We discovered that WHR was independently associated with prevalent atherosclerosis and provided better discrimination than either BMI or WC. The associations between obesity measurements and atherosclerosis mirror those observed between obesity and cardiovascular mortality, suggesting that obesity contributes to cardiovascular mortality via increased atherosclerotic burden.

Background-Bleeding in patients undergoing percutaneous coronary intervention (PCI) is associated with increased morbidity, mortality, length of hospitalization, and cost. We identified baseline clinical characteristics associated with bleeding complications after PCI and developed a simplified, clinically useful algorithm to predict patient risk. Methods and Results-Data were analyzed from 302 152 PCI procedures performed at 440 US centers participating in the National Cardiovascular Data Registry. As defined by the National Cardiovascular Data Registry, bleeding required transfusion, prolonged hospital stay, and/or a drop in hemoglobin Ͼ3.0 g/dL from any location, including percutaneous entry site, retroperitoneal, gastrointestinal, genitourinary, and other/unknown location. Bleeding complications occurred in 2.4% of patients. From the best-fitting model consisting of 15 clinical elements associated with post-PCI bleeding in a random 80% training cohort, we developed a parsimonious risk algorithm. Predictors of bleeding included age, gender, previous heart failure, glomerular filtration rate, peripheral vascular disease, no previous PCI, New York Heart Association/Canadian Cardiovascular Society Functional Classification class IV heart failure, ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, and cardiogenic shock. The parsimonious model was validated in the remaining 20% of the population (c-statistic, 0.72) and in clinically relevant subgroups of patients. This simplified model was used to derive a clinical risk algorithm, with larger numbers corresponding with greater risk. In 3 categories, bleeding rates were greater in patients with higher estimates (Յ7, 0.7%; 8 to 17, 1.8%; Ն18, 5.1%). Conclusions-This Clinical Perspective on p 229 Methods Study PopulationA description of the NCDR has been published. 6,7 We used version 3.04 of the CathPCI database, which contains data on PCI procedures performed from January 1, 2004, to March 31, 2006 DefinitionsFull descriptions of the data element definitions for version 3.04 of the CathPCI registry are available online at https://www.accncdr.com/ webncdr/DefaultCathPCI.aspx. Bleeding is defined by the CathPCI registry as (1) occurring at percutaneous entry site, during or after catheterization laboratory visit until discharge, which may be external or a hematoma Ͼ10 cm for femoral, Ͼ5 cm for brachial, or Ͼ2 cm for radial access; (2) retroperitoneal; (3) gastrointestinal; (4) genitourinary; and (5) other/unknown origin during or after catheterization laboratory visit until discharge. All bleeding events required a transfusion, prolonged hospital stay, and/or a drop in hemoglobin Ͼ3.0 g/dL. PCI indication consisted of (1) elective; (2) urgent (required during same hospitalization to minimize further clinical deterioration, worsening or sudden chest pain, congestive heart failure, acute MI, anatomy, intra-aortic balloon pump, unstable angina with intravenous nitroglycerin, or angina at rest); (3) emergency (to procedure or in transit to the ...

OBJECTIVETo determine the association between circulating soluble receptor for advanced glycation end products (sRAGE) and coronary atherosclerosis.RESEARCH DESIGN AND METHODSUsing data from the Dallas Heart Study, a probability-based population sample, the association between plasma levels of sRAGE and coronary artery calcium (CAC) was assessed among 2,571 subjects with complete imaging and sRAGE data.RESULTSAn inverse graded association was observed between sRAGE quartiles and CAC, with CAC prevalence of 28.5% in quartile 1 compared with 15.7% in quartile 4 (P < 0.0001). After multivariable adjustment, the associations between sRAGE levels in the first and second quartiles (versus fourth quartile) and CAC remained statistically significant (adjusted odds ratio 1.71 [95% CI 1.2–2.4] and 1.5 [1.0–2.1], respectively).CONCLUSIONSsRAGE is a novel biomarker that is inversely associated with coronary atherosclerosis. The role of sRAGE in the pathobiology of atherosclerosis and its potential prognostic and therapeutic implications warrant further investigation.

Disorders of glucose metabolism are associated with increased risk for cardiovascular disease (CVD) complications, including coronary, peripheral and cerebral arterial disease, that account for the majority of morbidity and mortality among patients with diabetes mellitus (DM). These associations between glucose and CVD risk extend continuously well below the glycaemic thresholds established for the diagnosis of diabetes, including significantly increased risk associated with impaired fasting glucose, impaired glucose tolerance, and even high normal glucose concentrations. While these epidemiological observations have established a clear association between cardiovascular disease and dysglycaemia and suggest a direct causal link, the mechanisms by which hyperglycaemia may contribute to the development, progression and instability of atherosclerosis remain unclear. A number of recent advances in the realm of vascular biology have identified several novel, plausible pathways that might link hyperglycaemia with atherosclerosis, individually or in aggregate. Key among them are the interaction between advanced glycation end-products (AGEs) and the receptor for AGEs (RAGE), which exists as a trans-membrane signalling receptor and as a circulating form, soluble RAGE (sRAGE). The purpose of this review is to provide an overview of the present understanding of RAGE and sRAGE, their plausible role linking perturbed glucose metabolism with the development, progression and instability of atherosclerosis, and the potential therapeutic implications of modulation of this biological system.