Biomarkers of Coronary Microvascular Dysfunction in Patients With Microvascular Angina: A Narrative Review.

The current gold standard for diagnosis of coronary microvascular dysfunction (CMD) in the absence of myocardial diseases, whose clinical manifestation is microvascular angina (MVA), is reactivity testing using adenosine or acetylcholine during coronary angiography. This invasive test can be difficult to perform, expensive, and harmful. The identification of easily obtainable blood biomarkers which reflect the pathophysiology of CMD, characterized by high reliability, precision, accuracy, and accessibility may reduce risks and costs related to invasive procedures and even facilitate the screening and diagnosis of CMD. In this review, we summarized the results of several studies that have investigated the possible relationships between blood biomarkers involved with CMD and MVA. More specifically, we have divided the analyzed biomarkers into 3 different groups, according to the main mechanisms underlying CMD: biomarkers of "endothelial dysfunction," "vascular inflammation," and "oxidative stress." Finally, in the last section of the review, we consider mixed mechanisms and biomarkers which are not included in the 3 major categories mentioned above, but could be involved in the pathogenesis of CMD.

Evaluation of remnant cholesterol levels and Monocyte-to-HDL-cholesterol ratio in South Asian patients with acute coronary syndrome.

BACKGROUND AND AIMS: In the present study, we aimed to compare the clinical and coronary angiography features between South Asian and Caucasian patients with Acute Coronary Syndrome (ACS). In particular, we focused our analysis on the evaluation of recent cardiovascular risk markers, such as remnant cholesterol, corresponding to all plasma cholesterol minus HDL-C (high-density lipoprotein cholesterol) and LDL-C (low-density lipoprotein cholesterol), and the Monocyte-to-HDL-cholesterol ratio. We also compared values of several lipoprotein ratios and the Platelet-to-lymphocyte ratio, accurate predictors of coronary events and coronary artery disease. METHODS AND RESULTS: We recruited 40 South Asian and 40 Caucasian patients admitted for ACS. Data were collected by consulting patients' medical records. We used Chi-square test and Student's t-test to analyse qualitative and quantitative variables, respectively. South Asian patients, compared to Caucasians, showed higher mean values of the parameters analysed: remnant cholesterol (32.6 ± 17 vs 26.5 ± 9.6), Monocyte-to-HDL-cholesterol ratio (26.4 ± 48.7 vs 16.5 ± 8.3), Platelet-to-lymphocyte ratio (124.7 ± 130.7 vs 120.5 ± 58.8). Moreover, higher mean values of several lipoprotein ratios were also found in South Asian patients compared to the control group. However, statistical significance was not reached for any of these differences observed. CONCLUSIONS: The evaluation of the parameters analysed in this study might provide accurate information regarding the cardio-metabolic risk in South Asian patients. However, further studies with larger samples are needed to obtain more significant results.

[Cardiovascular health in Asian immigrants to Italy: risk factors, pathogenesis and pharmacological treatment]. / Malattie cardiovascolari nei pazienti provenienti dal Sud dell'Asia e 'residenti in Italia: fattori di rischio, patogenesi e trattamento farmacologico.

In the last decades a significant increase of the migratory phenomenon from South Asian countries to the western world has occurred due to several factors, such as economic crisis, political instabilities, persecutions and wars. It is well established that South Asians (SA) have a higher prevalence of coronary artery disease (CAD) and premature onset of myocardial infarction episodes than other populations. This higher predisposition might be caused by genetic factors, common in both SA residing in their birth country and in those residing abroad, but it may also be due to the new spatial environment in which they live. We have found a higher prevalence of traditional cardiovascular risk factors in SA compared with other populations; in particular abdominal obesity, caused by an unhealthy diet rich in refined carbohydrates and saturated fats, plays a key role in the development of insulin-resistance, diabetes, dyslipidemia and hypertension, leading to the increase risk of CAD in SA. Even emerging risk factors were found to be higher in this ethnic group; indeed, the evidence of higher levels of pro-thrombotic and pro-inflammatory factors, such as lipoprotein(a) and pro-inflammatory adipokines, as well as the influence of air pollution and psychosocial stress, may have consequences on the risk, treatment and outcomes of CAD in this population.