The multiplicative interactions of leukocyte counts with some other risk factors enhance the prognostic value for coronary artery disease.

BACKGROUND: The markers of inflammation and (apo)lipoproteins are associated with coronary artery disease (CAD). Simultaneous assessment of the risk factors has been proposed to improve the diagnosis of CAD. The aim of this study was to examine the potential interactions between leukocyte counts and other risk factors. METHODS: The markers of inflammation, (apo)(lipo)proteins, (non)electrolytes, hematological parameters and classical risk factors, were determined in 264 clinically stable angiographically documented subjects. The subjects were classified as CAD cases or controls according to the results of coronary angiography. RESULTS: The frequency and severity of CAD, Framingham CAD scores, relative and absolute risk for CAD and the prevalence of diabetes mellitus and smoking were significantly higher in the third relative to the first tertile of leukocyte counts. Subjects with leukocyte counts in the upper tertile had significant higher levels of serum glucose, triglyceride, hsC-reactive protein, potassium, phosphorus and measured osmolality, and lower levels of apoAI, total protein, albumin and the ratio of albumin/globulins. Analyses by bivariate correlation on differential leukocyte counts showed that these associations are carried mostly by neutrophil, except for diabetes, glucose and triglyceride which were due to lymphocyte counts. By constructing dummy combined variables, high leukocyte counts accompanied by smoking, hypertension, diabetes, and high levels of serum glucose, cholesterol, apoB and apoB/apoAI ratio, exhibited amplified high risk for CAD. CONCLUSIONS: The results show that leukocyte count does interact multiplicatively with smoking, hypertension, diabetes, glucose, cholesterol, apoB and apoB/AI ratio. The simultaneous assessment of leukocyte counts and interactive risk factors enhances the diagnosis of CAD.

Interactions of lipoprotein(a) with diabetes mellitus, apolipoprotein B and cholesterol enhance the prognostic values for coronary artery disease.

BACKGROUND: Synergistic interactions between elevated serum lipoprotein(a) [Lp(a)] and other unfavorable risk factors have been proposed to cause very high risk for coronary artery disease (CAD). The aim of this study was to examine the potential interactions between Lp(a) and other risk factors. METHODS: The profiles of serum (apo)(lipo)proteins, markers of inflammation, indicators of hemoconcentration as well as classical risk factors were determined in 264 clinically stable angiographically documented subjects. Correlation, linear and logistic regression and stratification analyses were performed. RESULTS: The frequency and severity of CAD and the prevalence of diabetes mellitus were significantly higher in the 3rd relative to 1st tertile of Lp(a). Subjects with Lp(a) levels in the upper tertile had significantly higher levels of serum glucose, total cholesterol and low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (apoB), calcium, phosphate and their ion product. Bivariate correlation analysis indicated that serum Lp(a) was associated positively with the occurrence and severity of CAD, diabetes mellitus and the levels of serum glucose, cholesterol, LDL-C, apoB, calcium, phosphate and inversely to physical inactivity. In linear regression analysis, LDL-C (or apoB), diabetes, physical inactivity and phosphate were the major independent determinants of Lp(a) values. In multiple logistic regression analysis, after adjusting for major risk factors, Lp(a) showed a significant and independent association with the prevalence of CAD. By constructing dummy combined variables, elevated Lp(a) accompanied with diabetes or high levels of serum glucose, apoB and cholesterol exhibited an amplified high risk for CAD. CONCLUSIONS: The results indicate that serum Lp(a) does interact multiplicatively with diabetes, apoB and cholesterol. The simultaneous assessment of Lp(a) and interactive risk factors enhances the discriminating value for CAD.

Indicators of dehydration and haemoconcentration are associated with the prevalence and severity of coronary artery disease.

1. The vascular endothelium is injured by blood flow abnormalities exacerbated by different risk factors, including markers of haemoconcentration. The aim of the present study was to assess the association between markers of haemoconcentration and dehydration and the prevalence and severity of coronary artery disease (CAD). 2. Subjects in the present study (189 men and 126 women) were classified as either CAD cases or controls according to the results of coronary angiography. The severity of CAD was scored on the basis of the number and the extent of lesions on coronary arteries. Serum electrolytes, osmolality and haematological parameters were measured. 3. Compared with control subjects, patient with CAD had increased levels of serum osmolality, calculated osmolality, tonicity, sodium, glucose and blood urea nitrogen (BUN). Significant differences were also observed in the haematocrit and haemoglobin concentration, but not in erythrocyte counts and total serum protein. On multiple logistic regression analysis adjusting for major risk factors, serum osmolality, glucose and BUN exhibited significant associations with CAD, but the correlations were lessened by diabetes. Analysis using anova showed a significant correlation between serum osmolality, sodium, glucose and BUN and the severity of CAD. The area under the receiver operating characteristic curves, as a relative measure of the test's efficiency, was the highest and significant for serum osmolality, BUN and glucose. 4. The results indicate that some of the markers of dehydration and haemoconcentration are associated significantly with the prevalence and severity of CAD, but the independence of these correlations is questioned. These markers may play a role in the pathogenesis of atherosclerosis.

Total and differential leukocytes counts, but not hsCRP, ESR, and five fractioned serum proteins have significant potency to predict stable coronary artery disease.

BACKGROUND: The role and diagnostic value of markers of inflammation is well recognized in acute coronary syndromes but it is uncertain in patients with stable coronary artery disease (CAD). This study was done to investigate the association of markers of inflammation with the occurrence and severity of CAD and to evaluate their predictive values. METHODS: Markers of inflammation, electrophoresis serum protein fractions, serum (apo)lipoproteins and classical risk factors were determined in 270 angiographically documented subjects. The subjects were classified as CAD cases and controls according to angiography. The severity of CAD was scored on the basis of the number and extent of lesions. RESULTS: The counts of total leukocytes (7.14+/-1.86 cell/nl vs. 6.58+/-1.62, p

Interactions of serum hsCRP with apoB, apoB/AI ratio and some components of metabolic syndrome amplify the predictive values for coronary artery disease.

BACKGROUND: Plasma high-sensitivity CRP (hsCRP) is a marker of inflammation, and it is reported to link with coronary artery disease (CAD). Interactions between elevated serum hsCRP and other unfavorable risk factors have been proposed to cause high risk for CAD. OBJECTIVES: To examine the potential interactions between serum hsCRP and lipids and non-lipidic risk factors. METHODS: Markers of inflammation, the profiles of serum (apo)(lipo) proteins as well as classical risk factors were determined in 270 clinically stable angiographically documented subjects. The patients were stratified into tertiles according to hsCRP distribution. RESULTS: The Framingham CAD scores, relative and absolute risk for CAD and the prevalence of diabetes mellitus and hypertension were significantly higher in 3rd relative to 1st tertile of hsCRP. Subjects with hsCRP levels in the upper tertile had significant higher levels of serum glucose, triglyceride, apolipoprotein (apo)B, apoB/apoAI ratio and the counts of total leukocyte and neutrophil and lower levels of HDL-C, albumin and the ratio of albumin/globulins. Analyses by bivariate correlation as well as linear regression showed that serum hsCRP was associated positively with the occurrence of diabetes and hypertension, the counts of total leukocyte and neutrophil and the levels of serum glucose, uric acid, apoB, apoB/apoAI ratio, alpha1- and alpha2-globulins and inversely with albumin, albumin/globulin ratio and HDL-C. By constructing dummy combined variables, elevated hsCRP accompanied with male sex, diabetes, hypertension and high levels of serum glucose, apoB, apoB/apoAI ratio and cholesterol exhibited amplified high risk for CAD. CONCLUSIONS: The results show that hsCRP does interact multiplicatively with apoB and some variables of metabolic syndrome. The simultaneous assessment of hsCRP and interactive risk factors enhances discriminating value for CAD. It is suggested to use hsCRP in conjunction with apoB or apoB/apoAI ratio instead of cholesterol ratios in global risk assessment.

The ratio of apoB/apoAI, apoB and lipoprotein(a) are the best predictors of stable coronary artery disease.

BACKGROUND: The ratio of low- to high-density lipoprotein-cholesterol (LDL-C/HDL-C) conventionally represents the balance of proatherogenic and anti-atherogenic lipids. However, growing evidence supports the idea that the ratio of apolipoprotein (apo) B/apoAI is a better index for risk assessment of coronary artery disease (CAD). The aim of this study was to evaluate the efficiency of advanced profile of serum (apo)lipoproteins for predicting stable CAD in secondary prevention. METHODS: The study subjects, 138 men and 126 women aged 40-70 years, were classified as CAD cases or controls, according to the results of coronary angiography. The severity of CAD was scored on the basis of the number and extent of lesions in coronary arteries. Serum (apo)lipoproteins were measured by immunoturbidometric and electrophoresis methods. RESULTS: Patients with CAD compared with controls had increased serum levels of triglycerides (2.6+/-2.0 vs. 2.0+/-1.2 mmol/L, p< or =0.005), apoB (1.36+/-0.31 vs. 1.19+/-0.24 g/L, p< or =0.0001), lipoprotein(a) [Lp(a)] (0.69+/-0.60 vs. 0.43+/-0.31 g/L, p< or =0.0001) and apoB/apoAI ratio (1.07+/-0.32 vs. 0.87+/-0.18, p< or =0.0001), and decreased serum levels of HDL-C (1.02+/-0.29 vs. 1.11+/-0.34 mmol/L, p< or =0.03), apoAI (1.32+/-0.22 vs. 1.37+/-0.19 g/L, p< or =0.04) and LDL-C/apoB ratio (0.91+/-0.32 vs. 1.02+/-0.25 mmol/g, p< or =0.01). Multiple logistic regression analysis after adjusting for major risk factors showed that the apoB/apoAI ratio, apoB and Lp(a) were among seven significant and independent determinants of CAD. The area under the receiver operating characteristic (ROC) curves (AUC) as a relative measure of test efficiency was highest and significant for the apoB/apoAI ratio (AUC=0.71, p< or =0.0001), apoB (0.67, p< or =0.0001), Lp(a) (0.63, p< or =0.001), the LDL-C/apoB ratio (0.62, p< or =0.006), triglycerides (0.62, p< or =0.004) and apoAI (0.58, p< or =0.05). ANOVA analysis showed significant association for the apoB/apoAI ratio, apoB, Lp(a) and triglycerides, and moderate association for total cholesterol and its subfractions, with the severity of CAD. CONCLUSIONS: The results indicate that the apoB/apoAI ratio, apoB and Lp(a) are independent risk factors for CAD and are superior to any of the cholesterol ratios. We suggest using the apoB/apoAI ratio as the best marker of CAD in clinical practice.

Serum calcium and phosphorus associate with the occurrence and severity of angiographically documented coronary heart disease, possibly through correlation with atherogenic (apo)lipoproteins.

The associations of serum calcium and phosphorus concentrations as well as other cardiovascular risk factors were investigated in relation to the existence and severity of coronary heart disease (CHD) in 260 clinically stable, angiographically defined CHD patients aged 40-70 years. The subjects were classified as CHD(+) cases if one or more coronary arteries had a significant stenosis (> or =70%) and CHD(-) controls if there was no stenosis (< or =10%) in any artery. The severity of coronary occlusion was scored on the basis of the number and extent of lesions, as normal, mild, moderate or severe. Fasting serum concentrations of electrolytes, lipids and (apo)lipoproteins were determined. The concentrations of serum total calcium (2.41 +/-0.14 vs. 2.33 +/- 0.22 mmol/L, p < or = 0.05), albumin-corrected calcium (2.33 +/- 0.25 vs. 2.23 +/- 0.25 mmol/L, p < or = 0.01), phosphorus (1.32 +/-0.21 vs. 1.25 +/- 0.17 mmol/L, p < or = 0.007) and the ion product of calcium and phosphorus (3.16 +/- 0.58 vs. 2.91 +/- 0.50, p < or =0.0001) were significantly higher in the CHD(+) compared to the CHD(-) group. Patients with CHD compared with controls had increased serum levels of triglyceride, total cholesterol, low-density lipoprotein-cholesterol (LDL-C), apolipoprotein B (apoB), lipoprotein(a) [Lp(a)] and decreased serum levels of high-density lipoprotein (HDL)-C and apoAI. Multiple logistic regression analysis showed strong and significant association between diabetes mellitus (odds ratio, OR = 5.24, p < or = 0.0001), male gender (OR = 8.84, p < or =0.0001), Lp(a) (OR = 1.014, p < or =0.006), hypertension (OR = 2.61, p < or =0.02), apoB (OR = 1.031, p < or =0.001), age (OR = 1.055, p < or =0.003), phosphorus (OR = 2.438, p < or =0.01), albumin-adjusted calcium (OR = 1.532, p < or =0.05), cholesterol (OR = 1.009, p < or =0.05) and the occurrence of CHD. On the basis of bivariate correlation analysis, serum-adjusted calcium was positively correlated with the levels of cholesterol (r = 0.285, p < or =0.0001), LDL-C (r = 0.320, p < or =0.0001), Lp(a) (r = 0.173, p < or = 0.005), apoB (r = 0.237, p < or =0.0001), LDL-C/apoB ratio (r = 0.180, p < or= 0.007), apoAI (r = 0.181, p < or =0.003) and inversely to HDL-C (r = -0.146, p < or =0.02) and HDL-C/apoAI ratio (r = -0.263, p < or =0.0001). Serum phosphorus concentration was a significant correlate of triglyceride (r = 0.199, p < or =0.001) and Lp(a) (r = 0.129, p < or =0.04). The results demonstrated that serum calcium and phosphorus are associated with the prevalence and severity of CHD, probably through correlation with atherogenic lipids and (apo)lipoproteins. Serum calcium and phosphorus and their ion product were also independent risk factors for CHD.