Role of ankle-brachial pressure index as a predictor of coronary artery disease severity in diabetic and non-diabetic patients

PurposeThe aim of the study was to estimate the role of ankle-brachial pressure index (ABI) in predicting severity of coronary artery disease (CAD) in patients with or without diabetes mellitus.MethodsThis study included 120 patients with CAD proved by coronary angiography and ABI was measured for all of them. They were divided into 4 groups; Group (A): Non-diabetic patients without peripheral arterial disease (PAD) (ABI < or =0.9) , Group (B):diabetic patients without PAD (ABI < or =0.9), Group (C):Non-diabetic patients with PAD (ABI>0.9) and Group (D):diabetic patients with PAD (ABI>0.9).ResultsHypertension was more prevalent in group (D) (p value>0.05). Group (C) had the highest mean age and the highest percentage of smokers, after normalization of the effects of the risk factors mean Gensini score, mean number of affected coronary vessels, mean number of coronary artery lesions and the percentage of coronary artery chronic total occlusions (CTO) were significantly higher in groups (C & D) (p>0.001) (Table 1).ConclusionABI had a significant relationship with the degree of CAD severity. Therefore ABI seems to be a reliable independent prognostic marker of CAD severity in patients with or without diabetes mellitus

Serum endostatin level as a marker for coronary artery calcification in type 2 diabetic patients

Objective: To assess the relationship between serum endostatin (ES) and coronary artery calcification (CAC) in type 2 diabetic (T2DM) patients. Methods: The study included 110 participants with coronary artery disease (CAD); 55 with T2DM, for serum ES levels by enzyme-linked immunosorbent assay and CAC by contrast-enhanced spiral computed tomography (CT). Results: Mean serum ES value was 66.54 ng/mL [95% confidence interval (CI), 61.77–71.32 ng/mL]. Serum ES levels positively correlated with Agatston score index [ASI; r = 0.701, p < 0.001; high sensitive C-reactive protein (hs-CRP) r = 0.783, p < 0.001]. On multiple regression analysis, the highest three ES quartiles (2, 3, and 4) were related to ASI in diabetic patients, adjusted ES level was an independent predictor of CAD [odds ratio (OR) = 1.065; 95% CI, 1.008–1.126; p = 0.026] and for the number of coronary vessels affected (OR = 1.089; 95% CI, 1.018–1.164; p = 0.013) in T2DM patients. Receiver operating characteristics (ROC) analysis showed serum ES at a cutoff value of 86.5 ng/mL can predict the risk of CAC in T2DM, with a sensitivity of 74.1%, specificity of 71.4%, p < 0.001 and area under curve (AUC) of 0.776. Conclusion: Measurement of serum ES levels can improve diagnosis of CAC and could be useful as a high sensitive marker for the presence and progression of atherosclerosis in T2DM patients. Keywords: Coronary calcification, Coronary heart disease, Endostatin, Type 2 D

Sex-specific cardiovascular comorbidities with associations in dermatologic and rheumatic disorders

Cardiology, dermatology, and rheumatology form a fascinating triad. Many skin and joint disorders are associated with cardiovascular comorbidities because they share etiologic elements. Female predominance is often remarkable and likely related to autoimmune pathology. Although studies have shown that X-encoded genes may be involved in the differences in immunity between males and females, other studies have also shown that sex chromosomes are irrelevant and that estrogens and androgens are responsible for the differences. The elevated immune activity in females provides a beneficial position in coping with a pathogenic stimulus but may also enhance their susceptibility to autoimmunity. The complexity of the immune system and its role as a defensive force against infection requires an armamentarium to precisely identify and selectively control inflammatory processes or cells which promote atherosclerosis. On the other hand, the inflammation in skin diseases seems to be an active source of diverse proinflammatory cytokines and chemokines which can predispose to cardiovascular comorbidities. Also, it has been shown that comorbidity disproportionately accelerates risk in women. The skin offers a readily available window to facilitate detection of risk factors or even to assist the diagnostic process regarding a variety of disorders, including those with cardiovascular involvement. Current imaging techniques provide exquisite capabilities for diagnosing and possibly even counteracting atherosclerotic plaque formation, before serious cardiovascular events occur. Combining imaging approaches (such as videocapillaroscopy, intravascular ultrasound, and FDG positron emission tomography) with insights based on immunology will likely accelerate advances in this area. We review major dermatologic manifestations and rheumatologic disorders which are associated with cardiac and vascular abnormalities. In particular we discuss sex-specific aspects concerning incidence and severity of cardiovascular disease associated with systemic sclerosis, rheumatoid arthritis, systemic lupus erythematosus, psoriasis, atopic dermatitis, and hidradenitis suppurativa