Introduction
New Cardiovascular Guidelines
Future for Anti-Lipid Medication
HDL SUBFRACTIONS CORRELATE WITH THE EXTENT OF CORONARY ATHEROSCLEROTIC LESIONS: FROM THE CORDIOPREV STUDY
Abstract
Background and Aims
Atherosclerotic coronary artery disease (single-vessel coronary (SVD) or multivessel coronary disease (MVD)) determined by angiography is associated with the prognosis of the disease. However, the underlying mechanisms of this relationship remain unclear. We aim to investigate whether potential biomarkers as lipoprotein subfractions are associated with angiographic severity.
Methods
Patients from the CORDIOPREV study were classified into two groups (SVD or MVD) attending to angiography severity. High-throughput nuclear magnetic resonance spectroscopy was employed to determine lipoprotein subfractions concentration and composition. We assessed whether HDL subfractions were correlated to coronary disease severity. We also analysed whether HDL subfractions were independent predictors of MVD when added to classical clinical known risk factors.
Results
SVD patients showed higher concentration of medium and small HDL particles compared with MVD patients. For medium HDL subfractions, total lipids, phospholipids, total cholesterol, cholesteryl esters and free cholesterol reflected HDL particle concentration, whereas for small HDL subfractions, total lipids, phospholipids, and free cholesterol mirrored lipoprotein particle concentration. Among traditional CV risk factors age, presence of HTA and T2DM were independently associated with angiography severity. In multivariate logistic regression models, medium and small HDL particles remained inversely associated with angiography severity (OR 0.8 (95% CI: 0.67-0.94); OR 0.8 (95% CI: 0.69-0.93), respectively).
Conclusions
In persons with CHD, angiography severity is inversely related to small and medium HDL subclasses concentration measured by NMR. These particles are also independent predictors of the presence of MVD and its use increased the prediction of this entity over traditional risk factors.
FACTORS ASSOCIATED WITH LOW D-DIMER LEVELS AT DIAGNOSIS OF VENOUS THROMBOEMBOLISM
Abstract
Background and Aims
D-dimer is used in the diagnosis of venous thromboembolism (VTE) due to its high negative predictive value, but false negatives can occur. Our objective was to determine the factors associated with low D-dimer levels in a cohort of patients diagnosed with VTE.
Methods
We conducted a prospective observational study on 3165 patients diagnosed with VTE (pulmonary embolism (PE), deep venous thrombosis (DVT) or superficial venous thrombosis (SVT)) in a tertiary care hospital, comparing different characteristics according to their D-dimer levels (< or > 500 ng/ml).
Results
Our results are shown in tables 1 and 2.
Conclusions
Patients with low D-dimer levels at VTE diagnosis were younger, and had fewer comorbidities including hypertension, dementia, anemia, kidney disease and ischemic heart disease. Interestingly, patients with low D-dimer significantly had more family history of VTE and more prevalence of thrombophilia; this has not been previously reported in the literature and warrants further research.
Previous studies have shown that low D-dimer levels at diagnosis are associated with low thrombus burden. Accordingly, we found that low D-dimer patients had less symptomatic VTE, and episodes of PE were less severe. Furthermore, low D-dimer levels were associated with fewer hospital admission.
Upper extremities and splanchnic DVT were more frequent in patients with low D-dimer levels. In this sense, D-dimer has not been validated for these VTE locations.
In conclusion, patients diagnosed with VTE and low D-dimer levels have milder presentations and a lower thrombotic burden, but with a higher prevalence of thrombophilia and family history of VTE.