High Density Lipoprotein Cholesterol Comes of Age

Despite the excellent success of lowering low-density lipoprotein cholesterol (LDLc) cholesterol for treating coronary heart disease (CHD), a major part of the population still suffer from CHD. This fact is more prominent among the high risk patients who receive lipid lowering treatment with statins. This treatment is based on the prevailing view that LDL cholesterol (LDLc) is the only important risk factor for CHD. It is well known that HDL plays a crucial role for preventing CHD. Several epidemiologic studies and clinical trials have reported that high density lipoprotein cholesterol (HDLc) is an independent risk factor for CHD as well. A large scale meta-analysis of clinical trials clearly supports that increasing HDLc is equally important as decreasing LDLc, suggesting that physicians should pay attention to increasing HDLc as well as decreasing LDLc. Ongoing trials that are focused on this issue will test this hypothesis in the near future.

Severity of Coronary Artery Disease and Visceral Fat Obesity

BACKGROUND: The visceral fat obesity is known to be associated with coronary artery disease. We investigated the relation between visceral fat obesity and the severity of coronary artery disease by angiography. METHODS: The coronary artery disease (CAD) group included 54 angina patients (43 men and 11 women) with angiographically demonstrated coronary artery disease. The control group included angiographically normal 28 controls (15 men and 13 women). The subjects with hypertension, non-insulin dependent diabetes mellitus (NIDDM) and taking any medication known to affect the insulin sensitivity were excluded. We measured the visceral fat area, abdominal subcutaneous fat area, thigh muscle area and the thigh fat area with computed tomography (CT) in both groups. We measured the plasma lipid profile, fasting plasma insulin and glucose level in both groups. RESULTS: There were no differences in the age, sex ratio and body mass index (BMI) between both groups. Total cholesterol and triglyceride increased in CAD group significantly (p<0.05, p<0.001). The HDL cholesterol decreased in CAD group. But there was no statistical significance (p=0.056). The fasting insulin increased in CAD group significantly (p<0.001). There were significant differences between CAD group and the control group in the visceral fat area (117.8+/-34.4 cm2vs. 85.5+/-17.6 cm2, p<0.001), thigh fat area (50.0+/-22.3 cm2vs. 65.8+/-12.9 cm2, p<0.001), visceral fat to abdominal subcutaneous fat area ratio (VS ratio:0.81+/-0.31 vs. 0.51+/-0.15, p<0.001) and the visceral fat to thigh fat area ratio (VSFTF ratio:2.72+/-1.24 vs. 1.34+/-0.35, p<0.001). In the male subgroup (CAD:43, control:15), triglyceride and fasting insulin increased in CAD group significantly (p<0.001). The visceral fat area, VS ratio, and VSFTF ratio increased in CAD group significantly (P<0.001) The thigh fat area decreased in CAD group significantly (P<0.001). In the female subgroup (CAD:11, control:13), fasting insulin and visceral fat area increased in CAD group significantly (p<0.001, p<0.05). Multiple logistic regression analysis revealed that VSFTF ratio, fasting insulin and the HDL cholesterol were independent associated factors of coronary artery disease. In comparison with normal control, one-vessel disease and multi-vessel disease (two vessel and three vessel), there were significant differences between groups in fasting insulin, triglyceride, visceral fat area, thigh fat area, VS ratio, VSFTF ratio. In Turkey's HSD Post Hoc test, however, there were no significant differences between one-vessel disease and multi-vessel disease. CONCLUSION: We observed significant increases in the visceral fat area, VS ratio and VSFTF ratio and decrease in thigh fat area in angiographically demonstrated CAD group compared with age, BMI matched angiographically normal control. But we did not observed any relation between the visceral fat area and the severity of coronary disease by angiography.

Visceral Fat Accumulation in Coronary Artery Disease

BACKGROUND: The visceral fat accumulation, an important factor to increase the insulin resistance is known to be associated with coronary artery disease. We investigated the relation between visceral fat accumulation and the coronary artery disease. METHODS: The coronary artery disease (CAD) group included 14 patients (9 men and 5 women) with angina pectoris. All patients had typical chest pain, diagnosed as coronary artery disease with coronary angiogram or treadmill test. The patients with hypertension, hyperlipidemia, non-insulin dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT) and taking any medication known to affect the insulin sensitivity were excluded. The control group included 24 healthy volunteers (11 men and 13 women) who were not taking any medication. We measured the visceral fat area, abdominal subcutaneous fat area, thigh muscle area and the thigh fat area with computed tomography (CT) in both groups. We measured the plasma lipid profile, plasma insulin and glucose level during the oral glucose tolerance test in both groups. RESULTS: There were no differences in the age, sex ratio, body mass index (BMI) and the waist to hip ratio (WHR) between both groups. The total cholesterol and LDL cholesterol were significantly higher in CAD group (p<0.001). The HDL cholesterol was significantly lower in CAD group (p<0.05). The fasting insulin, fasting glucose, area under curve (AUC) of the insulin and glucose, and the insulin to glucose (IG) ratio were significant higher in CAD group (p<0.001). There were significant differences between CAD group and the control group in the visceral fat area (94.2+/-19.1 cm2 vs. 76.5+/-34.3 cm2, p<0.05), thigh fat area (60.2+/-24.8 cm2 vs. 92.6+/-41.0 cm2, p<0.01) and the visceral fat to thigh fat area ratio (VSFTF ratio : 1.74+/-0.61 vs. 1.07+/-0.80, p<0.01). The visceral fat area was independently associated with fasting insulin (r=0.661, p<0.01), fasting glucose (r=0.490, p<0.05), the AUC of glucose (r=0.605, p<0.01), HDL cholesterol (r= -0.528, p<0.01) and triglyceride (r=0.483, p<0.05) in control group. After adjustment for visceral fat area, there were still significant differences in the fasting insulin, fasting glucose, AUC of insulin, AUC of glucose and the IG ratio between both groups. CONCLUSION: We observed significant increase in the visceral fat area and VSFTF ratio and decrease in thigh fat area in CAD group compared with age, BMI, WHR matched control group. The insulin resistance was observed in the CAD group. The visceral fat area and VSFTF ratio was associated with cardiovascular risk factors such as low HDL cholesterol and the insulin resistance in control group.

Visceral Fat Accumulation in Coronary Artery Disease

BACKGROUND: The visceral fat accumulation, an important factor to increase the insulin resistance is known to be associated with coronary artery disease. We investigated the relation between visceral fat accumulation and the coronary artery disease. METHODS: The coronary artery disease (CAD) group included 14 patients (9 men and 5 women) with angina pectoris. All patients had typical chest pain, diagnosed as coronary artery disease with coronary angiogram or treadmill test. The patients with hypertension, hyperlipidemia, non-insulin dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT) and taking any medication known to affect the insulin sensitivity were excluded. The control group included 24 healthy volunteers (11 men and 13 women) who were not taking any medication. We measured the visceral fat area, abdominal subcutaneous fat area, thigh muscle area and the thigh fat area with computed tomography (CT) in both groups. We measured the plasma lipid profile, plasma insulin and glucose level during the oral glucose tolerance test in both groups. RESULTS: There were no differences in the age, sex ratio, body mass index (BMI) and the waist to hip ratio (WHR) between both groups. The total cholesterol and LDL cholesterol were significantly higher in CAD group (p<0.001). The HDL cholesterol was significantly lower in CAD group (p<0.05). The fasting insulin, fasting glucose, area under curve (AUC) of the insulin and glucose, and the insulin to glucose (IG) ratio were significant higher in CAD group (p<0.001). There were significant differences between CAD group and the control group in the visceral fat area (94.2+/-19.1 cm2 vs. 76.5+/-34.3 cm2, p<0.05), thigh fat area (60.2+/-24.8 cm2 vs. 92.6+/-41.0 cm2, p<0.01) and the visceral fat to thigh fat area ratio (VSFTF ratio : 1.74+/-0.61 vs. 1.07+/-0.80, p<0.01). The visceral fat area was independently associated with fasting insulin (r=0.661, p<0.01), fasting glucose (r=0.490, p<0.05), the AUC of glucose (r=0.605, p<0.01), HDL cholesterol (r= -0.528, p<0.01) and triglyceride (r=0.483, p<0.05) in control group. After adjustment for visceral fat area, there were still significant differences in the fasting insulin, fasting glucose, AUC of insulin, AUC of glucose and the IG ratio between both groups. CONCLUSION: We observed significant increase in the visceral fat area and VSFTF ratio and decrease in thigh fat area in CAD group compared with age, BMI, WHR matched control group. The insulin resistance was observed in the CAD group. The visceral fat area and VSFTF ratio was associated with cardiovascular risk factors such as low HDL cholesterol and the insulin resistance in control group.

Immediate Results of AVE Micro-II Stent

BACKGROUND: Several kinds of stents have shown their safety and efficacy to treat acute or subacute closure after balloon angioplasty as well as to reduce restenosis rate. However, one of the limitations of stents is difficult to deploy especially in tortuos vessels, lesions at a bend, and distal to previously deployed stents. The Micro stent II, which was one of the most recently developed stents, ia a rapid-exchage balloon expandable stainless steel stent with a zigzag design connected with a continuous single weld in each 3mm segments. It scores over excellent trackability and optimum radio-opacity. Therefore, it is easy to operate and feasible in tortuous, distal lesions and variety of lesion lengths. We report our experiences with Micro-II stent implanatation in the first 76 patients at Tonsei cardiovascular center to assess its safety and efficacy in patients with complex coronary anatomy and clinical results in the first months. METHODS: Between January 1996 and July 1996, eighty-six Micro-II stent were implanted in the coronary arteries of 76 patients(male 65.8%, age 59+/-10 year). Forty-five patients had unstable angina, the others had stable angina(17pts), acute myocardial infarction(14pts). RESULTS: 1) Indication of stenting was de novo 51(59.3%), suboptimal result 25(29.1%), restenosis 1(1.2%) and 9(10.4%) of lesions were stented in bail out situation. 2) Single stent were implanted in 76(88.4%)lesions, overlapping stent in 10(11.6%)lesions. Among overlapping stents, the second stent with Micro-II stent and with another kind of stent were 4.6%, 7.0%, respectively. 3) Procedure related complication including a subacute closure was occurred in 1(1.2%) patient who had distal dissection and 45% residual stenosis. In 12(14%) lesions, preistent dissection has been noticed after stent impantation. 4) Angiographic success(defined as a residual stenosis of <30% without major dissection) was achieved in 82 of 86 attempts(95.3%). The procedual success rate(defined as a residual stenosis of <30% without occurrence of major clinical events within 4 weeks after procesure) was 96.1%(73/76 patients). Angiographic success and procedural success rate in calcified lesion were 100% and 100%, respectively. Angiographic success and procedural success rate in more than 45` angulated lesion were 97% and 100%, respectively. 5) The mean minimal luminal diameter of the target lesions was increased from 0.42+/-0.40mm before stent implantation to 2.93+/-0.50mm(p<0.001). The percentage of diameter stenosis was reduced from 86.49+/-13.04% to 1.40+/-7.11%(p<0.001) after stent implantation. CONCLUSION: Coronary stenting with AVE Micro-II stent can be safety performed and is particularly beneficial in tortuous and calcified arteries. There was a high tendency for peristent dissection which need to special consideration to avoid. Follow-up data is needed to assess mid and term patency. Coronary artery disease . AVE Micro-II stent . Immediate results.

Insulin Resistance as an Associated Factor of Essential Hypertension in Korean

BACKGROUND: The insulin resistance is reported as the independent risk factor of the DM and the ischemic heart disease. The association between the insulin resistance and the essential hypertension was reported at the various countries and races. We performed this study to know if the hypertensive patients show the increased insulin resistance than that of the normotensive persons and factors that influence the insulin resistance and the blood pressure. METHODS: The serum lipid profiles, OGTT, body habitus measurement and abdominal CT at umbilical level were performed in 24 hypertensive patients(male : 10, female : 14) and 45 normotensive persons(male : 19, female : 26) who showed the same distributions of age, sex, weight and body mass index(BMI). RESULTS: The average age of the hypertensive group was 49.1+/-7.9 years, and that of the normotensive group was 46.1+/-7.6 years(p>0.05). The average blood pressure of the hypertensive group was 152.2+/-14.2/98.4+/-6.4mmHg and that of the normotensive group was 116.8+/-9.4/78.2+/-49.mmHg(p<0.001). The hypertensive group had significantly higher area under curve(AUC) of glucose(246.8+/-30.4 Vs 219.2+/-32.2mg/dL.hr) and AUC of insulin(88.9+/-38.2 Vs 69.6+/-34.2microU/mL.hr) than the normotensive group(p<0.05), while there were no differences in the age, sex, weight, body mass index(BMI) and waist to hip ratio(WHR) between two groups. They had nodifferences in lipid profile and plasma renin activity. In CT assessment, the hypertensive group had significantly higher visceral fat to thigh muscle area ratio(VSFTM ratio)(0.61+/-0.29 Vs 0.47+/-0.20) and visceral fat to thigh muscle and fat area ratio(VSFTMF ratio)(0.27+/-0.10 Vs 0.22+/-0.13)(p<0.05), while they had same degree of visceral fat to subcutaneous fat area(VS) ratio and visceral fat area. The visceral fat area, VSFTM ratio, VS ratio, visceral fat area to thigh fat area ratio(VSFTF ratio) were positively correlated with AUC of insulin and AUC of glucose ordinary(p<0.05). After adjustment for plasma insulin, AUC of insulin, VS ratio, VSFTM ratio, age and BMI, the AUC of glucose was positively correlated with the diastolic blood pressure(R square=0.19, p <0.05) and the AUC of glucose and WTR were positively correlated with the systolic blood pressure(R square=0.26, p<0.05). THe subgroup over the 75 percentile of AUC of glucose, AUC of insulin and VSFTM ratio in study population had significantly higher odds ratio of the hypertension(OR of AUC of glusose : 5.8, OR of AUC of insulin : 3.2, OR of VSFTM ratio : 4.5, p<0.05). CONCLUSION: These results suggest that the insulin resistance is more prevalent in the hypertensive patients and associated with the hypertension.