Which patients with coronary artery disease should include oral nitrates on their discharge medication list?

BACKGROUND: Which patients with coronary artery disease (CAD) should have oral nitrates on their discharge medication list after coronary angiography (CAG)? To assess the relationship between oral nitrates included in the discharge medication list and major adverse cardiovascular events (MACEs) among CAD patients, we designed this retrospective cohort study. METHODS: A total of 2979 CAD patients hospitalised in the Department of Cardiology, Affiliated Hospital of Jining Medical University from May 2013 to October 2015 were enrolled, grouped according to whether oral nitrates were included at discharge after CAG, and followed up for MACEs for a mean of 4.42 years after discharge. The primary endpoint was MACEs. Multivariate Cox proportional hazards models were used to analyses potential confounding factors. Stratified analysis was used to observe the relationship between oral nitrates and MACEs by different covariates. RESULTS: The median follow-up time was 4.61 years, and 296 (9.94%) patients experienced MACEs. Multivariate Cox proportional hazards model analysis showed no association between oral nitrates on the discharge medication list and the occurrence of MACEs among patients with CAD (p > 0.05) after adjusting for some covariates, such as SYNTAX score (hazard ratio (HR): 1.18, 95% confidence interval (CI): 0.90-1.55, p = 0.2420). Stratified analysis revealed a higher incidence of MACEs among hypertensive patients prescribed oral nitrates at discharge (HR: 1.67, 95% confidence CI: 1.13-2.46, p = 0.0046). However, prescribing nitrates at discharge for patients with low uric acid levels increased the incidence of MACEs, which showed a possible trend towards significance (HR: 1.44, 95% CI: 0.99-2.09, p = 0.0525). CONCLUSION: There was no association between oral nitrates included in the discharge medication list and the development of MACEs among patients with CAD after adjusting for some covariates, such as SYNTAX score. Oral nitrates after discharge for CAD patients combined with hypertension increased the occurrence of MACEs. Oral nitrates after discharge for CAD patients combined with low uric acid levels may increase theoccurrence of MACEs, and close monitoring for any adverse events is recommended.

Immunomodulating effects of casein-derived peptides QEPVL and QEPV on lymphocytes in vitro and in vivo.

Lymphocytes serve an important function in mediating specific immune responses. When the body is stimulated by internal or external antigens, activated lymphocytes proliferate to clear pathogens by secreting antibodies or cytokines. Some bioactive peptides were isolated from fermented milk in previous studies. One of the peptides, Gln-Glu-Pro-Val-Leu (QEPVL), was synthesized and used in this experiment. Results show that QEPVL can significantly activate lymphocytes both in vitro and in vivo. QEPVL can also increase the lymphocyte proliferation rate and cyclic AMP levels. This positive regulation had a dose-effect relationship within certain concentration ranges. QEPVL can also inhibit LPS-induced inflammation by regulating nitric oxide release and the production of the cytokines IL-4, IL-10, IFN-γ, and TNF-α in vivo. Digesting QEPVL in artificial gastrointestinal juice yields the digestion product Gln-Glu-Pro-Val (QEPV), which exhibits bioactivities similar to those of QEPVL in vitro. Overall, QEPVL has significant immunomodulating effects on lymphocytes and contributes to inflammation treatment through the oral route as a functional food ingredient.