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Coronary Artery Disease: HELP
Articles from South Africa
Based on 48 articles published since 2008
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These are the 48 published articles about Coronary Artery Disease that originated from South Africa during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2
1 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.

2 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.

3 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.

4 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.

5 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.

6 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.

7 Clinical Trial Comparison between surrogate indices of insulin sensitivity and resistance, and the hyperinsulinaemic euglycaemic glucose clamp in urban South African blacks with and without coronary artery disease. 2010

Ntyintyane, Lucas / Panz, Vanessa / Raal, Frederick / Gill, Geoffrey. ·Carbohydrate and Lipid Metabolism Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa. ·Diab Vasc Dis Res · Pubmed #20382779.

ABSTRACT: Coronary artery disease (CAD) and diabetes mellitus (DM) are increasing in urban black South Africans during their transition from a rural to a western lifestyle. Insulin resistance is associated with CAD and DM. Fasting-based indices [homeostasis model assessment of insulin resistance (HOMA IR), log HOMA IR, and quantitative insulin sensitivity check index (QUICKI)] were calculated and their correlations with the glucose disposal rate (M) obtained from the hyperinsulinaemic euglycaemic glucose clamp were compared in 40 patients with CAD and 20 patients without CAD. Normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and DM were categorised using the oral glucose tolerance test. M and QUICKI were lower in patients with CAD (p<0.0001 and p<0.02); HOMA IR and log HOMA IR were higher (p<0.02). M and QUICKI decreased and HOMA IR and log HOMA IR increased progressively across the NGT, IGT and DM categories in patients with and without CAD. Glucose concentrations increased across the glucose tolerance categories in patients with CAD (p<0.001) and without CAD (p<0.01). Linear regression analysis revealed significant correlations between M and log HOMA IR (r=-0.3412; p<0.02) and QUICKI (r=0.4078; p<0.003), and between waist circumference (WC) and log HOMA IR (r=0.4637) and QUICKI (r=-0.4680) both p<0.001. We concluded that patients with CAD were more insulin resistant than patients without CAD. As glucose tolerance declined, insulin resistance worsened. Log HOMA IR and QUICKI were comparable to the hyperinsulinaemic euglycaemic glucose clamp and these surrogate indices provided a valid method to estimate insulin sensitivity/resistance in our patients.

8 Clinical Trial Repeat surgery for coronary artery bypass grafting: the role of the left thoracotomy approach. 2009

Harris, David G / Coetzee, Andre R / Augustyn, Johan T / Saaiman, Andre. ·Department of Cardiac Surgery and Cardiology, Kuils River Private Hospital, Cape Town, South Africa. drdharris@yahoo.co.uk ·Heart Surg Forum · Pubmed #19546070.

ABSTRACT: OBJECTIVE: Repeat coronary artery bypass surgery has increased risks compared with the first operation, including low cardiac output and injury to patent grafts. The left thoracotomy approach has been advocated specifically in patients with intact grafts of the left internal mammary artery (LIMA) to the left anterior descending coronary artery (LAD) needing lateral wall grafting. We have evaluated this technique in conjunction with an off-pump procedure in all patients. METHODS: There were 55 patients over an 8-year period, and 6 (10.9%) were female. The mean age was 63.2 years (range, 41-82 years), and the age at the time of the previous operation was 51.7 years (range, 31-69 years). Four patients (7.2%) underwent a third operation. Comorbidities were diabetes mellitus (25 patients, 45.5%), renal impairment (8 patients, 14.5%), calcified ascending aorta (9 patients, 16.4%), carotid disease (4 patients, 7.2%), and peripheral vascular disease (11 patients, 20.0%). Fifteen patients (27.2%) had previous coronary stents. Nine patients (16.4%) had a preoperative intra-aortic balloon pump. Predicted mortality (logistic EuroSCORE) was 14.2%. RESULTS: Forty-three patients (78.1%) had intact LIMA-to-LAD grafts. Twenty-two patients (40.0%) required a major posterolateral thoracotomy, and 33 patients (60.0%) had a minor thoracotomy. Thirteen patients (23.6%) had stents placed as a hybrid procedure during the same admission. Thirteen patients (23.6%) additionally underwent anterior wall grafting (LAD to the first marginal area). The LIMA was used in 7 patients where it had not been used before. There were 91 distal grafts (including 4 sequentials). We performed 54 venous grafts and 26 radial artery grafts. Twenty-one patients (38.1%) had 1 distal graft, 32 patients (58.1%) had 2 grafts, and 2 patients (3.6%) had 3 distal grafts performed (mean, 1.6 grafts/patient). The proximal graft site was the proximal descending aorta in 20.0% of the patients, the distal aorta in 67.5%, and the subclavian artery in 12.5%. In 10 patients (18.2%), the distal branches of the right coronary (posterior descendens or right posterolateral) were grafted. No patient required conversion to cardiopulmonary bypass or sternotomy. No patient needed an intra-aortic balloon pump postoperatively. The mean blood loss (24 hours) was 380 mL (range, 125-1100 mL), the mean ventilation time was 4.8 hours (range, 0-12 hours), the mean intensive care unit stay was 2.7 days (range, 2-8 days), and the mean hospital stay was 6.3 days (range, 5-20 days). There was 1 postoperative death (1.8% mortality). One late death occurred on follow-up. Four patients underwent cardiac catheterization for chest pain, and the grafts were shown to be open. CONCLUSION: The procedure is safe, especially in patients with intact LIMA-to-LAD grafts needing lateral and inferior wall revascularization. Multislice computed tomography scanning allows better preoperative planning, especially regarding the site of implantation of the proximal graft, allowing a less invasive incision. The off-pump technique preserves cardiac and pulmonary function. The in-hospital death rate (1.8%) compares very well with the EuroSCORE-predicted mortality (14.2%).

9 Article Cardiac Magnetic Resonance in Stable Coronary Artery Disease: Added Prognostic Value to Conventional Risk Profiling. 2018

Catalano, Oronzo / Moro, Guido / Mori, Alessia / Perotti, Mariarosa / Gualco, Alessandra / Frascaroli, Mauro / Pesarin, Clara / Napolitano, Carlo / Ntusi, Ntobeko A B / Priori, Silvia G. ·Division of Cardiology, Istituti Clinici Scientifici Maugeri, Pavia, Italy. · Division of Radiology, Istituti Clinici Scientifici Maugeri, Pavia, Italy. · Occupational Medicine Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy. · Molecular Cardiology, Istituti Clinici Scientifici Maugeri, Pavia, Italy. · Department of Medicine, Cape Universities Body Imaging Centre, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa. · Division of Cardiology, Molecular Cardiology, Istituti Clinici Scientifici Maugeri, Pavia, Italy. · University of Pavia, Pavia, Italy. ·Biomed Res Int · Pubmed #30035118.

ABSTRACT: Aims: Cardiovascular magnetic resonance Methods: We performed a single centre, observational prospective study that enrolled 465 CAD patients (80% males; 63±11 years), optimally treated with ACE-inhibitors/ARB, aspirin, and statins (76-85%). Assessments included conventional evaluation (clinical history, atherosclerosis RF, electrocardiography, and echocardiography) and a comprehensive CMR with LV dimensions/function, late gadolinium enhancement (LGE), and stress perfusion CMR (SPCMR). Results: During a median follow-up of 62 months (IQR 23-74) there were 50 deaths and 92 major adverse cardiovascular events (MACE). CMR variables improved multivariate model prediction power of mortality and MACE over traditional RF alone (F-test p<0.05 and p<0.001, respectively). LGE was an independent prognostic factor of mortality (hazard ratio [95% CI]: 3.4 [1.3-8.8]); moreover, LGE (3.3 [1.7-6.3]) and SPCMR (2.1 [1.4-3.2]) were the best predictors of MACE. Conclusion: LGE is an independent noninvasive marker of mortality in the long term in patients with stable CAD and optimized medical therapy. Furthermore, LGE and SPCMR independently predict MACE beyond conventional risk stratification.

10 Article Alcohol intake in relation to non-fatal and fatal coronary heart disease and stroke: EPIC-CVD case-cohort study. 2018

Ricci, Cristian / Wood, Angela / Muller, David / Gunter, Marc J / Agudo, Antonio / Boeing, Heiner / van der Schouw, Yvonne T / Warnakula, Samantha / Saieva, Calogero / Spijkerman, Annemieke / Sluijs, Ivonne / Tjønneland, Anne / Kyrø, Cecilie / Weiderpass, Elisabete / Kühn, Tilman / Kaaks, Rudolf / Sánchez, Maria-Jose / Panico, Salvatore / Agnoli, Claudia / Palli, Domenico / Tumino, Rosario / Engström, Gunnar / Melander, Olle / Bonnet, Fabrice / Boer, Jolanda M A / Key, Timothy J / Travis, Ruth C / Overvad, Kim / Verschuren, W M Monique / Quirós, J Ramón / Trichopoulou, Antonia / Papatesta, Eleni-Maria / Peppa, Eleni / Iribas, Conchi Moreno / Gavrila, Diana / Forslund, Ann-Sofie / Jansson, Jan-Håkan / Matullo, Giuseppe / Arriola, Larraitz / Freisling, Heinz / Lassale, Camille / Tzoulaki, Ioanna / Sharp, Stephen J / Forouhi, Nita G / Langenberg, Claudia / Saracci, Rodolfo / Sweeting, Michael / Brennan, Paul / Butterworth, Adam S / Riboli, Elio / Wareham, Nick J / Danesh, John / Ferrari, Pietro. ·Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France. · Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa. · Medical Research Council, British Heart Foundation, Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. · Department Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. · Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France. · Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona, Spain. · Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany. · Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands. · Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute, Florence, Italy. · Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands. · Danish Cancer Society Research Center, Copenhagen, Denmark. · Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway. · Genetic Epidemiology Group, Folkhälsan Research Center and Faculty of Medicine, University of Helsinki, Helsinki, Finland. · Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany. · Andaluzian School of Public Health, University of Granada, Granada, Spain. · Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain. · Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy. · Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. · Cancer Registry and Histopathology Department, Civic M P Arezzo Hospital, Ragusa, Italy. · Department of Clinical Sciences, Lund University, Malmö, Sweden. · Rennes University Hospital, Rennes, France. · Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. · Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Public Health Directorate of Asturias, Oviedo, Spain. · Hellenic Health Foundation, Athens, Greece. · WHO Collaborating Centre for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, University of Athens Medical School, Athens, Greece. · Navarre Public Health Institute, Institute for Health Research (IdiSNA), Pamplona, Spain. · Research Network in Health Services in Chronic Diseases (REDISSEC), Pamplona, Spain. · Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain. · Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden. · Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Department of Medicine, Umeå University, Umeå, Sweden. · Department Medical Sciences, University of Torino, Italian Institute for Genomic Medicine -IIGM/HuGeF, Torino, Italy. · Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, Gipuzkoa, Spain. · Department of Epidemiology and Public Health, University College London, London, UK. · Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece. · Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK. · Genetic Epidemiology Group, Genetics Section, International Agency for Research on Cancer, Lyon, France. ·BMJ · Pubmed #29844013.

ABSTRACT: OBJECTIVE: To investigate the association between alcohol consumption (at baseline and over lifetime) and non-fatal and fatal coronary heart disease (CHD) and stroke. DESIGN: Multicentre case-cohort study. SETTING: A study of cardiovascular disease (CVD) determinants within the European Prospective Investigation into Cancer and nutrition cohort (EPIC-CVD) from eight European countries. PARTICIPANTS: 32 549 participants without baseline CVD, comprised of incident CVD cases and a subcohort for comparison. MAIN OUTCOME MEASURES: Non-fatal and fatal CHD and stroke (including ischaemic and haemorrhagic stroke). RESULTS: There were 9307 non-fatal CHD events, 1699 fatal CHD, 5855 non-fatal stroke, and 733 fatal stroke. Baseline alcohol intake was inversely associated with non-fatal CHD, with a hazard ratio of 0.94 (95% confidence interval 0.92 to 0.96) per 12 g/day higher intake. There was a J shaped association between baseline alcohol intake and risk of fatal CHD. The hazard ratios were 0.83 (0.70 to 0.98), 0.65 (0.53 to 0.81), and 0.82 (0.65 to 1.03) for categories 5.0-14.9 g/day, 15.0-29.9 g/day, and 30.0-59.9 g/day of total alcohol intake, respectively, compared with 0.1-4.9 g/day. In contrast, hazard ratios for non-fatal and fatal stroke risk were 1.04 (1.02 to 1.07), and 1.05 (0.98 to 1.13) per 12 g/day increase in baseline alcohol intake, respectively, including broadly similar findings for ischaemic and haemorrhagic stroke. Associations with cardiovascular outcomes were broadly similar with average lifetime alcohol consumption as for baseline alcohol intake, and across the eight countries studied. There was no strong evidence for interactions of alcohol consumption with smoking status on the risk of CVD events. CONCLUSIONS: Alcohol intake was inversely associated with non-fatal CHD risk but positively associated with the risk of different stroke subtypes. This highlights the opposing associations of alcohol intake with different CVD types and strengthens the evidence for policies to reduce alcohol consumption.

11 Article Results, meta-analysis and a first evaluation of U 2018

Tsikas, Dimitrios / Hanff, Erik / Bollenbach, Alexander / Kruger, Ruan / Pham, Vu Vi / Chobanyan-Jürgens, Kristine / Wedekind, Dirk / Arndt, Tanja / Jörns, Anne / Berbée, Jimmy F P / Princen, Hans M G / Lücke, Thomas / Mariotti, François / Huneau, Jean-François / Ückert, Stefan / Frölich, Jürgen C / Lenzen, Sigurd. ·Core Unit Proteomics, Institute of Toxicology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany. tsikas.dimitros@mh-hannover.de. · Core Unit Proteomics, Institute of Toxicology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany. · Hypertension in Africa Research Team (HART), MRC Research Unit for Hypertension and Cardiovascular Disease, Department of Physiology, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa. · Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany. · Institute of Laboratory Animal Science, Hannover Medical School, Hannover, Germany. · Institute of Clinical Biochemistry, Hannover Medical School, Hannover, Germany. · Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands. · Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands. · Gaubius Laboratory, TNO Metabolic Health Research, Leiden, The Netherlands. · Department of Neuropaediatrics, University Children's Hospital, Ruhr University, Bochum, Germany. · UMR Physiologie de la Nutrition et du Comportement Alimentaire, AgroParisTech, INRA, Université Paris-Saclay, 75005, Paris, France. · Division of Surgery, Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany. ·Amino Acids · Pubmed #29728915.

ABSTRACT: We recently found that renal carbonic anhydrase (CA) is involved in the reabsorption of inorganic nitrite (NO

12 Article Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Predicts Hemodynamic Outcome In Humans With Coronary Artery Disease: Primary Results of the International Multicenter iFR GRADIENT Registry. 2018

Kikuta, Yuetsu / Cook, Christopher M / Sharp, Andrew S P / Salinas, Pablo / Kawase, Yoshiaki / Shiono, Yasutsugu / Giavarini, Alessandra / Nakayama, Masafumi / De Rosa, Salvatore / Sen, Sayan / Nijjer, Sukhjinder S / Al-Lamee, Rasha / Petraco, Ricardo / Malik, Iqbal S / Mikhail, Ghada W / Kaprielian, Raffi R / Wijntjens, Gilbert W M / Mori, Shinsuke / Hagikura, Arata / Mates, Martin / Mizuno, Atsushi / Hellig, Farrel / Lee, Kelvin / Janssens, Luc / Horie, Kazunori / Mohdnazri, Shah / Herrera, Raul / Krackhardt, Florian / Yamawaki, Masahiro / Davies, John / Takebayashi, Hideo / Keeble, Thomas / Haruta, Seiichi / Ribichini, Flavio / Indolfi, Ciro / Mayet, Jamil / Francis, Darrel P / Piek, Jan J / Di Mario, Carlo / Escaned, Javier / Matsuo, Hitoshi / Davies, Justin E. ·Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom; Fukuyama Cardiovascular Hospital, Fukuyama, Japan. · Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom. · Royal Devon and Exeter Hospital and University of Exeter, Exeter, United Kingdom. · Hospital Clínico San Carlos, Faculty of Medicine, Complutense University, Madrid, Spain. · Gifu Heart Center, Gifu, Japan. · Royal Brompton Hospital and Harefield Trust, London, United Kingdom. · Toda Central General Hospital, Toda, Japan. · Universita degli Studi Magna Græcia di Catanzaro, Catanzaro, Italy. · Academic Medical Centre, Amsterdam, the Netherlands. · Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan. · Fukuyama Cardiovascular Hospital, Fukuyama, Japan. · Na Homolce Hospital, Prague, Czech Republic. · St Luke's International Hospital, Tokyo, Japan. · Sunninghill Hospital, Johannesburg, University of Cape Town, South Africa. · United Lincolnshire Hospital, Lincoln, United Kingdom. · Imelda Hospital, Bonheiden, Belgium. · Sendai Kousei Hospital, Sendai, Japan. · Essex Cardiothoracic Centre, Basildon and Anglia Ruskin University, Chelmsford, Essex, United Kingdom. · Charité-Universitätsmedizin Campus Virchow, Berlin, Germany. · University of Verona, Verona, Italy. · Imperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom. Electronic address: justindavies@heart123.com. ·JACC Cardiovasc Interv · Pubmed #29673507.

ABSTRACT: OBJECTIVES: The authors sought to evaluate the accuracy of instantaneous wave-Free Ratio (iFR) pullback measurements to predict post-percutaneous coronary intervention (PCI) physiological outcomes, and to quantify how often iFR pullback alters PCI strategy in real-world clinical settings. BACKGROUND: In tandem and diffuse disease, offline analysis of continuous iFR pullback measurement has previously been demonstrated to accurately predict the physiological outcome of revascularization. However, the accuracy of the online analysis approach (iFR pullback) remains untested. METHODS: Angiographically intermediate tandem and/or diffuse lesions were entered into the international, multicenter iFR GRADIENT (Single instantaneous wave-Free Ratio Pullback Pre-Angioplasty Predicts Hemodynamic Outcome Without Wedge Pressure in Human Coronary Artery Disease) registry. Operators were asked to submit their procedural strategy after angiography alone and then after iFR-pullback measurement incorporating virtual PCI and post-PCI iFR prediction. PCI was performed according to standard clinical practice. Following PCI, repeat iFR assessment was performed and the actual versus predicted post-PCI iFR values compared. RESULTS: Mean age was 67 ± 12 years (81% male). Paired pre- and post-PCI iFR were measured in 128 patients (134 vessels). The predicted post-PCI iFR calculated online was 0.93 ± 0.05; observed actual iFR was 0.92 ± 0.06. iFR pullback predicted the post-PCI iFR outcome with 1.4 ± 0.5% error. In comparison to angiography-based decision making, after iFR pullback, decision making was changed in 52 (31%) of vessels; with a reduction in lesion number (-0.18 ± 0.05 lesion/vessel; p = 0.0001) and length (-4.4 ± 1.0 mm/vessel; p < 0.0001). CONCLUSIONS: In tandem and diffuse coronary disease, iFR pullback predicted the physiological outcome of PCI with a high degree of accuracy. Compared with angiography alone, availability of iFR pullback altered revascularization procedural planning in nearly one-third of patients.

13 Article Ischaemic heart disease and pregnancy: the tale of two stories. 2018

Matshela, Mamotabo R. ·University of KwaZulu-Natal, Durban; Mediclinic Heart Hospital, Pretoria, South Africa; London School of Economics and Political Science, London, UK. Email: mamotabomatsh@gmail.com. ·Cardiovasc J Afr · Pubmed #29583151.

ABSTRACT: Ischaemic heart disease (IHD) is presumed to be rare in pregnancy. Based on that assumption, patients go undiagnosed or undertreated. IHD in pregnancy frequently occurs as a result of an unusual aetiology, therefore each patient needs to be managed individually since each may present differently. This may pose challenges to the consulting clinician. Pregnancy itself is a risk factor for cardiovascular disease, due to its associated hypercoagulable state. From current reports, the prevalence of IHD in females is increasing due to lifestyle changes, including cigarette smoking, diabetes and stress. In our modern societies, women delay childbearing until they are older, allowing time for risk factors to cluster. Although presumed to be rare in pregnant women, IHD is currently estimated to occur three to four times more often during pregnancy in middle- and high-income women, warranting an extensive review highlighting cases of IHD in pregnancy.

14 Article Atherosclerotic disease is the predominant aetiology of acute coronary syndrome in young adults. 2018

Pillay, A K / Naidoo, D P. ·Department of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa. Email: asheganp@yahoo.com. · Department of Cardiology, University of KwaZulu-Natal, Durban, South Africa. ·Cardiovasc J Afr · Pubmed #29293260.

ABSTRACT: OBJECTIVES: Few studies have evaluated young adults in their third and fourth decades with coronary artery disease (CAD). This study evaluated the clinical and angiographic profile of young adults ( < 35 years) with CAD. METHODS: A 10-year (2003-2012) retrospective chart review was performed on patients less than 35 years diagnosed with CAD at Inkosi Albert Luthuli Central Hospital, Durban. RESULTS: Of the 100 patients who met the study criteria, the majority were male (90%), of Indian ethnicity (79%), and presented with acute coronary syndrome (93%). Smoking (82%), dyslipidaemia (79%) and dysglycaemia (75%) were the most prevalent risk factors. Almost half of the subjects (48%) met criteria for the metabolic syndrome. Angiographic findings revealed multi-vessel (42%), single-vessel (36%) and non-occlusive disease (20%); only two subjects had normal epicardial vessels. Disease severity was influenced by dyslipidaemia (p = 0.002) and positive family history (p = 0.002). Non-coronary aetiologies were identified in 19% of subjects. CONCLUSION: Atherosclerotic disease associated with risk-factor clustering was highly prevalent in young adults with CAD.

15 Article Coronary artery tuberculosis: An unusual case of sudden death. 2018

Peddle, Laura / Otto, Michael. ·Division of Forensic Medicine and Toxicology, Level 1, Falmouth Building, University of Cape Town Faculty of Health Sciences, Observatory, Cape Town 7925, South Africa. Electronic address: laura.peddle@uct.ac.za. · Division of Anatomical Pathology, Level 4, Falmouth Building, University of Cape Tow Faculty of Health Sciences, Observatory, Cape Town 7925, South Africa. Electronic address: marco.otto@outlook.com. ·Leg Med (Tokyo) · Pubmed #29175584.

ABSTRACT: -- No abstract --

16 Article A cross-sectional analysis of the association between age and gender and prescribed minimum benefit chronic disease list conditions among South Africans with concomitant hypertension, diabetes and dyslipidaemia. 2017

Burger, Johanita / Lubbe, Martie / Serfontein, Jan / Ellis, Suria. ·North-West University, Medicine Usage in South Africa (MUSA). · North-West University, Faculty Natural Sciences, Statistical Consultation. ·Afr Health Sci · Pubmed #29026381.

ABSTRACT: BACKGROUND: Prescribed Minimum Benefit Chronic Disease List (PMB CDL) conditions are a regulated list of conditions most common to South Africa. OBJECTIVES: To investigate the prevalence and association between PMB CDL conditions and age and gender among patients with concomitant hypertension, diabetes and dyslipidaemia. METHODS: The study population consisted of patients (n = 17 866) with a prescription containing at least one co-prescribed antilipemics, antihypertensive and antidiabetic (identified using the MIMS Desk Reference). ICD-10 codes on claims for PMB CDL conditions were counted. RESULTS: 39.5% of patients had a PMB CDL condition. Women had higher odds for hypothyroidism (OR 6.30, 95% CI; 5.52, 7.19, CONCLUSION: Hypothyroidism was an important discriminating factor for co-morbidity in women with concomitant hypertension, diabetes and dyslipidaemia, in particular with cardiovascular disease.

17 Article Periprocedural myocardial infarction during percutaneous coronary intervention in an academic tertiary centre in Johannesburg. 2017

Tsabedze, Nqoba / McCutcheon, Keir / Mkhwanazi, Lancelot / Garda, Riaz / Vachiat, Ahmed / Ramjee, Rohan / Moosa, Jameel / Maluleke, Themba / Mukeshimana, Gloria / Karolia, Saffiyyah / Mpanya, Dineo / Manga, Pravin. ·Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa. Electronic address: Nqoba.Tsabedze@wits.ac.za. · Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa. · Division of Diagnostic Radiography, Department of Radiation Sciences, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa. · Division of Nuclear Medicine and Molecular Imaging, Department of Radiation Sciences, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa. ·Int J Cardiol · Pubmed #28062147.

ABSTRACT: BACKGROUND: Percutaneous coronary intervention (PCI) is effective therapy for significant atherosclerotic coronary artery disease. Despite medical and technological advances in PCI, periprocedural myocardial infarction (PMI) remains a common complication. The frequency and factors associated with PMI have been well investigated in the developed world, yet there is a paucity of data from the developing world, especially Sub-Saharan Africa. METHODS: We prospectively enrolled 153 adult patients undergoing PCI at the Charlotte Maxeke Johannesburg Academic Hospital from the 1st of February 2014 to 31st October 2014. Periprocedural Creatinine Kinase-MB and hs-Troponin I were routinely measured before PCI and at 16-24h post-procedure. The third universal definition of myocardial infarction was used to define a PMI event. RESULTS: 152 participants met the inclusion criteria and were analysed for PMI. 70.4% participants were male. The mean age was 58.8 (SD 10.9) years old. Sixteen (10.5%) participants fulfilled the criteria for PMI. Side branch pinching with preserved TIMI III flow was noted in 62.5% of PMI cases. Duration of procedure (P=0.007), right coronary artery intervention (p=0.042) and total stent length (p=0.045) were independently associated with PMI. CONCLUSION: PMI occurred in 10.5% of cases undergoing PCI. This is consistent with the prevalence of PMI internationally. Larger multicentre studies are required in our demographic region to further define relevant predictors and outcomes associated with PMI.

18 Article Influence of coronary artery disease and subclinical atherosclerosis related polymorphisms on the risk of atherosclerosis in rheumatoid arthritis. 2017

López-Mejías, Raquel / Corrales, Alfonso / Vicente, Esther / Robustillo-Villarino, Montserrat / González-Juanatey, Carlos / Llorca, Javier / Genre, Fernanda / Remuzgo-Martínez, Sara / Dierssen-Sotos, Trinidad / Miranda-Filloy, José A / Huaranga, Marco A Ramírez / Pina, Trinitario / Blanco, Ricardo / Alegre-Sancho, Juan J / Raya, Enrique / Mijares, Verónica / Ubilla, Begoña / Ferraz-Amaro, Iván / Gómez-Vaquero, Carmen / Balsa, Alejandro / López-Longo, Francisco J / Carreira, Patricia / González-Álvaro, Isidoro / Ocejo-Vinyals, J Gonzalo / Rodríguez-Rodríguez, Luis / Fernández-Gutiérrez, Benjamín / Castañeda, Santos / Martín, Javier / González-Gay, Miguel A. ·Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Department, IDIVAL, Santander, Spain. · Rheumatology Department, Hospital Universitario la Princesa, IIS-IP, Madrid, Spain. · Rheumatology Department, Hospital Universitario Doctor Peset, Valencia, Spain. · Cardiology Department, Hospital Lucus Augusti, Lugo, Spain. · Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Santander, Spain. · Division of Rheumatology, Hospital Universitario Lucus Augusti, Lugo, Spain. · Rheumatology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain. · Rheumatology Department, Hospital Clínico San Cecilio, Granada, Spain. · Rheumatology Division, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain. · Department of Rheumatology, Hospital Universitario Bellvitge, Barcelona, Spain. · Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain. · Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. · Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain. · Immunology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain. · Department of Rheumatology, Hospital Clínico San Carlos, Madrid, Spain. · Instituto de Parasitología y Biomedicina 'López-Neyra', CSIC, PTS Granada, Granada, Spain. · School of Medicine, University of Cantabria, Santander, Spain. · Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. ·Sci Rep · Pubmed #28059143.

ABSTRACT: A genetic component influences the development of atherosclerosis in the general population and also in rheumatoid arthritis (RA). However, genetic polymorphisms associated with atherosclerosis in the general population are not always involved in the development of cardiovascular disease (CVD) in RA. Accordingly, a study in North-American RA patients did not show the association reported in the general population of coronary artery disease with a series of relevant polymorphisms (TCF21, LPA, HHIPL1, RASD1-PEMT, MRPS6, CYP17A1-CNNM2-NT5C2, SMG6-SRR, PHACTR1, WDR12 and COL4A1-COL4A2). In the present study, we assessed the potential association of these polymorphisms with CVD in Southern European RA patients. We also assessed if polymorphisms implicated in the increased risk of subclinical atherosclerosis in non-rheumatic Caucasians (ZHX2, PINX1, SLC17A4, LRIG1 and LDLR) may influence the risk for CVD in RA. 2,609 Spanish patients were genotyped by TaqMan assays. Subclinical atherosclerosis was determined in 1,258 of them by carotid ultrasonography (assessment of carotid intima media thickness and presence/absence of carotid plaques). No statistically significant differences were found when each polymorphism was assessed according to the presence/absence of cardiovascular events and subclinical atherosclerosis, after adjustment for potential confounder factors. Our results do not show an association between these 15 polymorphisms and atherosclerosis in RA.

19 Article Comparison of Outcomes of Staged Complete Revascularization Versus Culprit Lesion-Only Revascularization for ST-Elevation Myocardial Infarction and Multivessel Coronary Artery Disease. 2017

Marino, Marcello / Crimi, Gabriele / Leonardi, Sergio / Ferlini, Marco / Repetto, Alessandra / Camporotondo, Rita / Demarchi, Andrea / De Pascali, Ilaria / Falcinella, Francesca / Oltrona Visconti, Luigi / De Servi, Stefano / Ferrario, Maurizio / De Ferrari, Gaetano Maria / Gnecchi, Massimiliano. ·Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy. · Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. · Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Coronary Care Unit and Laboratory for Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. · Coronary Care Unit and Laboratory for Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. · Department of Molecular Medicine, University of Pavia, Pavia, Italy; Coronary Care Unit and Laboratory for Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. · Department of Molecular Medicine, University of Pavia, Pavia, Italy; Coronary Care Unit and Laboratory for Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: g.deferrari@smatteo.pv.it. · Department of Molecular Medicine, University of Pavia, Pavia, Italy; Coronary Care Unit and Laboratory for Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Medicine, University of Cape Town, Cape Town, South Africa. ·Am J Cardiol · Pubmed #28007297.

ABSTRACT: The management of noninfarct-related arteries in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) is still debated. We evaluated the prognostic impact of staged complete revascularization with percutaneous coronary intervention (PCI) in STEMI patients with MVD admitted to our hospital from 2005 to 2013. Patients undergoing staged complete revascularization (n = 300) were compared with 1:1 propensity score-matched patients with culprit lesion-only treatment (n = 300). We considered a composite primary end point of all-cause death, myocardial infarction, and urgent PCI. Secondary end points included components of the primary, cardiovascular death, any PCI excluding staged PCI. We also performed an analysis including only patients surviving at least 5 days. The median follow-up was 553 days. The primary end point occurred in 10.3% of patients in the staged complete revascularization group and in 16.3% of patients in the culprit lesion-only group (hazard ratio 0.61, 95% CI 0.38 to 0.95, p = 0.031). Although this difference was no longer significant when considering only the survivors at day 5, all-cause and cardiovascular mortalities were still reduced in the staged complete revascularization group. Complete revascularization was associated with a better outcome (hazard ratio 0.35, 95% CI 0.17 to 0.63, p = 0.005) if performed within 30 days of STEMI. In conclusion, compared with culprit lesion-only revascularization, in STEMI patients with MVD undergoing primary PCI, an approach of staged complete revascularization was associated with a better outcome.

20 Article Utility of adenosine stress perfusion CMR to assess paediatric coronary artery disease. 2017

Ntsinjana, Hopewell N / Tann, Oliver / Hughes, Marina / Derrick, Graham / Secinaro, Aurelio / Schievano, Silvia / Muthurangu, Vivek / Taylor, Andrew M. ·Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK. · Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK. · Deparetment of Paediatrics, Paediatric Cardiology Division, CH Baragwanath Academic Hospital and University of the Wiwatersrand, Johannesburg, South Africa. · Department of Imaging, Bambino Gesù Children's Hospital, Rome, Italy. ·Eur Heart J Cardiovasc Imaging · Pubmed #27461210.

ABSTRACT: Aims: Cardiovascular magnetic resonance (CMR), using adenosine stress perfusion and late-gadolinium enhancement (LGE), is becoming the 'gold standard' non-invasive imaging modality in the assessment of adults with coronary artery disease (CAD). However, despite its proved feasibility in paediatric patients, clinical utility has not been demonstrated. Therefore, this study aims to establish the role of adenosine stress perfusion CMR as a screening test in paediatric patients with acquired or congenital CAD. Methods and results: A total of 58 paediatric patients underwent 61 consecutive clinically indicated coronary artery assessments for diagnostic and clinical decision-making purposes. The diagnosis was based on X-ray or computed tomography coronary angiography for anatomy, adenosine stress CMR imaging for myocardial perfusion and LGE for tissue characterization. Two studies were aborted because of unwanted side effects of adenosine stress, thus 59 studies were completed in 56 patients [median age 14.1 years (interquartile range 10.9-16.2)]. When compared with coronary anatomical imaging, adenosine stress perfusion CMR performed as follows: sensitivity 100% (95% confidence interval, CI: 71.6-100%), specificity 98% (95% CI: 86.7-99.9%), positive predictive value (PPV) 92.9% (95% CI: 64.2-99.6%), and negative predictive value 100% (95% CI: 89.9-100%). Conclusion: In paediatric CAD, adenosine stress perfusion CMR imaging is adequate as an initial, non-invasive screening test for the identification of significant coronary artery lesions, with anatomical imaging used to confirm the extent of the culprit lesion.

21 Article Depression Symptoms Facilitated Fibrinolytic Dysregulation and Future Coronary Artery Disease Risk in a Black Male Cohort: The Sympathetic Activity and Ambulatory Blood Pressure in Africans Study. 2017

Malan, Leoné / Mashele, Nyiko / Malan, Nicolaas T / Harvey, Brian H / Potgieter, Johan C / Van Rooyen, Johannes M. ·Leoné Malan, RN, PhD Professor, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa. Nyiko Mashele, PhD PhD Student, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa. Nicolaas T. Malan, DSc Research Professor, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa. Brian H. Harvey, PhD Professor, Center of Excellence for Pharmaceutical Sciences, Division of Pharmacology, School for Pharmacy, North-West University, Potchefstroom Campus, South Africa. Johan C. Potgieter, PhD Professor, School for Psychosocial Behavioral Sciences, North-West University, Potchefstroom Campus, South Africa. Johannes M. Van Rooyen, DSc Professor, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa. ·J Cardiovasc Nurs · Pubmed #27428354.

ABSTRACT: BACKGROUND: Hypercoagulation is associated with coronary artery disease (CAD). Whether depression symptoms dysregulate inflammatory and hemostatic markers in an African cohort is not known; therefore, we assessed the relationship between depressive symptoms and inflammatory and hemostatic markers as potential CAD risk markers in an African sex cohort. MATERIAL AND METHODS: We included 181 black African urban-dwelling teachers (88 men, 93 women; aged 25-60 years) from the Sympathetic Activity and Ambulatory Blood Pressure in Africans Study. The Patient Health Questionnaire was used to assess depressive symptoms. Fasting plasma concentrations of C-reactive protein, fibrinogen, D-dimer, plasminogen activator inhibitor-1 (PAI-1) and 24-hour blood pressure measures were obtained. RESULTS: Moderately severe depression symptom status was similar in the black sex groups. Both sex groups showed a mean hypertensive state and low-grade inflammation (C-reactive protein > 3 mg/L). Levels of PAI-1 were higher in depressed men, whereas D-dimer levels were lower in depressed women when considering concomitant confounders. In black men only, depressive symptoms were associated with levels of PAI-1 (adj. R = 0.12; β = .22 [95% confidence interval, .0-.44]; P = .04) and D-dimer (adj. R = 0.12; β = .28 [95% confidence interval, .08-.48]; P = .01), independent of confounders. CONCLUSION: In black men, depression symptoms accompanied by a mean hypertensive status may up-regulate inflammatory and thrombotic processes. Depression symptoms in black men facilitated hypercoagulation or fibrinolytic dysregulation and potentially increased their CAD risk. Early screening of fibrinolytic markers and for the presence of depressive symptoms is recommended.

22 Article Infarct size following complete revascularization in patients presenting with STEMI: a comparison of immediate and staged in-hospital non-infarct related artery PCI subgroups in the CvLPRIT study. 2016

Khan, Jamal N / Nazir, Sheraz A / Greenwood, John P / Dalby, Miles / Curzen, Nick / Hetherington, Simon / Kelly, Damian J / Blackman, Daniel / Ring, Arne / Peebles, Charles / Wong, Joyce / Sasikaran, Thiagarajah / Flather, Marcus / Swanton, Howard / Gershlick, Anthony H / McCann, Gerry P. ·Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK. · Multidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. · Harefield Hospital, Royal Brompton and Harefield Foundation Trust, NIHR Cardiovascular Biomedical Research Unit, Middlesex, UK. · University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK. · Kettering General Hospital, Kettering, NN16 8UZ, UK. · Royal Derby Hospital, Derby, UK. · Leicester Clinical Trials Unit, University of Leicester, UK and Department of Mathematical Statistics and Actuarial Science, University of Leicester, University of the Free State, Bloemfontein, South Africa. · Norfolk and Norwich University Hospitals NHS Foundation Trust and Norwich Medical School, University of East Anglia, Norwich, UK. · The Heart Hospital, University College London Hospitals, London, UK. · Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK. gpm12@le.ac.uk. ·J Cardiovasc Magn Reson · Pubmed #27842548.

ABSTRACT: BACKGROUND: The CvLPRIT study showed a trend for improved clinical outcomes in the complete revascularisation (CR) group in those treated with an immediate, as opposed to staged in-hospital approach in patients with multivessel coronary disease undergoing primary percutaneous intervention (PPCI). We aimed to assess infarct size and left ventricular function in patients undergoing immediate compared with staged CR for multivessel disease at PPCI. METHODS: The Cardiovascular Magnetic Resonance (CMR) substudy of CvLPRIT was a multicentre, prospective, randomized, open label, blinded endpoint trial in PPCI patients with multivessel disease. These data refer to a post-hoc analysis in 93 patients randomized to the CR arm (63 immediate, 30 staged) who completed a pre-discharge CMR scan (median 2 and 4 days respectively) after PPCI. The decision to stage non-IRA revascularization was at the discretion of the treating interventional cardiologist. RESULTS: Patients treated with a staged approach had more visible thrombus (26/30 vs. 31/62, p = 0.001), higher SYNTAX score in the IRA (9.5, 8-16 vs. 8.0, 5.5-11, p = 0.04) and a greater incidence of no-reflow (23.3 % vs. 1.6 % p < 0.001) than those treated with immediate CR. After adjustment for confounders, staged patients had larger infarct size (19.7 % [11.7-37.6] vs. 11.6 % [6.8-18.2] of LV Mass, p = 0.012) and lower ejection fraction (42.2 ± 10 % vs. 47.4 ± 9 %, p = 0.019) compared with immediate CR. CONCLUSIONS: Of patients randomized to CR in the CMR substudy of CvLPRIT, those in whom the operator chose to stage revascularization had larger infarct size and lower ejection fraction, which persisted after adjusting for important covariates than those who underwent immediate CR. Prospective randomized trials are needed to assess whether immediate CR results in better clinical outcomes than staged CR. TRIAL REGISTRATION: ISRCTN70913605 , Registered 24th February 2011.

23 Article Sirtuin 1 rs1467568 and rs7895833 in South African Indians with early-onset coronary artery disease. 2016

Ramkaran, Prithiksha / Phulukdaree, Alisa / Khan, Sajidah / Moodley, Devapregasan / Chuturgoon, Anil A. ·Discipline of Medical Biochemistry and Chemical Pathology, University of KwaZulu-Natal, Durban, South Africa. · Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa. · Department of Cardiology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. · Discipline of Medical Biochemistry and Chemical Pathology, University of KwaZulu-Natal, Durban, South Africa. Email: chutur@ukzn.ac.za. ·Cardiovasc J Afr · Pubmed #27841908.

ABSTRACT: BACKGROUND: Sirtuin 1 (SIRT1), a class III histone deacetylase, has been identified as a candidate molecule affecting the epigenetic mechanisms of cardiovascular disease (CVD). Previous studies have shown that some SIRT1 single-nucleotide polymorphisms (SNPs) are associated with body mass index, diabetes, blood pressure, cholesterol metabolism and coronary artery calcification. We investigated two A>G SIRT1 SNPs, rs1467568 and rs7895833, in young South African (SA) Indians with coronary artery disease (CAD) and compared them to Indian and black controls. METHODS: For rs1467568, a total of 287 subjects were recruited into this study (104 CAD patients, 99 age-, gender- and race-matched controls, and 84 age- and gender-matched black controls). For rs7895833, a total of 281 subjects were recruited into this study (100 CAD patients, 99 age-, gender- and race-matched controls, and 82 age- and gender-matched black controls). All patients were male, of Indian ethnicity, stable CAD confirmed on angiography, mean age 37.5 years; range 24-45. All subjects were genotyped using TaqMan SNP genotyping assays. RESULTS: The variant allele for both SNPs was found at a higher frequency in the total Indian group compared to the total black population (rs1467568: 41 vs 18.5%, respectively, p < 0.0001, OR = 3.190, 95% CI: 2.058-40943; and rs7895833: 41 vs 22%, respectively, p < 0.0001, OR = 2.466, 95% CI: 1.620- 3.755). Indian controls presented with a higher frequency for both SNPs compared to black controls (rs1467568: 40 vs 18.5%, respectively, p < 0.0001, OR = 2.996, 95% CI: 1.850- 4.853; and rs7895833: 41 vs 22%, respectively, p < 0.0001, OR = 2.513, 95% CI: 1.578-4.004). No difference was seen in the distribution of both SNPs between CAD patients and either control group. We did not observe any association between the SNPs and clinical parameters in CAD patients and controls. CONCLUSION: Both SNP variant alleles occurred more frequently in SA Indians than in SA blacks. A larger study group and further analysis is required to assess whether these SIRT1 SNPs may serve as risk factors that contribute to Indians developing early-onset CAD.

24 Article Prevention of Stroke with Ticagrelor in Patients with Prior Myocardial Infarction: Insights from PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54). 2016

Bonaca, Marc P / Goto, Shinya / Bhatt, Deepak L / Steg, P Gabriel / Storey, Robert F / Cohen, Marc / Goodrich, Erica / Mauri, Laura / Ophuis, Ton Oude / Ruda, Mikhail / Špinar, Jindřich / Seung, Ki-Bae / Hu, Dayi / Dalby, Anthony J / Jensen, Eva / Held, Peter / Morrow, David A / Braunwald, Eugene / Sabatine, Marc S. ·From TIMI Study Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.P.B., D.L.B., E.G., D.A.M., E.B., M.S.) · Tokai University School of Medicine · Institute of Medical Science, Isehara, Japan (S.G.) · FACT, DHU-FIRE INSERM Unité 1148, Assistance Publique-Hôpitaux de Paris and Université Paris Diderot, Paris, France, and NHLI Imperial College, Royal Brompton Hospital, London, UK (P.G.S.) · University of Sheffield, United Kingdom (R.F.S.) · Division of Cardiology, Newark Beth Israel Medical Center, Rutgers-New Jersey Medical School, Newark (M.C.) · Brigham and Women's Hospital and Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (L.M.) · CWZ Hospital, Nijmegen, The Netherlands (T.O.O.) · Cardiology Research and Production complex MH RF, Moscow, Russia (M.R.) · Internal Cardiology Department, University Hospital and Medical faculty, Brno, Czech Republic (J.S.) · Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea (K.-B.S.) · Heart Institute, Intervention Center, People Hospital of Peking University, China (D.H.) · Life Fourways Hospital, Randburg, South Africa (A.J.D.) · and AstraZeneca, Mölndal, Sweden (E.J., P.H.). ·Circulation · Pubmed #27576775.

ABSTRACT: BACKGROUND: In the PEGASUS-TIMI 54 trial (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54), ticagrelor reduced the risk of major adverse cardiovascular events when added to low-dose aspirin in stable patients with prior myocardial infarction, resulting in the approval of ticagrelor 60 mg twice daily for long-term secondary prevention. We investigated the incidence of stroke, outcomes after stroke, and the efficacy of ticagrelor focusing on the approved 60 mg twice daily dose for reducing stroke in this population. METHODS: Patients were followed for a median of 33 months. Stroke events were adjudicated by a central committee. Data from similar trials were combined using meta-analysis. RESULTS: Of 14 112 patients randomly assigned to placebo or ticagrelor 60 mg, 213 experienced a stroke; 85% of these strokes were ischemic. A total of 18% of strokes were fatal and another 15% led to either moderate or severe disability at 30 days. Ticagrelor significantly reduced the risk of stroke (hazard ratio, 0.75; 95% confidence interval, 0.57-0.98; P=0.034), driven by a reduction in ischemic stroke (hazard ratio, 0.76; 95% confidence interval, 0.56-1.02). Hemorrhagic stroke occurred in 9 patients on placebo and 8 patients on ticagrelor. A meta-analysis across 4 placebo-controlled trials of more intensive antiplatelet therapy in 44 816 patients with coronary disease confirmed a marked reduction in ischemic stroke (hazard ratio, 0.66; 95% confidence interval, 0.54-0.81; P=0.0001). CONCLUSIONS: High-risk patients with prior myocardial infarction are at risk for stroke, approximately one-third of which are fatal or lead to moderate-to-severe disability. The addition of ticagrelor 60 mg twice daily significantly reduced this risk without an excess of hemorrhagic stroke but with more major bleeding. In high-risk patients with coronary disease, more intensive antiplatelet therapy should be considered not only to reduce the risk of coronary events, but also of stroke. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique Identifier: NCT01225562.

25 Article The Arg72 variant of the p53 functional polymorphism (rs1042522) is associated with coronary artery disease in young South Africans of Indian ancestry. 2016

Khan, Sajidah / Phulukdaree, Alisa / Ramkaran, Prithiksha / Moodley, Devapregasan / Chuturgoon, Anil A. ·Department of Cardiology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. · Discipline of Medical Biochemistry and Chemical Pathology, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa. · Discipline of Medical Biochemistry and Chemical Pathology, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa. Electronic address: CHUTUR@ukzn.ac.za. ·Gene · Pubmed #27436625.

ABSTRACT: BACKGROUND AND AIM: Tumor protein p53 (p53), classically referred to as a tumor suppressor gene, is involved in cell cycle regulation and may be related to atherosclerosis by affecting smooth muscle cell proliferation, a feature of atherogenesis. A polymorphism at codon 72 (rs1042522) results in functional variability and hence plays a role in the pathophysiology of coronary artery disease (CAD). This polymorphism has been well established for its role in cancer and has only recently been investigated in CAD. Limited data is available on South Africans (SA) of Indian ancestry. We examined associations of this polymorphism and clinical markers in a cohort of young SA Indian CAD patients. METHODS: A total of 284 subjects were recruited into this study which included 100 CAD patients (diagnosed on angiography, mean age 37.5, range 24-45years), 100 age- and sex-matched Indian controls and 84 age- and sex-matched Black controls. Polymorphic variants were assessed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Data for clinical markers were obtained from pathology reports. RESULTS: Genotype distribution differed significantly between CAD patients and Indian controls (Pro/Pro, Pro/Arg, Arg/Arg: 24%, 48%, 28% vs. 30%, 61%, 9% respectively, p=0.0025). There was a significant genotype distribution between Indian and Black controls (Pro/Pro, Pro/Arg, Arg/Arg: 30%, 61%, 9% vs. 45.2% 40.5%, 14.3% respectively, p=0.0212). A significantly higher frequency of the p53 Arg72 allele was found in CAD patients compared to controls (52% vs. 39.5% respectively, p=0.0159). The variant allele was slightly higher in Indian controls (39.5%) compared to Black controls (34.5%), but this did not reach statistical significance (p=0.3324). The levels of total cholesterol, LDL, HDL, triglycerides, fasting glucose, fasting insulin and %HbA1c were not significantly influenced by the p53 genotypic variants. CONCLUSION: Although the p53 codon 72 SNP is not associated with clinical markers of disease in CAD, the higher frequency of the variant allele in SA Indians may be a contributing factor for this population having an increased risk of developing premature CAD.

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