Risk assessment and aspirin use in Asian and Western populations

Runlin Gao1, Xiaoying Li21Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing; 2Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, ChinaObjective: The aim of this review was to examine aspirin utilization, cardiovascular risk ­estimation, and clinical evidence for aspirin prophylaxis in Asian versus Western countries.Methods: A literature search was performed using PubMed and the key terms "aspirin" and "Asia" or "Western".Results: Despite the growing burden of cardiovascular disease (CVD), aspirin is underutilized in high-risk patients in both Asian and Western countries. A number of risk estimation scores are available; however, validation is needed in countries such as Japan, India, and in South Asia. Underutilization of aspirin in Asia may be linked to an overestimation of bleeding risks. It is possible that a higher prevalence of Helicobacter pylori infection and genetic differences may make Asians more susceptible to gastrointestinal bleeding. Very low aspirin doses and even the wider use of gastroprotective agents may be the optimal approach to high-risk patients in Asia.Conclusions: Based on the current evidence, aspirin should be used for CVD prevention when the risk:benefit ratio is favorable. A number of trials are underway, including the Diabetic Atherosclerosis Prevention by Cilostazol and Japanese Primary Prevention Project, which will provide key data on the benefits of aspirin in Asian patients at risk of CVD, and may improve aspirin utilization and risk estimation.Keywords: aspirin, cardiovascular risk estimation, Asia, Wester

Six-month adherence to Statin use and subsequent risk of major adverse cardiovascular events (MACE) in patients discharged with acute coronary syndromes

Acknowledgements: The authors thank all participants who contributed to the study. Funding: CPACS-1 was funded by unrestricted educational grants from Guidant and Sanofi-Aventis, and grants from The Royal Australasian College of Physicians. AP is supported by an Australian National Heart Foundation Career Development Award. CPACS-2 was funded by an unrestricted grant from Sanofi-Aventis China. The George Institute for Global Health at Peking University Health Science Center sponsored the study and owns the data. Data analyses and reports were supported by Beijing Science and Technology Key Research Plan (D151100002215001). However, the authors are solely responsible for the design, analyses, the drafting and editing of the manuscript, and its final contents.Peer reviewedPublisher PD

A complete DNA sequence map of the ovine Major Histocompatibility Complex

<p>Abstract</p> <p>Background</p> <p>The ovine Major Histocompatibility Complex (MHC) harbors clusters of genes involved in overall resistance/susceptibility of an animal to infectious pathogens. However, only a limited number of ovine MHC genes have been identified and no adequate sequence information is available, as compared to those of swine and bovine. We previously constructed a BAC clone-based physical map that covers entire class I, class II and class III region of ovine MHC. Here we describe the assembling of a complete DNA sequence map for the ovine MHC by shotgun sequencing of 26 overlapping BAC clones.</p> <p>Results</p> <p>DNA shotgun sequencing generated approximately 8-fold genome equivalent data that were successfully assembled into a finished sequence map of the ovine MHC. The sequence map spans approximately 2,434,000 nucleotides in length, covering almost all of the MHC loci currently known in the sheep and cattle. Gene annotation resulted in the identification of 177 protein-coding genes/ORFs, among which 145 were not previously reported in the sheep, and 10 were ovine species specific, absent in cattle or other mammals. A comparative sequence analyses among human, sheep and cattle revealed a high conservation in the MHC structure and loci order except for the class II, which were divided into IIa and IIb subregions in the sheep and cattle, separated by a large piece of non-MHC autosome of approximately 18.5 Mb. In addition, a total of 18 non-protein-coding microRNAs were predicted in the ovine MHC region for the first time.</p> <p>Conclusion</p> <p>An ovine MHC DNA sequence map was successfully assembled by shotgun sequencing of 26 overlapping BAC clone. This makes the sheep the second ruminant species for which the complete MHC sequence information is available for evolution and functional studies, following that of the bovine. The results of the comparative analysis support a hypothesis that an inversion of the ancestral chromosome containing the MHC has shaped the MHC structures of ruminants, as we currently observed in the sheep and cattle. Identification of relative large numbers of microRNAs in the ovine MHC region helps to provide evidence that microRNAs are actively involved in the regulation of MHC gene expression and function.</p

Late thrombotic events after bioresorbable scaffold implantation: a systematic review and meta-analysis of randomized clinical trials

To compare the long-term safety and efficacy of bioresorbable vascular scaffold (BVS) with everolimus-eluting stent (EES) after percutaneous coronary interventions.Methods and Results: A systematic review and meta-analysis of randomized clinical trials comparing clinical outcomes of patients treated with BVS and EES with at least 24 months follow-up was performed. Adjusted random-effect model by the Knapp–Hartung method was used to compute odds ratios (OR) and 95% confidence intervals (CI). The primary safety outcome of interest was the risk of definite/probable device thrombosis (DT). The primary efficacy outcome of interest was the risk of target lesion failure (TLF). Five randomized clinical trials (n = 1730) were included. Patients treated with Absorb BVS had a higher risk of definite/probable DT compared with patients treated with EES (OR 2.93, 95%CI 1.37–6.26, P = 0.01). Very late DT (VLDT) occurred in 13 patients [12/996 (1.4%, 95%CI: 0.08–2.5) Absorb BVS vs. 1/701 (0.5%, 95%CI: 0.2–1.6) EES; OR 3.04; 95%CI 1.2–7.68, P = 0.03], 92% of the VLDT in the BVS group occurred in the absence of dual antiplatelet therapy (DAPT). Patients treated with Absorb BVS had a trend towards higher risk of TLF (OR 1.48, 95%CI 0.90–2.42, P = 0.09), driven by a higher risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularization. No difference was found in the risk of cardiac death.Conclusion: Compared with EES, the use of Absorb BVS was associated with a higher rate of DT and a trend towards higher risk of TLF. VLDT occurred in 1.4% of the patients, the majority of these events occurred in the absence of DAPT

Association between plasma trimethylamine N -oxide and neoatherosclerosis in patients with very late stent thrombosis

Abstract(#br)Background(#br)Trimethylamine N -oxide (TMAO) has been shown to promote the development of atherosclerosis. However, the relationship between plasma TMAO and neoatherosclerosis, an important underlying mechanism of very late stent thrombosis (VLST), is unknown.(#br)Methods(#br)This post hoc study investigated the association between TMAO and neoatherosclerosis in two independent cohorts. These included a control group of 50 healthy volunteers and a study cohort of 50 patients with VLST who presented with ST-segment elevation myocardial infarction and underwent optical coherence tomography examination. Of the 50 patients with VLST, 23 had neoatherosclerosis and 27 did not have neoatherosclerosis. Patients with neoatherosclerosis were further divided into two subgroups, including 14 patients with plaque rupture and 9 without plaque rupture.(#br)Results(#br)The plasma TMAO levels, detected using mass spectrometry, were significantly higher in patients with VLST than in healthy individuals (median [interquartile range]: 2.50 [1.67-3.84] vs. 1.32 [0.86-2.44] μM; P < 0.001). Among the VLST patients, the plasma TMAO levels were significantly higher in patients with neoatherosclerosis than in those without neoatherosclerosis (3.69 [2.46-5.29] vs. 1.96 [1.39-2.80] μM; P<0.001). In addition, in patients with neoatherosclerosis, patients with plaque rupture had significantly higher plasma TMAO concentrations than those without plaque rupture (4.51 [3.41-5.85] vs. 2.46 [2.05-3.55] μM; P=0.005). Multivariate analysis indicated that TMAO was an independent predictor of neoatherosclerosis (odds ratio 3.41; 95% confidence interval: 1.59-7.30; P=0.002). Moreover, the area under the receiver operating characteristic curve for TMAO, differentiated by neoatherosclerosis, was 0.85.(#br)Conclusions(#br)Plasma TMAO was significantly correlated with neoatherosclerosis and plaque rupture in patients with VLST

Impact of Diabetes Mellitus and Chronic Kidney Disease on Cardiovascular Outcomes and Platelet P2Y(12) Receptor Antagonist Effects in Patients With Acute Coronary Syndromes : Insights From the PLATO Trial

Background-There are limited data on how the combination of diabetes mellitus (DM) and chronic kidney disease (CKD) affects cardiovascular outcomes as well as response to different P2Y(12) receptor antagonists, which represented the aim of the present investigation. Methods and Results-In this post hoc analysis of the PLATO (Platelet Inhibition and Patient Outcomes) trial, which randomized acute coronary syndrome patients to ticagrelor versus clopidogrel, patients (n=15 108) with available DM and CKD status were classified into 4 groups: DM+/CKD+ (n=1058), DM+/CKD- (n=2748), DM-/CKD+ (n=2160), and DM-/CKD- (n=9142). The primary efficacy end point was a composite of cardiovascular death, myocardial infarction, or stroke at 12 months. The primary safety end point was PLATO major bleeding. DM+/CKD+ patients had a higher incidence of the primary end point compared with DM-/CKD- patients (23.3% versus 7.1%; adjusted hazard ratio 2.22; 95% CI 1.88-2.63; P Conclusions-In acute coronary syndrome patients, a gradient of risk was observed according to the presence or absence of DM and CKD, with patients having both risk factors at the highest risk. Although the ischemic benefit of ticagrelor over clopidogrel was consistent in all subgroups, the absolute risk reduction was greatest in patients with both DM and CKD.Peer reviewe

Microbial erosion assessment on waterlogged archaeological woods (WAWs) from a Chinese ancient shipwreck, Nanhai No. 1

Abstract This article aims at identifying the timber species of Nanhai No. 1, an ancient shipwreck (Song Dynasty, 800 years ago) sunk in the South China Sea, finding out the types of bacteria that corrode the wood components of the shipwreck and analyzing the erosion level. The changes of the internal structure of wood under different erosion degrees are described as well. With light microscope and electron microscope technology, the microscopic and submicroscopic structures of 20 wooden components from the shipwreck were investigated. The shipwreck was built of 6 timber species, including Pinus massoniana, Fokienia hodginsii, Terminalia hainanensis, Mischocarpus oppositifolius, Alnus trabeculosa and Mussaendopsis beccariana. Based on analyzing the traces left after bacterial erosion, it was determined that the erosive microbes in the sunken ship were mainly erosion bacteria and tunneling bacteria. According to the criteria from relevant literature, the analysis on the bacterial erosion degree of each wood sample shows that most of the wood components present weak to moderate erosion, except a few samples which are totally degraded. Comparison with the bacterial erosion on the wooden components of different ancient shipwrecks, sunk in different years in the southeast China, it is noticed that due to the different seabed environments (sunk conditions), the wood structure of the Nanhai No. 1 sunken ship is the best preserved although its sunken time is longer than the others. The silt-covered anaerobic environment could be one of the protective measures which preserves the ancient sunken ships