Is the ratio of apoB/apoA-1 the best predictor for the severity of coronary artery lesions in Chinese diabetics with stable angina pectoris？ An assessment based on Gensini scores

Background There is a paucity of data about the best lipid ratio predicting the severity of coronary artery disease （CAD） in patients with diabetes mellitus. We determined the relationship between five conventional lipid ratios and the extent of coronary artery lesions in Chinese Type 2 diabetics with stable angina pectoris （SAP）. Methods A prospective cohort study within 373 type 2 diabetic patients diag- nosed with stable CAD by coronary angiography was performed. All patients were classified into three groups according to the tertiles of Gensini scores （GS, low group 〈 8 points n = 143; intermediate group 8-28 points, n = 109; high group 〉 28 points, n = 121）. Association between the ratios of apolipoprotein （apo） B and apoA-1, total cholesterol and high density lipoprotein cholesterol （TC/HDL-C）, triglycerides and HDL-C （TG/HDL-C）, low density lipoprotein cholesterol and HDL-C （LDL-C/HDL-C）, Non-HDL-C/HDL-C and GS were evaluated using the receivers operating characteristic （ROC） curves and multivariate logistic regression models. Results The ratio of apoB/apoA-1, TC/HDL-C, LDL-C/HDL-C, and Non-HDL-C/HDL-C were correlated with Gensini scores. Area under the ROC curves for predicting high Gensini scores in the ratios of apoB/apoA-1, TC/HDL-C, LDL-C/HDL-C and Non-HDL-C/HDL-C were 0.62, 0.60, 0.59 and 0.60, respec- tively （P 〈 0.005 for all）. According to multivariate logistic regression analysis after adjusted with demographic characteristic and other lipid parameters, the ratio of apoB/apoA-1 is qualified as an independent discriminator for the severity of CAD. However, after fiu-ther adjusting different baseline variables, such as left ventricular ejective fraction, hemoglobin Alc, leukocytes count and serum creatinine, none of the above lipid ratios remained. Conclusions Compared with other lipid parameters, the ratio of apoB/apoA-1 appears to be more significantly correlated with the extent of coronary artery lesions in Chinese diabetics, but it was not an independent predictor in these settings.

Impact of estimated HDL particle size via the ratio of HDL-C and apoprotein A-I on short-term prognosis of diabetic patients with stable coronary artery disease

BackgroundRevascularization and statin therapy are routinely used in the management of stable coronary artery disease. However, it is unclear whether the estimated high-density lipoprotein （HDL） particle size （eHDL-S）, the ratio of HDL cholesterol （HDL-C） to apoprotein A-I （apoA-I）, is associated with the clinical outcomes of diabetic patients with stablecoronary artery disease （CAD）.MethodsWe per-formed a prospective cohort study of 328 patients diagnosed with stable CAD by coronary angiography. Patients were followed up for a mean duration of 12 months. The patients were divided into three groups by the tertiles of eHDL-S： low eHDL-S （〈 0.71,n= 118）; interme-diate eHDL-S （0.71-0.79,n= 111）; and high eHDL-S （〉 0.79,n= 99）. The associations between the baseline eHDL-S and short-term out-comes were evaluated using the Kaplan-Meier method and Cox proportional regression.Results The low eHDL-S group had higher trig-lyceride, hemoglobin A1c, uric acid, and leukocyte count than the other groups. During the follow-up period, 47/328 patients experienced a pre-specified outcome. According to the Kaplan-Meier analysis, the incidence of pre-specified outcomes was lower in the high eHDL-S group （P = 0.04）. However, eHDL-S was not independently associated with adverse outcomes in Cox proportional hazards regression （haz-ard ratio （HR）： 0.23, 95% confidence interval （95% CI）： 0.01-11.24,P = 0.493）.ConclusionAlthough the eHDL-S was associated with inflammatory biomarkers, it was not independently associated with the short-term prognosis of diabetic patients with stable CAD in the era of revascularization and potent statin therapy.

Impact of 1,25-(OH)_2D_3 on Left Ventricular Hypertrophy in Type 2 Diabetic Rats

Objective To investigate the impact of 1, 25-(OH)2D3 on left ventricular hypertrophy(LVH) in type 2 diabetic rats. Methods Type 2 diabetic mellitus(DM) model rats were established by intraperitoneally injecting with 30 mg/kg streptozotocin. After 8 weeks, 19 male rats were identified as diabetic with left ventricular hypertrophy(LVH) by ultrasound examination, and randomly assigned into three groups: untreated(DM-LVH, n=7), treated with insulin(DM-LVH+INS, n=6), and treated with 1, 25-(OH)2D3(DM-LVH+VD, n=6). Healthy male rats were used as the controls group(n=6). The fasting blood glucose and the insulin level were determined weekly. The left ventricular mass index, myocardial collagen content, collagen volume fraction, and 1, 25-(OH)2D3-receptor level were determined by 4 weeks later. Results In the DM-LVH model group, the insulin level was significantly decreased compared with the non-diabetic control group(P<0.05), whereas the blood glucose, left ventricular mass index, myocardial collagen content, collagen volume fraction, and 1, 25-(OH)2D3-receptor expression were significantly increased(all P<0.05). In the DM-LVH+INS and DM-LVH+VD groups, the insulin levels were significantly increased compared with the DM-LVH model group(P<0.05), whereas the other parameters were significantly decreased(all P<0.05). Conclusion 1, 25-(OH)2D3 could reverse LVH in diabetic rats and that the mechanism may involve stimulating insulin secretion and reducing blood glucose via direct up-regulation of 1, 25-(OH)2D3-receptor expression.

Coronary Artery Perforation Complicated With Acute Aortic Valve Regurgitation During Percutaneous Coronary Intervention:Report of Two Cases

CORONARY artery perforation catastrophic complication （CAP） is a rare, of percutaneous coronary intervention （PCI）. CAP during PCI procedure is invariably associated with high riskpatients with complex coronary artery disease such as coronary calcified lesions, multi-vessel lesions, coronary chronic total occlusion and so on,

Effect of tirofiban on inflammatory factors, endothelial function and cardiac function after interventional therapy in AMI patients

Objective:To investigate the effect of tironon on inflammatory factors, endothelial function and cardiac function after interventional therapy in AMI patients.Methods:A total of 120 patients with acute myocardial infarction in our hospital were selected as the research objects, all of them were in line with the indications of PCI operation. They were randomly divided into the observation group (60 cases) and the control group (60 cases). The control group was treated with aspirin and clopidogrel before and after PCI, and the observation group was treated with based on the use of tirofiban. Inflammatory factors, endothelial function and cardiac function index were detected and compared between the two groups.Results: Before treatment, there was no significant difference in hs-CRP, sCD40L and TNF-alpha levels in the two groups. After treatment, the hs-CRP of the two groups were (5.01±1.95) mg/L, (9.41±2.48) mg/L, sCD40L were (1.88±0.25) ng/mL, (2.77±0.27) ng/mL, TNF-α were (8.86±2.18) ng/L, (15.52±2.78) ng/L, respectively. The levels of hs-CRP, sCD40L and TNF-α in the two groups were all decreased, and the level of each index in the observation group was lower than that of the control group. There was no significant difference in NO, ET-1 and vWF levels between the two groups before treatment. After treatment, the NO of the two groups were (82.48±11.57) umol/L and (66.68±13.18) umol/L, respectively. The two groups of NO were all elevated, and the NO of the observation group was higher than that of the control group. After treatment, the ET-1 of the two groups were (55.03±6.58) ng/L, (66.17±5.42) ng/L, and vWF were (66.17±5.88)×10-2, (83.28±5.39)×10-2, respectively. The ET-1 and vWF of the two groups were all decreased, and the ET-1 and vWF of the observation group were lower than those of the control group. There was no significant difference in LVEF, LVESD and LVEDD between the two groups before treatment. After treatment, the LVEF, LVESD and LVEDD of the observation group were (63.87±6.43)%, (38.27±4.66) mm and (43.63±7.61) mm, respectively. The LVEF of the observation group was higher than that of the control group, and the LVESD and LVEDD were lower than that of the control group.Conclusion: Tirofiban can effectively improve the inflammatory factors, endothelial function and cardiac function of AMI patients after interventional therapy.