Gender Differences in Coronary Artery Disease: Review of Diagnostic Challenges and Current Treatment

Lee²,

et al. 2016

Journal of Diabetes

Section: Discussionmentioning

confidence: 86%

“…In general, it has been thought that CVD or IHD events occur more often among men than women. However, there have been several reports that women show increased risk for IHD and related mortality …”

Section: Discussionmentioning

confidence: 99%

Association of prediabetes, defined by fasting glucose, HbA1c only, or combined criteria, with the risk of cardiovascular disease in Koreans

Lee²,

et al. 2016

Journal of Diabetes

“…The sex-specific differences in cardiovascular risk and presentation are well known and largely reflect reduced risk in pre-menopausal women (21, 22). The gene expression terms appear to reflect an innate immune response, as illustrated by the preponderance of up-regulated genes preferentially expressed in granulocytes/neutrophils and natural killer cells.…”

Section: Discussionmentioning

confidence: 99%

Multicenter Validation of the Diagnostic Accuracy of a Blood-Based Gene Expression Test for Assessing Obstructive Coronary Artery Disease in Nondiabetic Patients

et al. 2010

Background Diagnosis of significant coronary artery disease (CAD) in at risk patients can be challenging, typically including non-invasive imaging modalities and ultimately the gold standard of coronary angiography. Previous studies suggested that peripheral blood gene expression can reflect the presence of CAD. Objective To validate a previously developed 23-gene expression-based classifier for diagnosis of obstructive CAD in non-diabetic patients. Design Multi-center prospective trial with blood samples drawn prior to coronary angiography. Setting Thirty-nine US centers. Patients An independent validation cohort of 526 non-diabetic patients clinically-indicated for coronary angiography Intervention None. Measurements Receiver-operator characteristics (ROC) analysis of classifier score measured by real-time polymerase chain reaction (RT-PCR), additivity to clinical factors, and reclassification of patient disease likelihood vs disease status defined by quantitative coronary angiography (QCA). Obstructive CAD defined as ≥50% stenosis in ≥1 major coronary artery by QCA. Results The overall ROC curve area (AUC) was 0.70 ±0.02, (p<0.001); the classifier added to clinical variables (Diamond-Forrester method) (AUC 0.72 with classifier vs 0.66 without, p = 0.003). Net reclassification was improved by the classifier over Diamond-Forrester and an expanded clinical model (both p<0.001). At a score threshold corresponding to 20% obstructive CAD likelihood (14.75), the sensitivity and specificity were 85% and 43%, yielding NPV of 83% and PPV 46%, with 33% of patient scores below this threshold. Limitations The study excluded patients with chronic inflammatory disorders, elevated white blood counts or cardiac protein markers, and diabetes. Conclusions This non-invasive whole blood test, based on gene expression and demographics, may be useful for assessment of obstructive CAD in non-diabetic patients without known CAD. Primary Funding Source CardioDx, Inc.

“…The precise role of BDNF in the pathogenesis of CAD is not clear but appears to be associated with an increased inflammatory response by activated T cells and macrophages in atherosclerotic coronary arteries (40).…”

Section: Discussionmentioning

confidence: 99%

Coronary artery disease and depression: Possible role of brain-derived neurotrophic factor and serotonin transporter gene polymorphisms

et al. 2009

Abstract. Cardiovascular disease (CVD) and depression are two of the most common human health problems. Patients with depression have an increased risk of developing cardiovascular disease and mortality after experiencing a cardiac event. Both diseases are complex disorders that are influenced by genetic and environmental factors. Brain-derived neurotrophic factor (BDNF) plays a critical role in regulating both vascular development and response to injury, and promotes survival, differentiation, and maintenance of neurons in the peripheral and nervous system. Evidence suggests that BDNF can enhance serotoninergic transmission. Serotonin modulates different brain functions and is known to regulate sleep, appetite, pain and inflammation. The aims of the present casecontrol study were to investigate the possible role of BDNF Val66Met, 5-HTTLPR and -1438 G/A polymorphisms in the development of coronary artery disease (CAD) in patients with and without depression. Regarding BDNF, our data suggest an involvement of the AA genotype in the pathogenesis of CAD in females and in the predisposition to CAD associated with depression. Furthermore, it could be argued that the GG genotype is protective against CAD in the female population and against CAD associated with depression. In our CAD population we also observed a significant increase in the L/L genotype and a decrease in the S/L genotype with respect to the controls. A higher frequency of the L allele, responsible for enhancing the efficiency of transcription, was found in CAD patients. These findings may be responsible for the increased capacity of platelet serotonin uptake previously observed in patients with CAD. Although no differences were found for genotype and allelic frequencies of the -1438 G/A polymorphism between the CAD patients and controls, we cannot exclude the possible role of this receptor in coronary artery disease.