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Nature Reviews. Genetics Jun 2017Coronary artery disease is the leading global cause of mortality. Long recognized to be heritable, recent advances have started to unravel the genetic architecture of... (Review)
Review
Coronary artery disease is the leading global cause of mortality. Long recognized to be heritable, recent advances have started to unravel the genetic architecture of the disease. Common variant association studies have linked approximately 60 genetic loci to coronary risk. Large-scale gene sequencing efforts and functional studies have facilitated a better understanding of causal risk factors, elucidated underlying biology and informed the development of new therapeutics. Moving forwards, genetic testing could enable precision medicine approaches by identifying subgroups of patients at increased risk of coronary artery disease or those with a specific driving pathophysiology in whom a therapeutic or preventive approach would be most useful.
Topics: Animals; Coronary Artery Disease; Humans; Precision Medicine; Translational Research, Biomedical
PubMed: 28286336
DOI: 10.1038/nrg.2016.160 -
In Vivo (Athens, Greece) 2019Current literature indicates that there is a strong correlation between coronary artery disease (CAD) and type 2 diabetes. The arteriosclerotic progression occurs... (Meta-Analysis)
Meta-Analysis Review
Current literature indicates that there is a strong correlation between coronary artery disease (CAD) and type 2 diabetes. The arteriosclerotic progression occurs earlier and in a greater extent in the diabetic than in the non-diabetic population. In diabetic subjects, the detection of arterial disease does not always precede the development of an acute arterial incident. Herein, we reviewed studies published within the last 5 years in order to reveal the risk factors for coronary artery disease in patients with type 2 diabetes. In addition, we aimed to discuss how to diagnose in an early stage or even screen the presence of coronary artery disease in asymptomatic diabetic patients. Possible blood markers as predictors of CAD, which are mostly related to the lipidemic profile of subjects, are included in this review. Less invasive imaging methods than conventional coronary angiography, included in the article, are gradually used more in the diagnosis of CAD and show high effectiveness. Data from 23 articles with 22,350 patients having type 2 diabetes were summarized and presented descriptively.
Topics: Animals; Biomarkers; Coronary Artery Disease; Diabetes Mellitus, Type 2; Diagnostic Imaging; Disease Susceptibility; Humans; Mass Screening; Prognosis; Risk Assessment; Risk Factors
PubMed: 31280191
DOI: 10.21873/invivo.11572 -
Circulation Journal : Official Journal... Apr 2016With ongoing progress in the prevention and treatment of coronary artery disease (CAD), a continued decrease in prevalence and lethality is expected in high-income... (Review)
Review
With ongoing progress in the prevention and treatment of coronary artery disease (CAD), a continued decrease in prevalence and lethality is expected in high-income countries. Prevention will include lipid-lowering, antithrombotic and anti-inflammatory therapies. With respect to the former, potent, safe and prolonged drugs (such as generic forms of PCSK9 inhibitors relying on monoclonal antibodies or miRNA) should result in a decreased incidence of acute coronary syndromes. Another key aspect will be the ability to identify genetic predictors of CAD and therefore implement targeted personalized prevention early in life. Curative treatment will involve a short course of potent and reversible antithrombotics, but long-term therapy will rely on the ability to stabilize or even regress plaque (eg, using PCSK9 inhibition or modified high-density lipoprotein infusions or anti-inflammatory therapies). Antithrombotic therapy will rely on highly reversible agents (or agents with specific titratable antagonists), and on personalized therapies in which the doses, combinations and duration of therapy will be determined differentially for each patient on the basis of clinical characteristics, genetic profiling and biomarkers. Finally, the need for revascularization in stable CAD will be rare, given the expected progress in prevention. The main challenge, 20 years from now, is likely to be the provision of such effective care at acceptable costs in low- and middle-income countries. (Circ J 2016; 80: 1067-1072).
Topics: Coronary Artery Disease; Forecasting; Humans; Precision Medicine
PubMed: 27063295
DOI: 10.1253/circj.CJ-16-0266 -
The American Journal of Medicine Aug 2021Coronary artery disease is a leading cause of morbidity and mortality worldwide. Noninvasive imaging tests play a significant role in diagnosing coronary artery disease,... (Review)
Review
Coronary artery disease is a leading cause of morbidity and mortality worldwide. Noninvasive imaging tests play a significant role in diagnosing coronary artery disease, as well as risk stratification and guidance for revascularization. Myocardial perfusion imaging, including single photon emission computed tomography and positron emission tomography, has been widely employed. In this review, we will review test accuracy and clinical significance of these methods for diagnosing and managing coronary artery disease. We will further discuss the comparative usefulness of other noninvasive tests-stress echocardiography, coronary computed tomography angiography, and cardiac magnetic resonance imaging-in the evaluation of ischemia and myocardial viability.
Topics: Cardiac Imaging Techniques; Coronary Artery Disease; Humans; Myocardial Perfusion Imaging; Prognosis
PubMed: 33864764
DOI: 10.1016/j.amjmed.2021.03.011 -
Journal of the American College of... May 2018Coronary artery disease (CAD) is a major cause of morbidity and mortality in patients ≥80 years of age. Nonetheless, older patients have typically been...
Coronary artery disease (CAD) is a major cause of morbidity and mortality in patients ≥80 years of age. Nonetheless, older patients have typically been under-represented in cardiovascular clinical trials. Understanding the pathophysiology, epidemiology, and optimal means of diagnosis and treatment of CAD in older adults is crucial to improving outcomes in this high-risk population. A patient-centered approach, taking into account health status, functional ability and frailty, cognitive skills, and patient preferences is essential when caring for older adults with CAD. The present systematic review focuses on the current knowledge base, gaps in understanding, and directions for future investigation pertaining to CAD in patients ≥80 years of age.
Topics: Aged, 80 and over; Coronary Artery Disease; Humans
PubMed: 29724356
DOI: 10.1016/j.jacc.2017.12.068 -
Tidsskrift For Den Norske Laegeforening... Mar 2018
Topics: Coronary Artery Disease; Diabetes Mellitus; Humans
PubMed: 29513432
DOI: 10.4045/tidsskr.18.0152 -
Journal of the American College of... Sep 2016Pathogenesis and diagnostic biomarkers for diseases can be discovered by metabolomic profiling of human fluids. If the various types of coronary artery disease (CAD) can... (Comparative Study)
Comparative Study
BACKGROUND
Pathogenesis and diagnostic biomarkers for diseases can be discovered by metabolomic profiling of human fluids. If the various types of coronary artery disease (CAD) can be accurately characterized by metabolomics, effective treatment may be targeted without using unnecessary therapies and resources.
OBJECTIVES
The authors studied disturbed metabolic pathways to assess the diagnostic value of metabolomics-based biomarkers in different types of CAD.
METHODS
A cohort of 2,324 patients from 4 independent centers was studied. Patients underwent coronary angiography for suspected CAD. Groups were divided as follows: normal coronary artery (NCA), nonobstructive coronary atherosclerosis (NOCA), stable angina (SA), unstable angina (UA), and acute myocardial infarction (AMI). Plasma metabolomic profiles were determined by liquid chromatography-quadrupole time-of-flight mass spectrometry and were analyzed by multivariate statistics.
RESULTS
We made 12 cross-comparisons to and within CAD to characterize metabolic disturbances. We focused on comparisons of NOCA versus NCA, SA versus NOCA, UA versus SA, and AMI versus UA. Other comparisons were made, including SA versus NCA, UA versus NCA, AMI versus NCA, UA versus NOCA, AMI versus NOCA, AMI versus SA, significant CAD (SA/UA/AMI) versus nonsignificant CAD (NCA/NOCA), and acute coronary syndrome (UA/AMI) versus SA. A total of 89 differential metabolites were identified. The altered metabolic pathways included reduced phospholipid catabolism, increased amino acid metabolism, increased short-chain acylcarnitines, decrease in tricarboxylic acid cycle, and less biosynthesis of primary bile acid. For differential diagnosis, 12 panels of specific metabolomics-based biomarkers provided areas under the curve of 0.938 to 0.996 in the discovery phase (n = 1,086), predictive values of 89.2% to 96.0% in the test phase (n = 933), and 85.3% to 96.4% in the 3-center external sets (n = 305).
CONCLUSIONS
Plasma metabolomics are powerful for characterizing metabolic disturbances. Differences in small-molecule metabolites may reflect underlying CAD and serve as biomarkers for CAD progression.
Topics: Aged; Coronary Artery Disease; Female; Humans; Male; Metabolomics; Middle Aged
PubMed: 27634119
DOI: 10.1016/j.jacc.2016.06.044 -
JACC. Cardiovascular Interventions Sep 2020
Topics: Coronary Artery Disease; Humans; Mitral Valve; Mitral Valve Insufficiency; Treatment Outcome
PubMed: 32972577
DOI: 10.1016/j.jcin.2020.07.015 -
International Heart Journal Dec 2016Gut microbiota have been attracting increased attention in many fields of medicine recently. We can perform a comprehensive analysis of gut microbiota using... (Review)
Review
Gut microbiota have been attracting increased attention in many fields of medicine recently. We can perform a comprehensive analysis of gut microbiota using next-generation sequencing techniques together with bioinformatics technology, which expands our knowledge of a large ecosystem consisting of a host and gut microbiota. We summarize some reports about the correlations between gut microbiota and metabolic disorders, particularly atherosclerosis, and discuss future directions for the diagnostic or therapeutic potential of gut microbiota. To take simple examples, we demonstrated that the order Lactobacillales was significantly increased; while the phylum Bacteroidetes was significantly decreased in coronary artery disease (CAD) patients compared with controls or healthy volunteers. The characteristics of gut microbiota in type 2 diabetes and dyslipidemia have been reported. However, these studies have limitations, and the biological significance of gut microbiota and the causal relationships are still controversial. We hope the reports listed in this review article might lead to the development of a novel therapy to prevent CAD via modulating gut microbiota or their metabolites.
Topics: Coronary Artery Disease; Gastrointestinal Microbiome; Gastrointestinal Tract; Humans
PubMed: 27818484
DOI: 10.1536/ihj.16-414 -
Ischemia with No Obstructive Arteries (INOCA): A Review of the Prevalence, Diagnosis and Management.Current Problems in Cardiology Jan 2023Ischemia with no obstructive arteries (INOCA) is defined as patients with angiographic evidence of ischemia but no obstructive coronary artery disease (CAD) at coronary... (Review)
Review
Ischemia with no obstructive arteries (INOCA) is defined as patients with angiographic evidence of ischemia but no obstructive coronary artery disease (CAD) at coronary angiography. INOCA is estimated to be prevalent is 3-4 million individuals with a female predominance. INOCA is composed of different endotypes including: microvascular dysfunction, vasospasm and a combination of the 2. Diagnosis of INOCA requires either non-invasive or invasive techniques aimed at assessing coronary flow reserve (CFR), Index of Microcirculatory Resistance (IMR) and spasm secondary to acetylcholine injection. Although INOCA is associated with an increased risk of MACE and a decrease in quality of life, less than half of patients are appropriately treated. Treatment of INOCA remains elusive with current therapeutics tailored towards the specific endotype and ongoing clinical trials looking to assess the efficacy of traditional CAD medications.
Topics: Humans; Female; Male; Microcirculation; Prevalence; Quality of Life; Coronary Artery Disease; Ischemia; Arteries
PubMed: 36183980
DOI: 10.1016/j.cpcardiol.2022.101420