disease, is a leading cause of mortality and morbidity throughout the world. The role of insertion/deletion (I/D) polymorphisms of the angiotensin-converting enzyme (ACE) gene in the etiology of CAD remains to be more completely clarified. The aim of this study was to determine the role of the ACE I/D polymorphism in patients with CAD and to study the association together with traditional risk factors in assessing the risk of CAD. METHODS: Our study population included 145 Tunisian patients with symptomatic CAD and a control group of 300 people matched for age and sex. All participants in the study were genotyped for the ACE I/D polymorphisms obtained by polymerase chain reaction amplification on genomic DNA. RESULTS: Our analysis showed that the ACE D allele frequency ( P < 10 CONCLUSION: The ACE D allele may be predictive in individuals who may be at risk of developing CAD. Further investigations of these polymorphisms and their possible synergisms with traditional risk factors for CAD could help to ascertain better predictability for CAD susceptibility.

20 Clinical Trial Role of Proximal Optimization Technique Guided by Intravascular Ultrasound on Stent Expansion, Stent Symmetry Index, and Side-Branch Hemodynamics in Patients With Coronary Bifurcation Lesions. 2017

Hakim, Diaa / Chatterjee, Arka / Alli, Olusuen / Turner, Joshua / Sattar, Assad / Foin, Nicolas / Leesar, Massoud A. ·From the Division of Cardiology, University of Alabama at Birmingham (D.H., A.C., O.A., J.T., A.S., M.A.L.) · Suez Canal University, Ismailia, Egypt (D.H.) · and Medtech Research Theme, National Heart Centre Singapore and Duke-NUS Medical School (N.F.). ·Circ Cardiovasc Interv · Pubmed #29038225.

ABSTRACT: BACKGROUND: Bench models of coronary bifurcation lesions demonstrated that the proximal optimization technique (POT) expanded the stent and opened the side branch (SB). We investigated the role of POT guided by intravascular ultrasound on the main vessel (MV) stent expansion and SB fractional flow reserve (FFR) in patients with coronary bifurcation lesion. METHODS AND RESULTS: In 40 patients with coronary bifurcation lesion, 120 intravascular ultrasound examinations of the MV were performed at baseline, after MV stenting, and POT followed by 95 FFR measurements of the SB. In the proximal stent segment, stent volume index and minimum stent area were larger after POT versus MV stenting (9.2±3.4 versus 7.40±2.0 mm CONCLUSIONS: This is the first study of POT guided by intravascular ultrasound in patients with coronary bifurcation lesion, demonstrating that POT symmetrically expanded the proximal and bifurcation segments of the stent. After POT, SB FFR was <0.75 in a third of patients, which improved to >0.75 after SB dilation or SB stenting+final POT.

21 Clinical Trial The Association between Serum LDL Cholesterol and Genetic Variation in Chromosomal Locus 1p13.3 among Coronary Artery Disease Patients. 2015

Rizk, Nasser M / El-Menyar, Ayman / Egue, Huda / Souleman Wais, Idil / Mohamed Baluli, Hissa / Alali, Khalid / Farag, Fathi / Younes, Noura / Al Suwaidi, Jassim. ·Health Sciences Department, CAS, Qatar University, P.O. Box 2713, Doha, Qatar. · Cardiology Unit, Ahmed Maher Teaching Hospital, Cairo, Egypt ; Clinical Medicine, Weill Cornell Medical School, P.O. Box 24144, Doha, Qatar. · Cardiology Unit, Al-Emadi Hospital, P.O. Box 5804, Doha, Qatar. · Clinical Chemistry Department, Hamad Medical Corporation (HMC), P.O. Box 3050, Doha, Qatar. · Cardiology Department, Heart Hospital, Hamad Medical Corporation (HMC), P.O. Box 3050, Doha, Qatar. ·Biomed Res Int · Pubmed #25969834.

ABSTRACT: BACKGROUND: Several polymorphisms of a locus on chromosome 1p13.3 have a significant effect on low-density lipoprotein cholesterol (LDL-C), atherosclerosis, and acute coronary syndrome (ACS). METHODS: We aimed to investigate the association between rs599839, rs646776, and rs4970834 of locus 1p13.3 and serum LDL-C and severity of coronary artery stenosis in ACS patients. Genotyping of the rs599839, rs646776, and rs4970834 polymorphisms was performed on Arab patients undergoing coronary angiography for ACS. Patients were divided into group A (ACS with insignificant stenosis (<50%)) and group B (with significant stenosis (≥ 50%)). RESULTS: Patients carrying the minor G allele in rs599839 had significantly lower mean of LDL-C (2.58 versus 3.44 mM, P = 0.026) than homozygous A allele carriers (GG versus AA). Carriers of minor C allele in rs64776 had significantly higher mean of HDL-C (2.16 versus 1.36 mM, P = 0.004) than carriers of the T alleles (AA versus GG). The odd ratio and 95% confidence interval for dominant model for G allele carriers of rs599839 were 0.51 (0.30-0.92), P = 0.038, among patients with significant stenosis. CONCLUSIONS: Polymorphisms rs646776 and rs599839 of locus 1p13.3 were significantly associated with LDL-C and other lipid parameters. In addition, the G-allele carriers of variant rs599839 had a significant protective effect against the atherosclerosis.

22 Clinical Trial Mipomersen preferentially reduces small low-density lipoprotein particle number in patients with hypercholesterolemia. 2015

Santos, Raul D / Raal, Frederick J / Donovan, Joanne M / Cromwell, William C. ·Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, São Paulo, Brazil. Electronic address: raul.santos@incor.usp.br. · Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. · Genzyme Corporation, Cambridge, MA, USA. · Lipoprotein and Metabolic Disorders Institute, Raleigh, NC, USA; Hypertension and Vascular Disease Center, Wake Forest University School of Medicine, Winston-Salem, NC, USA. ·J Clin Lipidol · Pubmed #25911076.

ABSTRACT: BACKGROUND: Because of variability in lipoprotein cholesterol content, low-density lipoprotein (LDL) cholesterol frequently underrepresents or overrepresents the number of LDL particles. Mipomersen is an antisense oligonucleotide that reduces hepatic production of apolipoprotein B-100, the sole apolipoprotein of LDL. OBJECTIVE: To characterize the effects of mipomersen on lipoprotein particle numbers as well as subclass distribution using nuclear magnetic resonance (NMR) spectroscopy. METHODS: We compared the tertiary results for the direct measurement of LDL particle numbers by NMR among 4 placebo-controlled, phase 3 studies of mipomersen that had similar study designs but different patient populations: homozygous familial hypercholesterolemia (HoFH), severe hypercholesterolemia, heterozygous familial hypercholesterolemia with established coronary artery disease, or hypercholesterolemia with high risk for coronary heart disease (HC-CHD). RESULTS: HoFH patients had the highest median total LDL particles at baseline compared with HC-CHD patients, who had the lowest. At baseline, the HoFH population uniquely had a greater mean percentage of large LDL particles (placebo, 60.2%; mipomersen, 54.9%) compared with small LDL particles (placebo, 33.1%; mipomersen, 38.9%). In all 4 studies, mipomersen was associated with greater reductions from baseline in the concentrations of small LDL particles compared with those of large LDL particles, and both total LDL particles and small LDL particles were statistically significantly reduced. CONCLUSIONS: Mipomersen consistently reduced all LDL particle numbers and preferentially reduced the concentration of small LDL particles in all 4 phase 3 studies.

23 Clinical Trial Patients with end-stage renal disease: optimal diagnostic and prognostic performance of myocardial gated-SPECT, initial results. 2013

Amin, Amr / Younis, Gehan / El-Khatib, Mohamed / Ali, Ismail. ·Departments of Nuclear Medicine, Faculty of Medicine, Cairo University, Egypt. amramin67@gmail.com ·Nucl Med Commun · Pubmed #23407369.

ABSTRACT: PURPOSE: We investigated the role of Tc-99m sestamibi myocardial perfusion gated single photon emission computed tomography (GSPECT) in identifying those patients with end-stage renal disease (ESRD) in whom optimal diagnosis of coronary artery disease and prediction of cardiac events (CEs) could be achieved. METHODS: This was a prospective study that included 41 asymptomatic ESRD patients who had been undergoing hemodialysis for 12 months or less (22 men and 19 women) with restricted selection criteria (asymptomatic traditional risk). Tc-99m sestamibi GSPECT was carried out for all patients, whereas coronary angiography (Cath) was carried out only for abnormal GSPECT patients, with a 2-year follow-up for CEs. Twenty individuals matched for age, sex, and BMI formed the control group. RESULTS: Of the 41 ESRD patients, 13 showed abnormal GSPECT [11/13 with myocardial perfusion defects and left ventricular dysfunction in concordance with Cath and 2/13 with only left ventricular dysfunction (i.e. stunning)] compared with 1/20 in the control group. None of the patients with negative results experienced CEs (negative predictive value 100%); these patients had a 2-year CE-free survival rate of 100% compared with 46% for patients with positive results on GSPECT (P<0.0001; seven GSPECT-positive patients developed CEs during their follow-up). Patients with positive results were more frequently male (P<0.001), were significantly older (P=0.01), and had highly sensitive C-reactive protein levels (P=0.002). Abnormal GSPECT was the only independent predictor of CEs (95% confidence interval, 7.1-46.7; hazard ratio, 46.1; P<0.001). CONCLUSION: GSPECT exhibited optimum performance for coronary artery disease detection and risk stratification in asymptomatic ESRD patients during their first year of regular hemodialysis who were selected according to our modification of the traditional risk category. This may help in selecting suitable candidates for Cath, revascularization, and future renal transplantation.

24 Clinical Trial Antiplatelet effect of once- or twice-daily aspirin dosage in stable coronary artery disease patients with diabetes. 2010

Addad, Faouzi / Chakroun, Tahar / Elalamy, Ismail / Abderazek, Fatma / Chouchene, Saoussen / Dridi, Zohra / Gerotziafas, Gregoris T / Hatmi, Mohamed / Hassine, Mohsen / Gamra, Habib. ·Department of Cardiology A, Fattouma Bourguiba University Hospital, Monastir, Tunisia. faouzi.addad@rns.tn ·Int J Hematol · Pubmed #20725815.

ABSTRACT: The aim of this pilot study was to compare the effect of two different regimens of aspirin dosage on platelet of coronary artery disease (CAD) diabetic patients. Twenty-five CAD diabetic patients were included. Initially, all patients received aspirin 100 mg/day for 10 days. At day 10, aspirin antiplatelet effect was determined by measuring the collagen/epinephrine closure time (CT) 2 h after the last aspirin dosage and the next morning at 8 a.m.. The aspirin regimen was modified to 100 mg twice daily for patients showing a non-optimal platelet-inhibitory effect (CT < 298 s at 8 a.m.). Persistent high platelet reactivity (HPR) was defined by a CT < 160 s. During the 100 mg/day aspirin regimen, the prevalence of HPR at 8 a.m. was 48%, and only 7 patients (28%) had showed an optimal platelet-inhibitory effect. Bridging to the twice-daily regimen, the HPR was significantly reduced (p=0.025), and the optimal platelet-inhibitory effect was reached for 3 other patients. Our results showed that 100 mg aspirin twice-daily dosing rather than a once-daily dose significantly improves the aspirin effect on platelet of CAD diabetic patients. However, large prospective studies were needed to confirm whether this strategy will be clinically relevant and safe.

25 Clinical Trial Apolipoprotein B and non-high-density lipoprotein cholesterol are better risk markers for coronary artery disease than low-density lipoprotein cholesterol in hypertriglyceridemic metabolic syndrome patients. 2010

Boumaiza, Imen / Omezzine, Asma / Rejeb, Jihene / Rebhi, Lamia / Kalboussi, Nesrine / Ben Rejeb, Nabila / Nabli, Naoufel / Ben Abdelaziz, Ahmed / Boughazala, Essia / Bouslama, Ali. ·Department of Biochemistry, University Hospital Shaloul, Sousse, Tunisia. ·Metab Syndr Relat Disord · Pubmed #20715933.

ABSTRACT: BACKGROUND: Metabolic syndrome is highly prevalent in the general population. Small dense low-density lipoprotein (sd-LDL) particles have been considered as a risk marker in metabolic syndrome diagnosis. Apolipoprotein B (ApoB) concentration reflects the number of LDL particles and is closely associated with atherosclerosis. The aim of this study was to compare the associations of ApoB, non-high-density lipoprotein cholesterol (NHDL-C), and low-density lipoprotein cholesterol (LDL-C) with metabolic syndrome and its relationship with significant coronary stenosis (SCS) in a Tunisian population. METHODS: We enrolled 192 patients, who underwent coronary angiography. The body mass index, blood lipids, fasting glucose, insulin concentration, and blood pressure of every patient were measured. Metabolic syndrome was diagnosed according to the International Diabetes Federation criteria. RESULTS: The frequency of metabolic syndrome was 58.3%. The comparison of the lipidic parameters between subject with and without metabolic syndrome showed a significant increase in ApoB and NHDL-C but not in LDL-C. By considering triglyceride (TG) limits (TG ≤ 0.9 mmol/L and TG > 1.70 mmol/L), we noted no differences in ApoB, NHDL-C, and LDL-C between subjects with and without metabolic syndrome in triglyceridemia ≤0.9 mmol/L. In triglyceridemia >1.70 mmol/L, a significant increase in ApoB and NHDL-C, but not in LDL-C, was noted. These results seem to consolidate the probability of increased sd-LDL in hypertriglyceridemic metabolic syndrome subjects. Indeed, in our study the odds ratio (OR) of SCS associated with metabolic syndrome is 3.81 (P = 0.007) in the studied population. This risk increases to 8.70 (P = 0.026) in hypertriglyceridemic subjects and seems to be associated with ApoB and NHDL-C (OR = 1.87, P = 0.038; OR = 1.26, P = 0.048). CONCLUSIONS: This study suggests that ApoB and NHDL-C seem to be more correlated to SCS in metabolic syndrome with hypertriglyceridemia than LDL-C.