Cardiac-self efficacy predicts adverse outcomes in coronary artery disease (CAD) patients

Background: Little is known about the predictive role of Cardiac Self Efficacy (CSE) in the ensuing months following a coronary event. We sought to determine whether CSE predicts adverse events in the months following discharge in patients with Coronary Artery Disease (CAD). Design: Data from a prospective study of 193 patients recently hospitalized for CAD. Methods: Data were collected via participant self-report and medical records at 3-month post-discharge (baseline;T1), 6-month post-discharge (T2) and 9-month post-discharge (T3). CSE was measured using the Cardiac Self Efficacy Scale. Multi-variate regression modeling was applied to explore the association between baseline CSE scores and cardiac-related hospital admissions and functional cardiac status at T2 and T3. Other outcomes included any hospital admissions, self-reported mental and physical health at follow up. Results: Higher CSE scores at baseline significantly predicted better cardiac functioning and self-rated mental and physical health at both T2 and T3 (with one exception);this was consistent across all five models. While baseline CSE did not predict cardiac or other hospital admission at T2, CSE was a significant predictor of both outcomes at T3;higher CSE scores resulted in reductions in likelihood of hospital admissions. After adjustment for psychosocial variables however, neither association remained. Baseline depression explained the association between baseline CSE and any cardiac admissions, as well as baseline CSE and any hospital admissions at T3 follow up. Conclusions: While CSE can predict key outcomes following a CAD event, much of the association can be explained by the presence of depression.

ASSOCIATION OF INSULIN RESISTANCE AND C-REACTIVE PROTEIN WITH CORONARY ARTERY DISEASE IN PATIENTS WITH NORMAL GLUCOSE TOLERANCE

Objective To examine insulin resistance and high sensitivity C-reactive protein （hsCRP） association with clinical and angiographic severity of coronary artery disease （CAD） in patients with normal glucose tolerance. Methods In 638 consecutive patients with normal glucose tolerance, 221 had atypical chest pain and normal coronary artery （control group）, 279 had stable angina and CAD （SAP group ）, and 138 suffered acute myocardial infarction （ MI group）. The degree of CAD was further divided into borderline lesion （ lumen diameter narrowing 50% - 69% ）, significant 1-, 2- or 3-vessel disease （ luminal diameter narrowing 〉I 70% ）. Fasting serum glucose, insulin and hsCRP levels and lipid profiles were measured, and homeostasis model assessment for insulin resistance （ HOMA-IR ） was calculated. Multivariate analysis was performed to assess risk factors for 3-vessel disease or acute MI. Results Serum hsCRP, lipoprotein （a） levels, and insulin resistance index （IRI） were higher in AMI group than those in SAP and control groups. Serum hsCRP level and IRI were also higher in 3-vessel disease than those in other groups. Multivariate regression analysis revealed that insulin resistance, cigarette smoking, serum hsCRP, and lipoprotein （a） levels were independent risk factors for acute MI. Lipoprotein （ a ） elevation was an independent risk factor for 3-vessel disease. Conclusion Insulin resistance and high serum hsCRP level were associated with occurrence of acute MI and angiographic severity of coronary disease in patients with normal glucose tolerance.

Nonalcoholic fatty liver disease is associated with coronary artery disease in Koreans

AIM:To investigate whether nonalcoholic fatty liver disease(NAFLD)affects coronary artery disease(CAD)and identify candidate mediators.METHODS:Patients who underwent coronary angiography were consecutively recruited.The patients were classified into four groups by coronary artery stenosis:A,insignificant;B,one-vessel disease;C,two-vessel disease;and D,three-vessel disease.Abdominal ultrasonography was performed to determine the presence of a fatty liver and categorize by grade:0,no evidence;1,mild;2,moderate;and 3,severe.We measured not only known CAD risk factors,but also serum insulin,HOMA-index,adiponectin,interleukin-6,tumor necrosis factor-αand high-sensitivity C-reactive protein levels.RESULTS:Of the 134 patients who met the inclusion criteria,82(61.2%)had ultrasonographically diagnosed NAFLD.Among the 46 patients with CAD,37(80.4%)had evidence of a fatty liver.The two groups(A vs B-D)were significantly different in terms of age,total cholesterol,triglycerides,low-density lipoprotein levels and fatty liver.Coronary artery stenosis was strongly associated with fatty liver in a grade-dependent manner(P=0.025).In binary logistic regression,NAFLD was a significant independent predictor of CAD(P=0.03,OR=1.685;95%CI:1.051-2.702).Among the candidate mediators,the serum adiponectin level showed a trend toward lowering based on CAD progression(P=0.071).CONCLUSION:NAFLD is an independent risk factor for CAD in a grade-dependent manner.Moreover,adiponectin might be related to the pathogenesis of NAFLD.

Interleukin-17A gene variants and risk of coronary artery disease:a large angiography-based study

Background Recent studies have also revealed that interleukin(IL)-17A plays a key role in atherosclerosis and its complication,but the relationship of its common variants with coronary artery disease(CAD) has not been extensively studied.Methods We systematically screened sequence variations in the IL17A gene and designed an angiog-raphy -based case-controlled study consisting of 1031 CAD patients and 935 control subjects to investigate the association between the selected polymorphisms of IL-17A gene and CAD risk in Chinese Han population.Results Frequencies of IL17A rs8193037 GG homozygote and G allele were significantly higher in the patient group than those in the control group(P【0.001;OR=0.68;95%CI=0.54-0.85).Stratification analysis showed that the IL17A rs8193037 G allele significantly increased the risk of CAD only among male subjects (P=0.001;OR=0.63;95%CI=0.47-0.83).After adjustment for conventional risk factors,binary logistic regression analysis showed that the G allele carriers(GG +AG) had significantly increased CAD risk compared with the AA homozygotes (adjusted P【0.001;OR 0.43;95%CI,0.33- 0.58).ELISA showed augmented IL17A production in plasma of the AMI patients.Conclusions Based on our data,we speculated that the SNP rs8193037 of IL17A gene is significantly associated with CAD risk in Chinese Han population and the rs8193037 G allele which is associated with increased expression of IL17A in AMI patients may be an independent predictive factor for CAD.

Is the advantage of coronary bypass graft surgery over percutaneous coronary intervention in diabetic patients with severe multivessel disease influenced by the status of insulin requirement？

Several studies have shown that coronary artery bypass graft surgery （CABG） is superior to percutaneous coronary intervention （PCI） in patients with diabetes and multi-vessel disease. Whether this advantage of CABG over PCI is confined to diabetics who require insulin is unknown. We review the published literature comparing CABG with PCI in diabetics including 8 cohorts and 4,786 patients. There was a lower rate for all-cause mortality （Relative risk （RR）： 0.78, 95% confidence interval （CI）： 0.62-0.99）, and for major adverse cardiac and cerebrovascular events （MACCE, RR： 0.59, 95% CI： 0.47-0.75） for CABG compared to PCI. Composite outcome of mortality, myocardial infarction and stoke was similar between CABG and PCI （RR： 0.87, 95% CI： 0.54-1.42）. Visual inspection of the forest plots showed that in most analyses, the point estimates of the RR are similar between the insulin requiring group and non-insulin requiring group. On meta-regression, there was no interaction between status of insulin requirement and revascularization strategies （P 〉 0.05 for all）. The pre- sented data on the still unpublished analysis of the FREEDOM trial showed similar results. Thus, in the current era, CABG is superior to PCI with lower mortality and MACCE rates, but the state of insulin requirement had no effect on the outcomes from the two revascularization strategies.

Evaluation of Treadmill Exercise Test Induced U-wave Inversion in Diagnosis of Coronary Artery Disease

U-wave changes during treadmill exercise test were compared between 34 patientswith CAD and 33 normal controls.All of them were confirmed by coronary angiographv.Tenpatients with CAD and 1 normal subject in this study showed U-wave inversion during exercisetest.Of the 10 patients,4 had significant stenosis in one-vessel and 6 in multi-vessel of the ma-jor coronary arteries.The sensitivity,specificity and predictive value of exercise-inducedU-wave inversion were 29％, 97％ and 91％,respectively.It is proposed that exercise inducedU-wave inversion is a reliable predictive index of CAD.

Illness Perception, Treatment Adherence and Coping in Persons with Coronary Artery Disease Undergoing Angioplasty

Background and Objective: Coronary artery disease (CAD) is the leading cause of sudden death. In this article, we compared patients’ illness perception (IP), treatment adherence and coping mechanisms of patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Methods: In this descriptive, prospective observational study IP, treatment adherence and coping of 140 patients were evaluated pre-PTCA, at the time of hospital discharge and 1 to 3 months post-PTCA by Illness Perception Questionnaire, Morisky Treatment Adherence and Carver’s brief COPE questionnaires. Results: 1 - 3 months post-PTCA, all dimensions of IP changed significantly except personal and treatment control. Adherence scores decreased simultaneously. With respect to coping mechanisms, all increased except behavioral disengagement, emotional support, instrumental support and religion which decreased significantly post-PTCA. Conclusions: In Overall, an improved IP and increased use of controllable causal attributions led to an increase in medication adherence and adaptive coping strategies. Post-treatment health behaviors are predictable by assessing patients’ illness-related beliefs beforehand.

Value of Pulsed Tissue Doppler Imaging in Predicting the Presence of Significant Coronary Artery Insufficiency

Background: Coronary artery disease (CAD) is a paramount cause of death. Global and regional left ventricular (LV) systolic function is an important non-invasive marker of CAD. We can use tissue Doppler imaging (TDI) to measure the low velocities generated by myocardium which are: S'-wave, E'-wave, and A'-wave. We aimed to examine the value of the S'-wave dispersion of TDI across mitral valve annular velocities to predict angiographically significant coronary artery obstruction. Patients and Methods: We included 100 patients with symptoms suggesting CAD. All patients had undergone full history taken and clinical examination;ECG, echocardiographic with assessment of LV function, and Doppler derived mitral valve velocities;TDI with measuring of S'-wave and coronary angiography. Lesions with ≥70% or more stenosis in major epicardial artery or ≥50% stenosis in the left main coronary artery were considered significant. Patients were classified into two groups according to the presence or absence of significant coronary stenosis. Results: Clinical and conventional echocardiographic and Tissue Doppler measures were comparable between the two groups;there was statisticallysignificant difference between Group I and Group II (P value;patients with significant coronary arteries lesions have higher S' wave dispersion as compared with patients with normal or mild significant coronary lesions. Conclusion: S'-wave dispersion may consider a good predictor of angiographically significant coronary artery disease.

Testosterone is negatively associated with the severity of coronary atherosclerosis in men

This study aimed to determine whether plasma testosterone is associated with the severity of coronary atherosclerosis in a group of 803 men who underwent elective coronary angiography. Testosterone levels were measured in 803 male patients who were categorized into three groups according to testosterone level tertiles. All patients underwent elective coronary angiography, and the severity of coronary artery disease （CAD） was determined by the Gensini score. Moreover, patients were classified into two groups according to Gensini scores （score ≤ 26 and score 〉26） using the median values as cutoff points. The plasma testosterone levels were measured by an ELISA kit. The level of testosterone was negatively associated with the Gensini score （r=-0. 188; P=0.000）. A multiple linear regression analysis revealed that testosterone was an independent risk factor for the Gensini score （β=-0,110; P=0.002） after adjusting for confounding covariates. In a multivariate logistic regression model, the severity of CAD was shown to be significantly lower in the third tertile （highest） of testosterone compared to the first tertile （lowest） of testosterone （odds ratio （0R）=0.465; 95% confidence interval （C1）. 0.327-0.662; P=0.000）. In this study, patients with lower testosterone levels had higher Gensini scores in a group of 803 men who underwent elective coronary angiography. Additional studies are needed to clarify the direction of causality and possible underlying mechanisms.

Myocardial insulin resistance does not always parallel skeletal muscle and whole body insulin resistance: A mini review<br>—Myocardial Insulin Resistance <br>

Insulin resistance (IR) is recognized to be of critical importance in a variety of metabolic diseases and coronary artery disease (CAD). Impaired skeletal muscle glucose utilization (SMGU) plays an important role in the pathogenesis of IR, whereas it is controversial whether myocardial IR is similar in this respect. Methods: Twenty-two studies of myocardial IR and skeletal muscle IR using positron emission tomography (PET) and/or whole body IR were reviewed. Heart and skeletal muscle IR were measured with PET and18F-FDG under hyperinsulinemic euglycemic insulin clamp technique. Whole body IR was also determined at the time of PET under hyperinsulinemic euglycemic insulin clamp technique. Results: One study reported that heart and skeletal muscle IR is present in untreated type 2 diabetes mellitus (T2DM), hypertension and CAD (as reflected in a myocardial glucose utiliation rate (MGU) in T2DM vs control [p -0.665, p -0.60, p -0.74, p -0.74, p 18F-FDG Uptake (MFU) in hypertriglyc-eridemics was (p = ns) despite findings of reduced skeletal muscle18F-FDG uptake (SMFU in hyper-triglyceridemia

Coronary Artery Bypass Surgery for Patients Presenting with Ventricular Arrhythmias: Propensity Matched Early and Late Outcome

Objectives: Patients with ischemic ventricular arrhythmia (IVA) in the form of fibrillation or tachycardia represent a surgical challenge. Evidence in the literature suggests that ventricular arrhythmia threatens survival even after cardiac surgery. We aim to review the results of our patients presenting with IVA with regard to short and long term outcome following cardiac surgery. Methods: This was a retrospective study of data entered prospectively into our cardiac surgical database between January 1999 and September 2015. A total of 9609 patients underwent Cardiac Surgery which included 54 patients after surviving IVA. The short- and long-term outcomes were compared to a propensity matched group. Actuarial survival was calculated using Kaplan Meier analysis. Results: The 54 study group patients were propensity matched on a 1:2 basis with a control group of non-IVA (n = 108). The baseline preoperative characteristics and risk factors were similar between the 2 groups and all cases underwent CABG only. Univariate analysis showed pacing postoperatively (33.3 vs 66.7%;p = 0.001) and postoperative ventricular arrhythmia (10 vs 22.2%;p = 0.039) to be significantly higher in the IVA group. Cox-multivariate analysis showed postoperative ventricular arrhythmia in either group (Hazard ratio = 1.5) to be the only significant factor to impact mortality (p 0.001). Long term survival was not significantly different between the two groups (10.4;CI: 9.08 - 11.75 vs 9.3;CI: 7.61 - 11.01 yrs, p = 0.3). Conclusion: Cardiac surgery on patients presenting with IVA can be performed safely yielding short and long term results equivalent to non-IVA cases. These patients should not be denied surgery with consideration of good long term outcome.

Influence of insulin resistance on long-term outcomes in patients with coronary artery disease after sirolimus-eluting stent implantation

Background Insulin resistance（IR）is significantly associated with coronary artery disease and cardiovascular events in patients with or without type 2 diabetes mellitus.This study aimed to evaluate the influence of IR on long-term outcomes of patients undergoing percutaneous coronary intervention（PCI）with sirolimus-eluting stent（SES）implantation.Methods A total of 467 consecutive patients undergoing SES-based PCI were divided into lR group（n=104）and non-IR group（n=363）.The patients were followed up for one year.The rate of major adverse cardiac events（MACEs） including death, non-fatal myocardial infarction and recurrent angina pectoris was compared by the log-rank test,and the independent risk factors were identified by the Cox regression analysis.Results MACEs occurred more frequently,and cumulative survival rate was lower in the IR group than in the non-IR group during the follow-up （all P〈0.05）.IR was an independent risk factor for the occurrence of cardiac death and non-fatal myocardial infarction（OR=2176,95% CI=1.35-5.47,P=0.034）.Old age,diabetes,and multi-vessel disease were determinants for recurrent angina pectoris after PCI（P〈0.05）.Subgroup analysis revealed that IR（OR=3.35,95% CI=1.07-13.59,P=0.013）and multi-vessel disease（OR=2.19,95%CI=1.01-5.14,P=0.044）were independent risk predictors for recurrent angina pectoris in patients with diabetes after PCI.Conclusions IR is associated with reduced MACE-free survival and remains an independent predictor for recurrent angina pectoris after PCI with SES implantation.

Estrogen receptor a gene PvulI polymorphism and coronary artery disease： a meta-analysis of 21 studies

The association between the estrogen receptor a gene （ESR1） Pvull polymorphism （c.454-397T〉C） and coronary artery disease （CAD） is controversial. Thus, we conducted a meta-analysis to evaluate the relationship. Data were collected from 21 studies encompassing 9926 CAD patients and 16710 controls. Odds ratios （ORs） with 95% confidence intervals （CIs） were used to assess the relationship between Pvull polymorphism and CAD. The poly- morphism in control populations in all studies followed Hardy-Weinberg equilibrium. We found a significant association between ESR1 Pvull polymorphism and CAD risk in all subjects. When the data were stratified by region, a significant association between ESR1 Pvull polymorphism and CAD risk was observed in Asian populations but not in Western populations. The current study suggests that ESR1 Pvull polymorphism has an important role in CAD susceptibility.

Adiponectin levels are associated with the number and activity of circulating endothelial progenitor cells in patients with coronary artery disease

Objective:To study the relationship between plasma adiponectin concentration and the functional activities of circulating endothelial progenitor cells(EPCs) in patients with coronary artery disease(CAD).Methods:Circulating EPCs were enumerated as AC133+/KDR+ cells via flow cytometry and identified by co-staining with DiI-acLDL and fluorescein isothiocy-anate(FITC)-conjugated lectin under a fluorescent microscope.The migratory capacity of EPCs was measured by modified Boyden chamber assay.Adhesion capacity was performed to count adherent cells after replating EPCs on six-well culture dishes coated with fibronectin.Results:The number of circulating EPCs(AC133+/KDR+ cells) decreased significantly in CAD patients,compared with control subjects [(74.2±12.3) vs(83.5±12.9) cells/ml blood,P<0.01].In addition,the number of EPCs also decreased in CAD patients after ex vivo cultivation [(54.4±8.6) vs(71.9±11.6) EPCs/field,P<0.01].Both circulating EPCs and differentiated EPCs were positively correlated with plasma adiponectin concentration.The functional activities of EPCs from CAD patients,such as migratory and adherent capacities,were also impaired,compared with control subjects,and positively correlated with plasma adiponectin concentration.Conclusion:The study demonstrates that the impairment of the number and functional activities of EPCs in CAD patients is correlated with their lower plasma adiponectin concentrations.

Initial Experience on Anatomical Snuff Box Approach for Coronary Angiogram &Percutaneous Coronary Intervention in a Tertiary Care Center Nepal

Introduction: Coronary Angiogram and Percutaneous Coronary Interventions are commonly performed via the femoral route. Then, transradial coronary catheterization became a popular & default technique due to less vascular access site complications and bleeding as compared to femoral route. Distal puncture of the radial artery through the anatomical snuff box access, however, has recently been shown potential benefit, like comfort to patients and operators, as well as maintenance of blood flow through the superficial palmar arch, in case of radial artery occlusion. Our aim was to evaluate the safety and feasibility of this new approach. Methods: A cross-sectional observational prospective study of patients underwent invasive diagnostic or therapeutic coronary procedures through the distal trans-radial access and traditional radial access. The primary endpoints were to access difficulties and in-hospital access-site related complications. Results: In 2 months, 190 patients underwent coronary procedures, of which 82 (43%) were selected in both distal transradial & traditional radial group. In 2(2.4%) & 3 (3.6%) cases, distal radial & traditional radial access cannulation was unsuccessful respectively (p >0.05). The mean age was 57.7 ± 10 & 57.2 ± 10 years in successful distal transradial & traditional radial cases respectively. There were no any major vascular complications in distal transradial group while there were 2 vascular complications in traditional radial group (p > 0.05). Conclusions: Distal transradial access is feasible and safe in selected cases, when performed by experienced operators. Larger case series and randomized trials are required to determine its efficacy in reducing vascular complications when comparing to the traditional technique.

Index of microcirculatory resistance: state-of-the-art and potential applications in computational simulation of coronary artery disease

The dysfunction of coronary microcirculation is an important cause of coronary artery disease(CAD).The index of microcirculatory resistance(IMR)is a quantitative evaluation of coronary microcirculatory function,which provides a significant reference for the prediction,diagnosis,treatment,and prognosis of CAD.IMR also plays a key role in investigating the interaction between epicardial and microcirculatory dysfunctions,and is closely associated with coronary hemodynamic parameters such as flow rate,distal coronary pressure,and aortic pressure,which have been widely applied in computational studies of CAD.However,there is currently a lack of consensus across studies on the normal and pathological ranges of IMR.The relationships between IMR and coronary hemodynamic parameters have not been accurately quantified,which limits the application of IMR in computational CAD studies.In this paper,we discuss the research gaps between IMR and its potential applications in the computational simulation of CAD.Computational simulation based on the combination of IMR and other hemodynamic parameters is a promising technology to improve the diagnosis and guide clinical trials of CAD.

Correlation between Hypertension and SYNTAX Score in Patients with Chest Pain Admitted to Cardiology Department for Coronary Angiography

Background: Hypertension is associated with an increased risk of cardiovascular events, cardiovascular and all-cause mortality. However, the diagnostic ability of hypertension for the presence and severity of CAD (coronary artery disease) has not been elucidated. This study investigates the relationship between hypertension and CAD complexity using the SYNTAX score to determine hypertension’s roles in coronary heart disease progression. Method: This is a prospective study that includes consecutive 410 adult patients at mean age (61 ± 11 years) who are admitted to Cardiology Department and undergo invasive coronary angiography (CAG) where a significant coronary lesion (SCL) is defined as stenosis ≥50% in vessel diameter ≥ 1.5 mm. The SYNTAX scores were calculated using the SYNTAX score algorithm. Results: The mean rank of SYNTAX score was significantly higher among hypertension than non-hypertension (mean rank: 279, 184, p = 0.006) groups. SYNTAX score was positively correlated with age (r: 0.263, p < 0.001) and LDL (correlation coefficient 0.102, p = 0.038) but inversely with HDL (r: 0.107, p = 0.031), in multivariate linear regression age (regression coefficient 0.3, p < 0.001), male (-4.4, p = 0.002), HDL (-6.4, p = 0.002) were significant independent risk factors for SYNTAX score, in ordinal regression model aging (odd ratio: 1.08, p < 0.001), being a male (2.84, p = 0.026), HDL (0.05, p < 0.001), BMI (0.86, p = 0.020) were significantly independent predictor of increase or decrease probability of falling in high syntax score group. Conclusion Hypertension affects the distribution of SYNTAX score among patients with and without hypertension, and the prevalence of significant coronary lesions was more frequent in hypertensive patients. Hypertension was not a predictor of significant or complex coronary artery lesion, but advanced age, being a male, HDL, LDL and BMI are considered as independent risk factors for high SYNTAX score, Subsequently and the complexity of CAD. Therefore, when patients with CAD have these factors, we expect that the Patient’s CAD complexity will be high.

Relationship between ApolipoproteinB 100/ApoA1 ratio and coronary artery disease in elderly

Background Less studies were done to compare the lipid ratios including ApoB100/ApoA1, LDL-C/HDL- C,TC/HDL-Cin elderly. So the study was to investigate the relationship between Apolipoprotein B100/ApoA1 ratio and coronary artery disease （CAD） in elderly. Methods 498 participants aged over 65 years with chest pain had been subsumed from Sep. 2009 to April 2011 of Guangdong General Hospital. Clinic informations of gender, age, history of hypertension, diabetes mellitus, smoking was collected. Simultaneously, serum lipids should be phlebotomized in 24 hours after be inpatient. ApoB100/ApoA1 ratio, LDL-C/HDL-C ratio. TC/HDL-C ratio, non-HDL-C were calculated using the above data. Accroding to the mean of ApoB100/ApoA1 ratio, ApoB100, non-HDL-C, all individuals were divided into two groups： high level group and low level group, while all individuals were divided into two groups whether the level of LDL-C was achieve 2.06 mmol/L. We classified the participants into CAD group and non-CAD group on the basis of CAG. The incidence of CAD was compared between the two groups of four different lipid indicators. The ability of estimating CAD was described by Reciever Operating Characteristic curve （ROC curve）. Result There were significantly statistical differences in the incidence of CAD between the high level group and low level group of ApoB100/ApoA1 ratio （75.0% vs. 55.9%, %2 = 19.681, P 〈 0.001）. By logistic regression analysis, odds ratio of ApoB100/ApoA1 ratio was 2.142, 95% CI （1.437, 3.195）（P 〈 0.001）. The AUC （area under curve） of ApoB100/ApoA1 ratio were 0.66. There were significant for diagnosis of CAD （P 〈 0.001）. Conclusion The ApoB100/ApoA1 ratio was an independent risk factor of CAD in elderly population, and it is better than traditional lipid indicators, and can be used for the ability of estimating CAD.

Advances in the treatment of nonalcoholic steatohepatitis

Nonalcoholic steatohepatitis is a subtype of metabolic dysfunction-associated liver disease which has emerged as one of the most common causes of cirrhosis and liver transplantation in the United States and many western countries.The two leading risk factors associated with nonalcoholic steatohepatitis are obesity and insulin resistance with patients often demonstrating features of the metabolic syndrome.Histological improvement including arrest or improvement in fibrosis can occur in patients who are able to modify these risk factors when diagnosed early in the course of their disease.In addition to the development of cirrhosis and its life-threatening complications including hepatocellular carcinoma,variceal bleeding,ascites and hepatic encephalopathy,nonalcoholic steatohepatitis is also associated with coronary artery,carotid artery and peripheral vascular disease with coronary artery disease identified as the most common cause of death.Although multiple clinical trials evaluating a variety of medications targeted at different aspects in the pathogenesis and progression of nonalcoholic steatohepatitis have been completed and are still in progress,there is currently no approved treatment for this disease except for risk factor modification.This article will review the most recent and salient medical advances in the treatment of nonalcoholic steatohepatitis.

Comprehensive metabolomic characterization of coronary artery diseases

With the support by the National Natural Science Foundation of China,the research team led by Prof.Qi Lianwen(齐炼文)at the State Key Laboratory of Natural Medicines,China Pharmaceutical University,uncovered the disturbed metabolic pathways to assess the diagnostic value of metabolomics-based biomarkers in different types of coronary artery disease(CAD),which was published in Journal of the