In multivariate analyses, the hazard ratios for total mortality among those in the lowest (referent) to highest quartiles of serum RA measured at study entry were 1.0, 0.83, 0.74, and 0.56, respectively (P-trend<0.001). For cardiovascular mortality, the comparable hazard ratios were 1.0, 0.76, 0.69, and 0.60 (P-trend<0.001). Furthermore, high RA levels (defined as >median) were associated with lower risk of total mortality (adjusted hazard ratios, 0.68; 95% confidence interval, 0.50-0.85; P=0.001) and cardiovascular mortality (adjusted hazard ratios, 0.62; 95% confidence interval, 0.45-0.78; P<0.001) compared with low RA (defined as ≤median). rodents. 14 Furthermore, all-trans RA treatment was shown to be effective in restoring the cardioprotective oxytocin-natriuretic peptides system and preventing abnormal cardiac remodeling in the ob/ob mice. 15 Our recent study showed that dietary supplementation of RA attenuated the development of atherosclerotic lesions in apolipoprotein E-deficient mice. 16 The improved effects of RA on cardiovascular diseases were further demonstrated in the in vitro studies that are involved in different types of cardiovascular cells. Activation of retinoid signaling effectively enhanced cholesterol efflux from cholesterol-loaded macrophage foam cells. [16][17][18] RA treatment inhibited the secretion of coagulatory factors from endothelial cells under proinflammatory conditions.
Conclusions19 Thus, retinoid therapy may have important implications in limiting or regressing atherosclerotic cardiovascular disease.Although animal studies provided the appealing data that RA supplementation might be a promising therapeutic nutrient for cardiovascular disease, the clinical relevance of circulating RA in the cardiovascular disease have not been carefully investigated before. Therefore, in this study, we prospectively evaluated the relationship of serum RA with the risk of mortality in patients with coronary artery disease (CAD).
Methods
Study SubjectsStudy participants were recruited between October 2008 and December 2011 as part of the Expanded Guangdong Coronary Artery Disease Cohort (EGCADC).20-23 EGCADC consisted of patients aged from 40 to 80 years old recruited from GCADC and outpatients from Guangdong General Hospital following the same inclusion and exclusion criteria, ascertainment of CAD, questionnaires and study protocol. A total of 2523 CAD patients were included in the EGCADC (1513 from GCADC and another 1010 from Guangdong General Hospital). The patients will be enrolled if they met one of the following inclusion criteria: history of myocardial infarction (MI), angiographic evidence of >50% stenosis in ≥1 coronary vessels, evidence of exercise-induced ischemia by treadmill or nuclear testing, and history of coronary revascularization or documented diagnosis of CAD by an internist or cardiologist. Participants were excluded if they could not walk 1 block, had MI within the past 6 months, malignancy, with missing or incomplete angiographic data, missing blood samples, laboratory me...