Trace elements in coronary heart disease

Concentrations of 14 trace elements (Bi, Cd, Co, Cs, Cu, Hg, Mn, Pb, Rb, Sb, Sn, Sr, Tl, and Zn) were determined by inductively coupled plasma mass spectrometry (ICP-MS) in 120 whole-blood and 121 plasma samples of 56 patients with angiographically documented coronary heart disease (CHD). One serum and two wholeblood reference materials were analyzed for quality control. At baseline, patients had elevated Co plasma as well as diminished Cu blood concentrations compared to healthy adults. The Zn concentrations in whole blood were below or at the lower end of the normal range, but the concentrations in plasma were elevated. All other trace elements were within the normal concentration ranges for healthy adults. After initial investigations, patients were randomly assigned to an experimental group (N = 27) and to a usual care group (N = 29). Experimental group patients were prescribed a lifestyle program that included a low-fat diet and a weekly moderate exercise. Patients were examined at baseline, after 6 and 12 mo for clinical assessment and fasting venous blood samples. No significant time-course changes in concentrations of trace elements in blood and plasma during the clinical treatment in both groups of patients could be observed. The experimental group patients lost weight and had lower blood pressure after 12 mo compared to baseline. The interventional therapy reduced the need for further revascularization procedures.     

Gender differences in coronary heart disease

Cardiovascular disease develops 7 to 10 years later in women than in men and is still the major cause of death in women. The risk of heart disease in women is often underestimated due to the misperception that females are ‘protected’ against cardiovascular disease. The under-recognition of heart disease and differences in clinical presentation in women lead to less aggressive treatment strategies and a lower representation of women in clinical trials. Furthermore, self-awareness in women and identification of their cardiovascular risk factors needs more attention, which should result in a better prevention of cardiovascular events. In this review we summarise the major issues that are important in the diagnosis and treatment of coronary heart disease in women. (Neth Heart J 2010;18:598–603.)     

Vegetarianism, coronary disease risk factors and coronary heart disease

Recent studies of vegetarians confirm a lower risk of fatal heart disease amongst such subjects. Lipid levels are lower in vegetarians, even when the diet of comparable meat-eaters is low in fat. This may partly explain the lower mortality, but it is not clear whether the absence of meat or some other aspect of the vegetarian diet is causal in this relationship.     

Inflammatory markers and coronary heart disease

PURPOSE OF REVIEW: Despite changes in lifestyle and the use of effective pharmacologic interventions to lower cholesterol levels, coronary heart disease remains the major cause of morbidity and mortality in the developed world. Cholesterol screening fails to identify almost 50% of those individuals who will present with acute coronary syndromes. Recent evidence from laboratory and prospective clinical studies demonstrates that atherosclerosis is not simply a disease of lipid deposition, but rather is an inflammatory process with highly specific cellular and molecular responses. The clinical utility of inflammatory markers has been examined in a variety of atherothrombotic diseases. Because C-reactive protein is highly stable in stored frozen samples, and automated and robust analytical systems for its measurement are available, it has become the most widely examined inflammatory marker. RECENT FINDINGS: C-reactive protein has consistently been shown to be a useful prognostic indicator in acute coronary syndromes and is a strong predictor of future coronary events in apparently healthy individuals. In addition, C-reactive protein can identify individuals with normal lipid levels who are at increased risk for future coronary events. Because drugs such as aspirin and statins reduce inflammatory risk, C-reactive protein has the potential to guide the use of these therapies in high-risk individuals for primary prevention. SUMMARY: C-reactive protein may have a role in global risk assessment for primary prevention and in targeting those patients who will benefit from anti-inflammatory therapies. In addition, it may also be a good prognostic indicator in patients with acute coronary syndromes.     

阿托伐他汀治疗冠状动脉粥样硬化性心脏病的疗效

目的:研究不同剂量的阿托伐他汀治疗冠状动脉粥样硬化性心脏病的疗效,并探讨性别与年龄对疗效的影响.方法:将320例冠状动脉粥样硬化性心脏病患者随机分为4组(每组80例):10mg/d阿托伐他汀治疗A组、40mg/d阿托伐他汀治疗B组、80mg/d阿托伐他汀治疗C组与常规治疗D组,其中常规治疗组采用硝酸甘油、血管紧张与素转换酶抑制剂阿司匹林等;疗程12周.分析比较各组患者治疗前后:TG、TC、HDL-C、LDL-C和hs-CRP的水平变化.结果:治疗12周后,与常规治疗组相比:①三个不同剂量的阿托伐他汀治疗组中患者的TG、TC、HDL-C、LDL-C和hs-CRP分子的浓度变化差异均有统计学意义,P＜0.05;其中以剂量为40 mg/d的阿托伐他汀治疗组的整体疗效相对最好,P＜0.05;②治疗效果与患者年龄呈负相关趋势;③在45-55岁这个年龄阶段,女性患者的治疗效果要好于同年龄阶段的男性患者,P＜0.05;④在老年患者中,大剂量的阿伐他汀的安全性明显低于中小剂量组.结论:中等剂量的阿托伐他汀对冠状动脉粥样硬化性心脏病的疗效显著,安全性良好.     

Linoleic acid and coronary heart disease

The extent to which higher intakes of linoleic acid (LA) affect risk for coronary heart disease (CHD) is examined by reviewing a wide variety of study types, mostly in humans. In experimental studies, LA has been shown to lower serum levels of low-density lipoprotein cholesterol (LDL-C), especially when substituted for saturated fatty acids. Such an effect would be expected to reduce risk for CHD. In observational studies in which the dietary intake or serum content of LA were either cross-sectionally or prospectively related risk for CHD, higher LA intakes or serum levels have usually been associated with reduced risk. The pooled results from 5 randomized trials where LA was substituted for saturated fatty acids revealed a significant decrease in risk for CHD events with an LA intake 2-3 times current levels. Thus, current recommendations to consume 5-10% of energy from LA are evidence-based, and should not be reduced.