Determinants of high-density lipoprotein (HDL) functions beyond proteome in Asian Indians: exploring the fatty acid profile of HDL phospholipids.

Impaired high-density lipoprotein (HDL) functions are associated with development of coronary artery disease. In this study, we explored the quantitative differences in HDL (i.e. HDL proteome and fatty acid profile of HDL phospholipids) underlying the functional deficits associated with acute coronary syndrome (ACS). The relationship between HDL function and composition was assessed in 65 consecutive ACS patients and 40 healthy controls. Cholesterol efflux capacity (CEC) of HDL and lecithin cholesterol acyl transferase (LCAT) activity were significantly lower in patients with ACS compared to controls. In HDL proteome analysis, HDL isolated from ACS individuals was enriched in apolipoprotein C2 (inhibitor of LCAT), apolipoprotein C4 and serum amyloid A proteins and was deficient in apolipoprotein A-I and A-II. The fatty acid profile of HDL phospholipids analyzed using gas chromatography showed significantly lower percentages of stearic acid (17.4 ± 2.4 vs 15.8 ± 2.8, p = 0.004) and omega-3 fatty acids [eicosapentaenoic acid (1.0 (0.6-1.4) vs 0.7 (0.4-1.0), p = 0.009) and docosahexaenoic acid (1.5 ± 0.7 vs 1.3 ± 0.5, p = 0.03)] in ACS patients compared to controls. Lower percentages of these fatty acids in HDL were associated with higher odds of developing ACS. Our results suggest that distinct phospholipid fatty acid profiles found in HDL from ACS patients could be one of the contributing factors to the deranged HDL functions in these patients apart from the protein content and the inflammatory conditions.

Underuse of Effective Cardiac Medications Among Women, Middle-Aged Adults, and Racial/Ethnic Minorities With Coronary Artery Disease (from the National Health and Nutrition Examination Survey 2005 to 2014).

Given the proven effectiveness of several cardiac medications for patients with coronary artery disease (CAD), we examined the national use of 4 classes of effective medications, overall and by age, sex, and race/ethnicity in 2005 to 2014. We used data from the National Health and Nutrition Examination Survey, including a self-reported diagnosis of CAD and independently verified medication use. Weighting procedures extrapolated our data to the adult US population with CAD. Analyses included 1,789 US adults aged ≥45 years with a history of CAD. The average age of this population was 68 years; 40% were women and 79% were non-Hispanic whites. In 2005 to 2014, 53.2% (standard error [SE] = 1.5) reported use of angiotensin-converting enzyme inhibitor/angiotensin receptor blockers, 58.5% (SE = 1.5) ß blockers, and 67.2% (SE = 1.4) statins. Two of these medications were used by 64.1% (SE = 1.5) of the study population and all 3 by 29.1% (SE = 1.3). In 2011 to 2014, 68.5% (SE = 2.4) of American adults with a history of CAD reported use of aspirin. The use of statins increased from 63.1% in 2005/2006 to 76.8% in 2013/2014. Adults aged 45 to 64 years old, women, and racial/ethnic minorities had lower use of effective cardiac medications compared with older adults, men, and non-Hispanic whites. In conclusion, the use of statins, but not other medications, has increased over the past 10 years among American adults with previously diagnosed CAD. Continued targeted efforts are needed to increase the receipt of effective cardiac medications among all US adults with CAD, especially those aged 45 to 64 years, women, and racial/ethnic minorities.

Ethnic Differences in Coronary Revascularisation following an Acute Coronary Syndrome in New Zealand: A National Data-linkage Study (ANZACS-QI 12).

BACKGROUND: The aim of this study was to describe ethnic differences in angiography and revascularisation rates following an acute coronary syndrome (ACS) in New Zealand. METHODS: National hospitalisation and mortality data were anonymously linked to determine receipt of angiography and revascularisation for 30-84 year-olds hospitalised with ACS between 2007 and 2012. Multilevel Cox regression, accounting for individual factors and admitting hospital, was used to estimate adjusted procedural rates within 30 days of admission. RESULTS: Of the 50,324 ACS patients included, 10% were Maori, 4% Pacific, 3% Indian and 83% New Zealand European or Other ethnicities (NZEO). A larger proportion of Maori (48%) than NZEO (36%), Pacific (19%) and Indian (14%) patients were admitted to hospitals without catheterisation facilities. More Maori and Pacific (22-24%) than NZEO and Indian patients (12-13%) had severe comorbidities. Maori and Pacific were less likely than NZEO patients to receive angiography (adjusted HRs 0.94 [0.91-0.98] and 0.93 [0.87-0.98] respectively) and revascularisation (adjusted HRs 0.79 [0.75-0.83] and 0.77 [0.71-0.83]), even after adjusting for important demographic and clinical factors. CONCLUSIONS: A higher comorbidity burden in Maori and Pacific patients and reduced access to catheterisation facilities for non-urban Maori contributed to lower procedure rates after ACS admission. Ethnic differences remained after adjustment for these factors and require further investigation.

Ethnicity and revascularisation following acute coronary syndromes: a 5-year cohort study (ANZACS-QI-3).

BACKGROUND: Prior studies have reported higher rates of coronary revascularisation in European compared with Maori and Pacific patients. Our aim was to define the current variation by ethnicity in investigation, revascularisation and pharmacotherapy after admission with an acute coronary syndrome (ACS). METHODS: Data from consecutive New Zealand residents <80 years of age admitted to the Middlemore Hospital coronary care unit with ACS (2007 to 2012) were collected prospectively. RESULTS: Of 2666 ACS patients <80y, 51.5% were European/Other, 14.2% Maori, 16.0% Pacific, 14.8% Indian, and 3.5% Asian. Cardiac risk factors and comorbidity varied markedly by ethnicity. The overall coronary angiography rate was high (89%). After adjustment for clinical factors which influence the decision to perform angiography, European/Other patients were about 5% more likely than Maori and Pacific patients to have angiography. Overall revascularisation was highest in Asian, Indian and European/Other (76.1%, 69.1% and 68.6%), and lower in Maori and Pacific patients (58.2% and 52.9%). Non-obstructive coronary disease was more common in Maori and Pacific (20.6 and 18.6%, respectively), than in European/Other, Indian and Asian patients (13.3%, 8.7% and 6.1%). After adjustment, Maori, Indian and Asian patients were as likely to receive revascularisation as European/Others, but revascularisation in Pacific patients was 13% lower. Discharge prescribing of triple preventive therapy was uniformly high across ethnic groups (overall 91%). CONCLUSIONS: There is a small unexplained variation in angiography rates across ethnic groups. Much of the observed variation in revascularisation may be due to differences in the coronary artery disease phenotype.

Acute coronary syndrome and khat herbal amphetamine use: an observational report.

BACKGROUND: The khat plant is a stimulant similar to amphetamine and is thought to induce coronary artery spasm. Khat is widely chewed by individuals originating from the Horn of Africa and the Arabian Peninsula. The aim of this study was to evaluate the clinical characteristics and outcome of khat chewers presenting with acute coronary syndrome. METHODS AND RESULTS: From October 1, 2008, through June, 30, 2009, 7399 consecutive patients with acute coronary syndrome were enrolled in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2). Nineteen percent of patients were khat chewers; 81% were not. Khat chewers were older, more often male, and less likely to have cardiovascular risk factors. Khat chewers were less likely to have a history of coronary artery disease and more likely to present late and to have higher heart rate and advanced Killip class on admission. Khat chewers were more likely to present with ST-segment-elevation myocardial infarction. Overall, khat chewers had higher risk of death, recurrent myocardial ischemia, cardiogenic shock, ventricular arrhythmia, and stroke compared with non-khat chewers. After adjustment for baseline variability, khat chewing was found to be an independent risk factor of death and for recurrent ischemia, heart failure, and stroke. CONCLUSIONS: Our data confirm earlier observations of worse in-hospital outcome among acute coronary syndrome patients who chew khat. This worse outcome persists up to 1 year from the index event. This observational report underscores the importance of improving education concerning the cardiovascular risks of khat chewing.

Religious observance and acute coronary syndrome in predominantly Muslim Albania: a population-based case-control study in Tirana.

PURPOSE: We aimed to assess the association of religious observance with acute coronary syndrome (ACS) in a predominantly Muslim population. METHODS: A case-control study conducted in Tirana, Albania in 2003-2006 included 467 nonfatal consecutive ACS patients (370 men, 97 women; 88% response) and a population-based control group (469 men, 268 women; 69% response). Religious observance was assessed as a composite score based on mosque/church attendance, frequency of prayer and ritual fasting. The association of religiosity with ACS was assessed by multivariable-adjusted logistic regression. RESULTS: Nonobservance was frequent in this population (67% among Muslim controls, 55% in Christian controls). Religious observance was inversely associated with ACS in both groups (multivariable-adjusted odds ratios for above median observance scores vs zero observance: 0.45 [95% confidence interval (CI) = 0.26-0.77] in Muslims, 0.58 [0.25-1.31] in Christians, and 0.48 [0.31-0.74] overall]. Associations with ACS were strongest for prayer and fasting. CONCLUSIONS: In a country experiencing major socioeconomic transition from rigid communism, including extreme state-enforced secularism, we found an apparent protective effect associated with religious observance in both Muslims and Christians. This may be the first such study reported in a Muslim population.