Incorporating Lipoprotein Number Into Treatment Of Lipoprotein Disorders

Because public health efforts and the direction of clinical research have been based around the cholesterol model for so long, a fundamental change to a measure of atherogenic lipoprotein number could have important drawbacks. First, most of the evidence base is reported in terms of LDL-C. Indeed, the reliance on LDL-C is so ingrained that it almost requires researchers to reinterpret studies that actually measured LDL-C, just to make the results align with studies that used the weaker...

Association of Adiponectin With Cardiovascular Risk

The experimental studies discussed above suggest an antiatherogenic role ofadiponectin and that hypoadiponectinemia therefore might be associated with increased risk of atherosclerotic disease. Indeed, several cross-sectional clinical studies have reported lower serum levels in patients with CHD (138-142) than in control subjects. Kumada et al. (138) studied 225 consecutive male patients with CHD and compared them with 225 voluntary blood donors. They found a twofold increased risk of CHD...

Potential for different fragments for different pathophysiological processes

Cytosolic vs Structural Pools Evidence for Existence of Two Cellular Pools Based on the bimodal release kinetics of cTnl, it is assumed that there are at least two pools oftroponin (26,27). They have been labeled cytosolic and structural, but the studies that have been conducted have usually made that distinction predicated on the ability to displace the troponin based on the buffer necessary rather than immunohistochemistry. Displacement with gentle buffers has been suggested to be associated...

Info

In the four pages committed to a discussion of myocardial infarction in the first edition of Harrison's Principles of Internal Medicine, published in 1950, there was no mention of use of the laboratory for management of patients. Thirty years later, when the first edition of Braunwald's Heart Disease, A Textbook of Cardiovascular Medicine was published, 2 out of the 1943 pages in the text contained a discussion of the laboratory examinations in acute myocardial infarction. Our knowledge base of...

Novel Candidate Markers Of Hemodynamic Stress

To discover novel pathways induced in the heart in response to hemodynamic overload in vivo, we used DNA microarray technology to characterize on a genomewide scale the acute and long-term response of the heart to pressure overload (95). We used the well-established transverse aortic constriction model of pressure overload hypertrophy in mice in which an occluding clip is surgically placed around the transverse aorta to create a hemodynamic overload on the left ventricle. LV RNA was harvested...

Definition of nonstelevation acute coronary syndrome

Although acute coronary syndrome (ACS) constitutes a continuum, it is usually divided into ST-elevation ACS (STEACS) and non-ST-elevation ACS (NSTEACS) according to the electrocardiogram (ECG) changes at presentation (Fig. 1). Patients presenting with symptoms of acute cardiac ischemia and ST-elevation on the ECG are referred to as having STEACS. Owing to the high specificity of ST-elevation, STEACS is, in practice, equivalent to ST-elevation myocardial infarction (STEMI). Patients presenting...

Inflammatory Biomarkers and Clinical Utility

Some have argued that assessment of inflammatory biomarkers is superfluous because of the lack of evidence-based interventions that would be predicated on them. Moreover, some oppose the measurement of inflammatory biomarkers on the grounds that if they revealed higher risk in patients already receiving maximal medical therapy, those results would not change management. A more optimistic position would argue that residual risk indicated by inflammatory biomarkers in an optimally managed patient...

References

B-type natriuetic peptide a biomarker for all seasons. N Engl J Med 2004 350 718-720. 3. Wang TJ, Larson MG, Levy D, et al. Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med 2004 350 655-663. 4. Hunt SA, Baker DW, Chin MH, et al. ACC AHA guidelines for the evaluation and management of chronic heart failure in the adult executive summary a report of the American College of Cardiology American Heart Association Task Force on...

Natriuretic Peptides As Prognostic Tools In Ischemic Heart Disease

The prognostic utility of both ANPs and BNPs has been assessed in the setting of ACS. Whereas elevated plasma ANP levels are related to increased mortality risk after MI, they Nonischemic Factors Affecting BNP Levels Left ventricular systolic dysfunction Left ventricular diastolic dysfunction Pulmonary embolism Sepsis Valvular heart disease e.g., aortic stenosis do not appear to contribute additional prognostic information when added to other known predictors of increased mortality, such as...

Natalie Khuseyinova MD and Wolfgang Koenig MD PhD

Lipoprotein-Associated Phospholipase A2 Although an atherogenic lipoprotein phenotype has been well recognized as an important predictor of cardiovascular disease, recent studies have demonstrated a number of additional markers as emerging biomarkers to identify patients at risk for future coronary heart disease. Among them, lipoprotein-associated phopholipase A2 Lp-PLA2 , which is directly involved in the oxidation of low-density lipoprotein LDL and further atherosclerotic plaque development,...

SCD40L as a Marker for Platelet Activation

Lib Rations Troponines

Plaque rupture induces platelet activation through the liberation of collagen, thrombin, and adenosine 5'-diphosphate ADP Fig. 6 . Platelet activation results in an increased surface expression of CD40L, which subsequently is cleaved from the membrane surface. The released sCD40L can activate CD40 on endothelial cells and thereby induce a proinflammatory cascade in the vessel wall. Moreover, sCD40L can activate CD40, which is also expressed on inflammatory cells such as monocytes and T-cells....

Urotensin Expression in Hypertension and Heart Failure

A high density of urotensin receptors is found in the smooth muscle layer of coronary arteries and LV myocytes 69 . Urotensin is approx 50 times more potent than ET-1 in contracting human coronary, mammary, and radial arteries in responding tissue however, some samples fail to respond to urotensin but are reactive toward ET-1 69 . These results demonstrate binding of urotensin to the urotensin receptor in the human vasculature. Urotensin gene expression is abundant in the human kidney and...

Immunoinhibition Technique

Uln Troponin

Single value above 99th percentile of control reference population is surrogate of myocardial necrosis in setting of myocardial ischemia a Time of first increase for the markers was 1-3 h for myoglobin, 3-4 h for CK-MB mass, 3-4 h for cTnT, and 4-6 h for cTnl. b , modest cardiac specificity , high cardiac specificity , very high absolute cardiac specificity. LD2 isoenzymes predominated in serum after MI, frequently in an LD1 gt LD2 flipped pattern, whereas LD4 and LD5 predominated in patients...

Joseph B Muhlestein MD

Introduction Chlamydia pneumoniae Helicobacter pylori Mycoplasma pneumoniae Cytomegalovirus Other Herpesviruses Human Immunodeficiency Virus Influenza Virus Total Pathogen Burden as an Aggregate Serological Risk Factor Clinical Use of Infectious Markers for Risk Stratification Not Yet Ready for Prime Time Conclusion References Chronic infection has been found to be significantly associated with the development of atherosclerosis and the clinical complications of unstable angina, myocardial...

Ellen O Weinberg PhD and Richard T Lee MD

Adrenomedullin Urocortin Urotensin Myotrophin Novel Candidate Markers of Hemodynamic Stress A marker of hemodynamic stress is a secreted molecule that is induced by hemodynamic stress, regardless of its function or mechanism of action. In this chapter, we describe the interleukin-1 receptor family member ST2, a novel biomarker of hemodynamic stress in acute myocardial infarction and heart failure. We also discuss other novel hemodynamic markers adrenomedullin, urocortin, urotensin, and...

Cook Pj Honeyborne D Chlamydia Pneumoniae. Int J Syst Bacteriol 39 88-90 1989

Dyslipidemia and other risk factors for coronary artery disease. In Braunwald E, ed. Heart Disease A Textbook of Cardiovascular Medicine, 5th ed. WB Saunders, Philadelphia, 1997, pp. 1126-1160. 2. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation 1998 97 18 1837-1847. 3. Grayston IT, Kuo C-C, Campbell LA, Wang S-P. Chlamydia pneumoniae sp. Nov. for Chlamydia sp strain...

And L Kristin Newby MD MHS

Elevated Troponin Levels After PCI Elevated Troponin Levels After CABG Conclusion References A significant proportion 20 of patients undergoing percutaneous coronary intervention PCI or coronary artery bypass graft CABG surgery develop elevated levels of creatine kinase MB isoform CK-MB afterward. Large increases in the concentration of CK-MB after PCI are associated with the risk of death, myocardial infarction, and repeat revascularization. However, the prognostic significance of modest...

Richard L Dunbar MD and Daniel J Rader MD

Heterogeneity of Atherogenic Lipoproteins What Marker of Atherogenic Lipoproteins Is Optimal for Clinical Practice Incorporating Lipoprotein Number Into Treatment of Lipoprotein Disorders Conclusion Appendix Case Study References In the past several decades, multiple landmark clinical trials have proven that certain lipoprotein abnormalities not only predict but also provoke atherosclerotic cardiovascular disease. Yet, there is a growing concern that traditional measures of atherogenic...

Timing ofTesting

Another issue frequently debated is when to test CRP in patients with ACS. Most studies ofCRP in ACS have provided data based on determination ofCRP at admission. Therefore, taking an evidence-based approach supports the use of CRP levels at admission for risk stratification. Admission levels are unaffected by revascularizationn procedures because PCI may increase CRP levels and are less likely to be affected by the inflammatory response to necrosis, and more likely to reflect the patient's...

Bertil Lindahl MD PhD FESC

Definition of Non-ST-Elevation Acute Coronary Syndrome Mechanisms Underlying Prognostic Relationship of Troponin in ACS Practical Issues Conclusion References The clinical history, standard 12-lead electrocardiogram ECG , and markers of myocardial necrosis constitute the basis for diagnosis and accurate risk assessment in patients with suspected of a non-ST-elevation acute coronary syndrome NSTEACS . Cardiac troponin T and cardiac troponin I are ideal biochemical markers for the detection of...

Other Biomarkers ofthe Myocardial Response to Ischemia

Fatty acids are the major energy substrate for myocardium and are predominantly stored intracellularly. Ofthose fatty acids found in circulation, the majority are bound to positively charged proteins especially albumin , whereas a small percentage lt 1 of the fatty acid in circulation is unbound. The concentration of unbound free fatty acid uFFA in circulation increases in response to mediators released rapidly after the onset of ischemia, such as catecholamines, CRP, TNF-a, or natriuretic...

I

World Health Organisation Troponin

Background Biomarkers of Cardiac Necrosis Necrosis Biomarkers Still in Development Future Markers of Myocardial Necrosis Biochemical markers play a crucial role in accurate diagnosis of myocardial necrosis and, more importantly, for assessing risk and directing appropriate therapy that improves clinical outcome. Development and utilization of biomarkers has evolved substantially over the past three decades. The earliest biomarkers, such as alanine aminotransferase and lactate dehydrogenase,...

Luigi M Biasucci Md Facc Faha Fesc and Antonio Abbate MD

Acute Coronary Syndrome An Inflammatory Disease C-Reactive Protein as Preferred Inflammatory Marker for Risk Stratification CRP and Other Inflammatory Markers Role of CRP in a Multimarker Assessment Approach Inflammatory Markers Beyond Risk Stratification and Back to Mechanisms of Disease Practical Considerations Conclusion References This chapter summarizes the rationale and evidence in support of the clinical use of inflammatory markers for risk prediction in patients with ischemic heart...

Shuaib M Abdullah MD and James A de Lemos MD

Patterns of BNP Synthesis and Release in Cardiac Ischemia Possible Mechanisms of BNP Synthesis and Release in Ischemic Heart Disease BNP as a Diagnostic Tool in Ischemic Heart Disease Natriuretic Peptides as Prognostic Tools in Ischemic Heart Disease Using BNP and NT-proBNP to Select Patients for an Early Interventional Strategy Proposed Application of BNP in ACS Incorporating Natriuretic Peptides With Other Clinical and Biochemical Markers of Risk Conclusion References In addition to their...

Patterns Of Bnp Synthesis And Release In Cardiac Ischemia

Natriuretic peptide levels are elevated both in animal models and in patients with coronary ischemia. In rats that underwent coronary artery ligation, BNP concentration in the left ventricle increased twofold at 12 h and fivefold at 24 h postinfarction, whereas atrial natriuretic peptide ANP levels were unchanged 8 . Elevated levels of BNP were found in noninfarcted as well as in infarcted areas of the myocardium, suggesting that increased African-American race Female gender Comorbidities CHF...

And Torbj0rn Omland MD PhD MPH

Discovery of the Natriuretic Peptides Synthesis and Release of Natriuretic Peptides Physiological Actions of Natriuretic Peptides The natriuretic peptide family consists of a group of structurally similar, but genetically distinct, peptide hormones that play a major role in the regulation of cardiovascular, endocrine, and renal homeostasis. Since the discovery of atrial natriuretic peptide almost 25 yr ago, remarkable progress has been made in the field of natriuretic peptide research. This...

Chlamydia Pneumoniae

Chlamydial Life Cycle

C. pneumoniae was isolated in 1986 3 . It was found to be responsible for a variety of respiratory illnesses including 10 of cases of community-acquired pneumonia. Like the more familiar Chlamydia trachomatis, C. pneumoniae is an obligate intracellular pathogen with a unique life cycle Fig. 1 4 . Generally, C. pneumoniae enters the body through a respiratory route and exists outside of cells in a spore form called the elementary body. Once inside the host cell it makes use ofthe cell's own...

HsCRP Metabolic Syndrome and Type 2 Diabetes Mellitus

Hdl Metabolic

Another reason for clinical interest in adding hsCRP to current risk algorithms derives from the fact that inflammation may play a key role in processes associated with metabolic syndrome, a condition that confers increased cardiovascular risk 72 . hsCRP levels are correlated positively with components of metabolic syndrome commonly measured in Fig. 8. Cardiovascular event-free survival according to baseline level of hsCRP among individuals with metabolic syndrome. Adapted from ref. 75. Fig. 8....

Evangelos Giannitsis MD and Hugo A Katus MD

Confirmation of Diagnosis of Acute Myocardial Infarction Monitoring Efficiency of Reperfusion Therapy The diagnosis and immediate initiation of reperfusion therapy in patients with acute ST-elevation myocardial infarction STEMI are based on results of the standard 12-lead electrocardiogram. Because the appearance of cardiac markers of myocardial injury in the blood is delayed relative to the onset of symptom, cardiac markers are neither helpful for early diagnosis nor should their results be...