Influence of coronary bifurcation angle on atherosclerosis

Hemodynamics plays a crucial role in the development and progression of coronary atherosclerosis,which is prone to occur in branch bifurcation.A n individual aortic-coronary artery model and three changed bifurcation angle models are constructed by Mimics and Freeform based on computed tomography angiography.The influence of different coronary bifurcation angles between left main(LM),left anterior descending(LAD),and left circumflex(LCX)on the blood flow field and related hemodynamic parameters are studied.It is shown that a wider bifurcation angle between LAD and LCX can cause a wider low-wall shear stress area,leading to atherosclerosis.Similarly,a decreased angle between LM and LAD is predisposed to prevent atherosclerosis.The results help to better understand the hemodynamic causes of atherosclerosis with various bifurcation angles in coronary arteries and to provide guidance for clinical assessment and prevention.

Ultrasound screening of multifocal atherosclerosis: markers for coronary heart disease

Background and Objective The frequency of multifocal atherosclerosis (MFA) in patients with coronary heart disease (CHD) has not been thoroughly studied. The purpose of our study was to perform ultrasound screening for MFA in patients with coronary atherosclerosis and make evaluation of the sensitivity and significance of different atherosclerosis markers. Methods Using Color Dupplex Ultrasound (CDU), we studied 32 clinically healthy persons and 87 patients of the city of B with clinical data for CHD where we also performed coronarography. Results In patients with coronary atherosclerosis we found high frequency of carotid atherosclerosis (93%) and peripheral artery disease (PAD) (81%). We established verifiable thickening of the intima-media (IMT) of the common carotid artery (CCA) and common femoral artery (CFA) in patients with CHD. There is a correlation between the frequency of carotid and femoral stenoses and CHD proven by coronarography. Patients with CHD had a high relative risk to develop carotid (RR = 5) and peripheral atherosclerosis (RR=3.5) and high frequency of asymptomatic stenoses and thromboses of the internal carotid artery (86.9%) and femoral artery (78.3%), as well as aneurisms of the abdominal aorta (8.1%). Markers for CAD with high sensitivity were the atherosclerotic plaques of ICA (0.93) and CFA (0.81) as well as IMT of the CFA (0.84). Conclusions MFA are common among patients with CHD. Ultrasound diagnosis is the method of choice for simultaneous non-invasive screening of carotid, peripheral and MFA and provides sensitive markers for coronary atherosclerosis. The most sensitive and specific markers for CHD are the combination of the IMT and atherosclerotic plaques of CCA, ICA and CFA (100% sensitivity and 0.92 specificity).

Cardiac Computed Tomography for the Diagnosis of Coronary Artery Atherosclerosis

Coronary artery disease (CAD) is a leading cause of mortality and morbidity in developed countries, although percutaneous coronary intervention and coronary artery bypass grafting have developed recently. Appropriate diagnosis will improve the prevention, treatment, and care of all patients. We could diagnose only calcification in the coronary arteries with the past computed tomography. Recently, multislice computed tomography has been already accepted as an efficient non-invasive tool for the detection of coronary artery stenosis. We get to estimate the coronary artery stenosis with cardiac computed tomography. We discuss the usefulness of cardiac computed tomography for the risk stratification of coronary artery atherosclerosis.

Establishment of a rat model with diet-induced coronary atherosclerosis

Coronary atherosclerotic disease is a serious disease in humans,but no suitable animal model is available currently for further studies.We used apolipoprotein E gene knockout（ApoE KO） rats to induce hypercholesterolemia through a special high cholesterol/bile salt diet（Paigen diet）,then analyzed aortic and coronaiy atherosclerosis lesions and the myocardial injury in order to establish a novel small animal model of coronary atherosclerosis.Plasma cholesterol of ApoE KO rats increased 7.6-fold compared with wild-type rats after 8 weeks on the Paigen diet.After 10 to 12 weeks of subsisting on the Paigen diet,ApoE KO rats developed mild aortic atherosclerosis with severe coronary atherosclerosis.Hematoxilyn and eosin staining showed that 11 out of 12 ApoE KO male rats had right coronary artery atherosclerosis,7 of them were〉70%occluded.Oil Red O（Lipid Stain）,Mac2 immuno-staining and Masson＇s tnchrome staining demonstrated substantial amounts of lipid,macrophages and collagen fibers in coronary atherosclerosis plaques.In addition,ApoE KO male rats had severe myocardial focal lesions with cholesterol ester as the main component in the lesions.In conclusion,ApoE KO rats developed severe hypercholesterolemia,coronary atherosclerosis and myocardial cholesterol ester deposition after subsisting on the Paigen diet and can be used as a novel animal model for studies on cholesterol metabolism and coronary atherosclerotic disease.

Inhibitory effect of the paraoxonase gene on the formation of rabbit coronary atherosclerosis

Objective:To observe the effect on the inhibition of coronary atherosclerosis hardening of the paraoxonase gene(PON-1) which transfected to the rabbit epicardial adipose tissue.Methods: Rabbit coronary atherosclerosis model was established by high-fat feeding,liposome-encapsulated recombinant plasmid pEGFP-PON-1 50μL was injected to the rabbit pericardial cavity,and was harvested 4 weeks after transfection.Results:The epicardial fat transfected PON-1 gene had effect on the high lipid level.It significantly increased expression of PON-1 in peripheral arterial vascular tissue(P【0.05);and significantly reduced total cholesterol and low-density lipoprotein cholesterol levels(P【0.05).and the thickness ratio of coronary artery intima/ media(P【0.05).Conclusions:The injection of the PON-1 gene in the pericardial cavity can effectively suppress the formation of coronary atherosclerosis.

Increased plasma levels of Lp(a) enhance the development of coronary atherosclerosis

Objective To test the hypothesis that increased plasma levels of Lp(a)may enhance the development of atherosclerosis in the setting of hypercholesterolemia.Methods The plasma Lp(a)was analyzed by SDS-PAGE Western blotting and quantitated using specific ELISA kits.Plasma total cholesterol,triglycerides and HDL-cholesterol were determined using Wako assay kits.The left coronary artery was used for the evaluation of coronary atherosclerosis(stenosis %).For quantitative study of the lesions in coronary atherosclerosis,hematoxylin-eosin and Elastica-van Gieson staining were used.To study cellular components(SMC vs.macrophages)and Lp(a)deposits in the lesions,immunohistochemical staining was performed and then image analysis system was used.Results Plasma total cholesterol,triglycerides,or HDL-C were not significantly different between transgenic(Trg)and nontransgenic(nonTrg)rabbits.Trg rabbits had 200% increase in coronary stenosis caused by atherosclerosis.The lesions of Trg WHHL rabbits contained more SMCs and less macrophage than those of nonTrg WHHL rabbits.Conclusions The results suggest that increased plasma levels of Lp(a)enhance the development of coronary atherosclerosis.

Ultrasound features of carotid atherosclerosis in patients with coronary heart disease and their correlation with disease severity

Objective:To study the ultrasound features of carotid atherosclerosis in patients with coronary heart disease and their correlation with disease severity. Methods:180 patients with coronary heart disease treated in our hospital between December 2010 and December 2015 were collected as observation group and divided into single-vessel disease group (n=50), double-vessel disease group (n=72) and triple-vessel disease group (n=58) according to the degree of coronary artery stenosis;50 healthy subjects receiving physical examination in our hospital during the same period were selected as control group. Carotid ultrasound was used to measure carotid atherosclerosis parameters, cardiac color Doppler ultrasound was used to detect cardiac function parameters, enzyme-linked immunosorbent assay (ELISA) was used to detect serum endothelial function indexes, and Pearson test was used to analyze the correlation between carotid ultrasound parameters and the cardiac function as well as endothelial function. Results:Carotid ultrasound parameters stiffness (β), elastic modulus (Ep), arterial compliance (AC) and pulse wave velocity (PWVβ) value of observation group were higher than those of control group, and with the increase of coronary artery lesion severity, the changes ofβ, Ep, AC and PWVβvalue increased (P<0.05);cardiac function parameters left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) value of observation group were higher than those of control group while left ventricular ejection fraction (LVEF) value was lower than that of control group, and with the increase of coronary artery lesion severity, the changes of LVEDD, LVESD and LVEF value increased (P<0.05);endothelial function indexes endothelin-1 (ET-1) and von willebrand factor (vWF) levels of observation group were higher than those of control group while nitric oxide (NO) level was lower than that of control group, and with the increase of coronary artery lesion severity, the changes of ET-1, vWF and NO levels increased (P<0.05). Carotid ultrasound parameterβ, Ep, AC and PWVβvalue in patients with coronary heart disease were directly correlated with the levels of cardiac function parameters and endothelial function indexes. Conclusions:The ultrasound parameter levels of carotid atherosclerosis in patients with coronary heart disease are directly correlated with the disease severity and can be used as the noninvasive and reliable means for early judgment of the disease.

EXCIMER LASER CORONARY ANGIOPLASTY ──A PRELIMINARY REPORT OF 11 CASES

We reported 11 cases of excimer laser coronary angioplasty (ELCA). All were males, the average age being 59.7 years. Five patients had sustained previous myocardial infarctions with post-infarction angina in 2 cases and 6 presented angina only. Coronary angiograms showed stenosis in LAD (N9), LCX(N6) and RCA (N6). According to the ACC/AHA classification, 6 were categorized as type B, and 5 type C. ELCA with adjunctive PTCA were performed in all 8 patients, 1. 3 mm (energy density 14. 5 mJ) and 1.6 mm (energy density 21.0 mJ) laser catheters with 20Hz pulse frequency were used There was one failure and in another ELCA was successful but death followed the procedure. The overall result was laser success 10 out of the 11 cases and procedure success 9.

Congenital absence of the right coronary artery:A case report

BACKGROUND As a rare anomaly,congenital absence of the right coronary artery(RCA)occurs during the development of coronary artery.Patients with congenital absence of the RCA often show no clinical symptoms,and this disease is considered benign.The left coronary artery gives blood supply to the whole myocardium.The prevalence of congenital absence of the RCA is approximately 0.024%-0.066%.There are few cases reported as for this disease.In this work,a patient,with congenital absence of the RCA diagnosed by coronary angiography(CAG),was described.CASE SUMMARY A 41-year-old man arrived at our hospital for treatment,due to the repeated palpitations for a duration of one year.Considering the possibility of coronary heart disease,the patient underwent CAG that indicated the congenital absence of the RCA.Unfortunately,the patient refused to accept computed tomography coronary angiography(CTCA),to further confirm the congenital absence of the RCA.CONCLUSION Single coronary artery is a rare type of coronary artery abnormality,which usually has no obvious clinical manifestations and is considered as a benign disease.CAG is the main means by which congenital absence of the RCA can be diagnosed,and the disease can also be further confirmed by CTCA.

Coronary atherosclerosis burden is not advanced in patients with β-thalassemia despite premature extracardiac atherosclerosis： a coronary artery calcium score and carotid intima-media thickness study

Background Thalassemic patients demonstrate an increased rate of extracardiae vascular complications and increased carotid wall intima-media thickness （cIMT）, but very low prevalence of coronary artery disease （CAD）. We investigated the atheroma burden by assessing the coronary artery calcium （CAC） and elMT in these patients. Methods We examined 37 patients with β-thalassemia and 150 healthy control volunteers with multi-detector computer tomography （CT） and ultrasonography to determine CAC score and cIMT, respectively. Results Propensity score matching （C-statistic： 0.88; 95% CI： 0.83-0.93） resulted in 27 pairs of patients; severe CAC was observed in 2 （7.4%） and 0 of β-thalassemia patients and healthy volunteers respectively （P = 0.5）. Median calcium score was 0 （0-0） in β-thalassemia patients and 0 （0-4） in healthy volunteers （P = 0.8）. Median intima-media thickness was higher in β-thalassemia patients compared to control group [0.45 （0.06-0.65） vs. 0.062 （0.054-0.086）; P = 0.04]. Conclusions Patients with β-thalassemia in comparison with healthy control subjects exhibit similar CAC score and increased cIMT. Our findings indicate a disparate rate of progression of atherosclerosis between coronary and extracardiac arteries in these patients lending support to the epidemiological evidence.

Myosteatosis is associated with coronary artery calcification in patients with type 2 diabetes

BACKGROUND Myosteatosis,rather than low muscle mass,is the primary etiologic factor of sarcopenia in patients with type 2 diabetes mellitus(T2DM).Myosteatosis may lead to a series of metabolic dysfunctions,such as insulin resistance,systematic inflammation,and oxidative stress,and all these dysfunctions are closely associated with the acceleration of T2DM and atherosclerosis.AIM To investigate the association between myosteatosis and coronary artery calcification(CAC)in patients with T2DM.METHODS Patients with T2DM,who had not experienced major cardiovascular events and had undergone both abdominal and thoracic computed tomography(CT)scans,were included.The mean skeletal muscle attenuation was assessed using abdominal CT images at the L3 level.The CAC score was determined from thoracic CT images using the Agatston scoring method.Myosteatosis was diagnosed according to Martin’s criteria.Severe CAC(SCAC)was defined when the CAC score exceeded 300.Logistic regression and decision tree analyses were performed.RESULTS A total of 652 patients with T2DM were enrolled.Among them,167(25.6%)patients had SCAC.Logistic regression analysis demonstrated that myosteatosis,age,duration of diabetes,cigarette smoking,and alcohol consumption were independent risk factors of SCAC.Myosteatosis was significantly associated with an increased risk of SCAC(OR=2.381,P=0.003).The association between myosteatosis and SCAC was significant in the younger patients(OR=2.672,95%CI:1.477-4.834,P=0.002),but not the older patients(OR=1.456,95%CI:0.863-2.455,P=0.188),and was more prominent in the population with lower risks of atherosclerosis.The decision tree analyses prioritized older age as the primary variable for SCAC.In older patients,cigarette smoking was the main contributing factor for SCAC,while in younger patients,it was myosteatosis.CONCLUSION Myosteatosis is a novel risk factor for atherosclerosis in patients with T2DM,especially in the population with younger ages and fewer traditional risk factors.

Acute coronary syndrome with severe atherosclerotic and hyperthyroidism: A case report

BACKGROUND Acute coronary syndrome(ACS)encompasses a spectrum of cardiovascular emergencies arising from the obstruction of coronary artery blood flow and acute myocardial ischemia.Recent studies have revealed that thyroid function is closely related to ACS.However,only a few reports of thyrotoxicosis-induced ACS with severe atherosclerosis have been reported.CASE SUMMARY A 33-year-old man,who had a history of hyperthyroidism without taking any antithyroid drugs and no history of coronary heart disease,experienced neck pain with occasional heart palpitations starting 3 mo prior that were aggravated after an activity.As the symptoms worsened at 21 d prior,he went to a hospital for treatment.The electrocardiogram examination showed a multilead ST segment elevation and pathological Q waves.Based on these findings and his symptoms,the patient was diagnosed with a suspected myocardial infarction and transferred to our hospital on July 2,2020.He was diagnosed with a rare case of ACS due to coronary artery atherosclerosis in the anterior descending artery complicated by hyperthyroidism.A paclitaxel-coated drug balloon was used for treatment to avoid the use of metal stents,thus reducing the time of antiplatelet therapy and facilitating the continued treatment of hyperthyroidism.The 9-mo follow-up showed favorable results.CONCLUSION This case highlights that atherosclerosis is a cause of ACS that cannot be ignored even in a patient with hyperthyroidism.

Correlation between Serum Level of Adiponectin and Severity of Coronary Artery Atherosclerosis

Objectives To investigate the correlation between serum level of adiponectin and severity of coronary artery atherosclerosis. Methods Coronary angiographies were performed and serum levels of adiponectin were measured in 88 patients with suspected coronary heart disease （CHD）. Patients were divided into groups according to the coronary angiographies and Gensini＇s scores of coronary artery atherosclerosis. The serum levels of adiponectin were compared in different groups, and multiple regressions were used to analyze the correlation factors of adiponectin. Results （1）Serum adiponectin concentration in CHD group [ 7. 1 mg/L （2.4 - 21.1 mg/L） ] was decreased as compared with that in control group [ 11.6 mg/L （4.4 - 28.2 mg/L ）, P 〈 0. 01 ] ; （2）The serum levels of adiponectin fell while the Gensini＇ s scores of coronary artery atherosclerosis increased （P 〈 0. 05, P 〈 0. 01 ） ; （3）Serum level of adiponectin was positively correlated with the high-density lipoprotein cholesterol, while negatively correlated with the Gensini＇ s score of coronary artery atherosclerosis and triglyceride （P 〈 0. 01 ）. Conclusions Serum adiponectin concentration was decreased in patients with CHD. Low serum levels of adiponectin reflected the severity of coronary artery atherosclerosis. Adiponectin was a protective factor of cardiovascular system.

外周血RDW、ox-LDL、Egr3水平与CAS病变程度的关系及预测心肌梗死的价值

目的 分析外周血红细胞体积分布宽度(RDW)、氧化低密度脂蛋白(ox-LDL)、早期生长反应因子3(Egr3)水平与冠状动脉粥样硬化(CAS)病变程度的关系,并探讨其预测急性心肌梗死(AMI)的价值。方法 选取2021年5月至2022年2月河南省第二人民医院收治的120例CAS患者作为研究组,另选取同期60例因胸痛入院但冠状动脉造影(CAG)检查结果正常的患者作为对照组。比较两组患者的一般资料、外周血RDW、ox-LDL、Egr3水平,并比较研究组不同CAS病变程度患者外周血RDW、ox-LDL、Egr3水平,采用Spearman相关系数分析外周血RDW、ox-LDL、Egr3水平与CAS病变程度的相关性。比较随访12个月内发生与未发生AMI患者入院时外周血RDW、ox-LDL、Egr3水平及心肌标志物[心肌肌钙蛋白I(cTnI)、肌酸激酶MB同工酶(CK-MB)、氨基末端脑钠肽前体(NT-proBNP)]水平,采用受试者工作特征曲线(ROC)分析RDW、ox-LDL、Egr3、心肌标志物对CAS患者发生AMI的预测价值,将RDW、ox-LDL、Egr3、心肌标志物联合预测AMI作为新预测方案,心肌标志物联合预测AMI作为常规预测方案,比较两种预测方案对AMI的预测价值。结果 研究组患者的外周血RDW、ox-LDL、Egr3水平分别为(21.65±3.79)%、(25.17±4.76)μg/L、(1 715.36±543.81) ng/L,明显高于对照组的(14.87±2.15)%、(1.35±0.43)μg/L、(1 129.48±368.25) ng/L,差异均有统计学意义(P<0.05);外周血RDW、ox-LDL、Egr3水平随着CAS病变程度的增加而逐渐升高,且差异均有统计学意义(P<0.05);经Spearman相关分析结果显示,外周血RDW、ox-LDL、Egr3水平与CAS病变程度呈正相关(P<0.05);发生AMI患者入院时外周血RDW、ox-LDL、Egr3水平、血清c Tn I、CK-MB、NT-proBNP水平明显高于未发生AMI患者,差异均有统计学意义(P<0.05);经ROC分析结果显示,入院时外周血RDW、ox-LDL、Egr3、血清cTnI、CK-MB、NT-proBNP预测CAS患者发生AMI的曲线下面积(AUC)分别为0.735、0.754、0.775、0.737、0.739、0.728,敏感度分别为60.00%、88.00%、64.00%、76.00%、64.00%、72.00%,特异度分别为82.76%、59.77%、83.91%、74.71%、82.76%、66.67%,各指标单独预测AMI的AUC比较差异无统计学意义(P>0.05);与常规预测方案AUC (0.844)比较,新预测方案的AUC (0.949)明显增大,净重新分类指数(NRI)、综合判别改善指数(IDI)均>0。结论 CAS患者外周血RDW、ox-LDL、Egr3水平与CAS病变程度呈正相关,且在预测AMI方面具有一定价值。

Treatment of Coronary Heart Disease from the Perspective of Liver Controlling Dispersion

The liver is in charge of distributing and regulating the movement of qi throughout the whole body,coordinating the transportation and transformation of the internal organs in the middle part of the body,promoting the biochemical circulation of qi,blood,and body fluids,and regulating emotions.Liver dysfunction can disrupt the transportation and transformation of qi,blood,and body fluids,causing phlegm turbidity,blood stasis,and other unwanted symptoms.Poor regulation of emotion further aggravates the accumulation of pathological substances,resulting in the obstruction of heart vessels,and ultimately coronary heart disease(CHD).Through regulating lipid metabolism,inflammatory reaction,vasoactive substances,platelet function,neuroendocrine,and other factors,liver controlling dispersing qi plays a comprehensive role in the prognosis of atherosclerosis,the primary cause of CHD.Therefore,it is recommended to treat CHD from the perspective of liver-controlling dispersion.

有限元分析冠状动脉新型刻痕球囊的安全性及有效性

背景:目前临床上使用的冠状动脉介入预扩张球囊主要是传统的高压球囊、乳突球囊等,它们在病变血管中可能会出现滑脱进而擦伤血管的情况。目的:评估新型旋刻球囊在血管扩张中的安全性及有效性。方法:(1)有限元分析:通过采集相关人体组织数据建立血管三维有限元模型,随后建立乳突球囊植入血管三维有限元模型与旋刻球囊植入血管三维有限元模型,分析不同充气压下球囊扩张时的血管应力、血管位移、球囊应力、球囊位移。(2)动物实验:将8只新西兰大耳兔随机分成2组,在髂动脉中分别植入乳突球囊与旋刻球囊进行扩张,每组4只。球囊撤出后取材,苏木精-伊红染色与透射电镜观察血管损伤情况。结果与结论:(1)有限元分析:两种球囊的弹力性质无明显差异,在相同充气压下,乳突球囊组血管应力、血管位移、球囊应力、球囊位移均远远大于旋刻球囊组,并且各指标的均匀性优于旋刻球囊组;随着充气压的增加,乳突球囊组血管应力、血管位移、球囊应力、球囊位移增加幅度远远大于旋刻球囊组。(2)动物实验:苏木精-伊红染色与透射电镜观察显示,旋刻球囊扩张造成的血管损伤只局限在内膜,而乳突球囊扩张造成的血管损伤比较严重,内膜、中膜损伤严重,部分节段可以看到血肿形成,血管周围的炎性细胞较多,局部可见有巨噬细胞堆积。(3)结果表明:相较于乳突球囊扩张,旋刻球囊扩张造成血管闭塞以及夹层的风险较小,但有一定出现球囊弯曲的概率。

慢性睡眠剥夺对CAS大鼠冠状动脉狭窄程度的影响

目的探讨慢性睡眠剥夺(chronic sleep deprivation,CSD)对冠状动脉粥样硬化(coronary atherosclerosis,CAS)模型大鼠冠状动脉狭窄进展程度的影响及其可能机制。方法选取健康SD大鼠96只,随机分为4组:正常对照组、CSD组、CAS模型组及CAS合并CSD组,每组24只;通过12w喂饲高胆固醇饲料、建立CAS动物模型;采用CSD对CAS模型大鼠实施12w干预,观察、分析4组大鼠焦虑行为、血清致炎因子和CAS斑块以及管腔狭窄程度的变化。结果 1)与CAS模型组比较,CAS合并CSD组跨格次数、直立次数及粪便粒数明显增多(P<0.05);2)CAS合并CSD组IL-1β、IL-6水平明显高于CAS模型组(P<0.05);3)CAS合并CSD组CAS斑块出现率(95.83±2.87)、冠状动脉狭窄程度(87.95±5.46)明显高于CAS模型组(83.33±2.64)、(75.42±5.11)(P<0.05)。结论 CSD可以通过提高大鼠焦虑状态、升高致炎因子水平,促进CAS斑块形成,从而加快冠状动脉狭窄进展程度。

Role of Helicobacter pylori infection in pathogenesis of atherosclerosis

Though a century old hypothesis, infection as a cause for atherosclerosis is still a debatable issue. Epidemiological and clinical studies had shown a possible association but inhomogeneity in the study population and study methods along with potential confounders have yielded conflicting results. Infection triggers a chronic inflammatory state which along with other mechanisms such as dyslipidemia, hyper-homocysteinemia, hypercoagulability, impaired glucose metabolism and endothelial dysfunction, contribute in pathogenesis of atherosclerosis. Studies have shown a positive relations between Cytotoxic associated gene-A positive strains of Helicobacter pylori and vascular diseases such as coronary artery disease and stroke. Infection mediated genetic modulation is a new emerging theory in this regard. Further large scale studies on infection and atherosclerosis focusing on multiple pathogenetic mechanisms may help in refining our knowledge in this aspect.

Atherosclerosis,inflammation and Chlamydia pneumoniae

Coronary heart disease is the single most common cause of illness and death in the developed world.Coronary atherosclerosis is by far the most frequent cause of ischemic heart disease,and plaque disruption with superimposed thrombosis is the main cause of the acute coronary syndromes of unstable angina,myocardial infarction,and sudden death.Atherosclerosis is the result of a complex interaction between blood elements,disturbed flow,and vessel wall abnormality,involving several pathological processes:inflammation,with increased endothelial permeability,endothelial activation,and monocyte recruitment;growth,with smooth muscle cell proliferation,migration,and matrix synthesis;degeneration,with lipid accumulation;necrosis,possibly related to the cytotoxic effect of oxidized lipid;calcification/ossification,which may represent an active rather than a dystrophic process;and thrombosis,with platelet recruitment and fibrin formation.In this review we discuss these processes and the possible pathological effects of Chlamydia infection and the ensuing phlogosis.

Genetics of coronary artery disease and myocardial infarction

Atherosclerotic coronary artery disease(CAD) comprises a broad spectrum of clinical entities that include asymptomatic subclinical atherosclerosis and its clinical complications, such as angina pectoris, myocardial infarction(MI) and sudden cardiac death. CAD continues to be the leading cause of death in industrialized society. The long-recognized familial clustering of CAD suggests that genetics plays a central role in its development, with the heritability of CAD and MI estimated at approximately 50% to 60%. Understanding the genetic architecture of CAD and MI has proven to be difficult and costly due to the heterogeneity of clinical CAD and the underlying multi-decade complex pathophysiological processes that involve both genetic and environmental interactions. This review describes the clinical heterogeneity of CAD and MI to clarify the disease spectrum in genetic studies, provides a brief overview of the historical understanding and estimation of the heritability of CAD and MI, recounts major gene discoveries of potential causal mutations in familial CAD and MI, summarizes CAD and MIassociated genetic variants identified using candidate gene approaches and genome-wide association studies(GWAS), and summarizes the current status of the construction and validations of genetic risk scores for lifetime risk prediction and guidance for preventive strategies. Potential protective genetic factors against the development of CAD and MI are also discussed. Finally, GWAS have identified multiple genetic factors associated with an increased risk of in-stent restenosis following stent placement for obstructive CAD. This review will also address genetic factors associated with in-stent restenosis, which may ultimately guide clinical decision-making regarding revascularization strategies for patients with CAD and MI.