RESUMO
BACKGROUND: Carotid duplex ultrasonography (DUS) is the primary screening tool for carotid artery stenosis, but has low reliability. MHR, which is the ratio of monocytes to high-density lipoprotein cholesterol (HDL-C), can be a marker for the degree and distribution of extracranial and intracranial atherosclerotic stenosis. OBJECTIVE: We determined the diagnostic value of DUS+MHR for internal carotid artery (ICA) stenosis. METHODS: We divided 273 hospitalized patients into non-stenosis (<50%) and ICA stenosis (≥50%) groups based on Digital Subtraction Angiography (DSA). We determined the peak systolic velocity (PSV) in the ICA on DUS, calculated the MHR, and investigated their relationship with ICA stenosis. RESULTS: On DSA, 34.1% (93/273) patients had moderate-to-severe ICA stenosis. DUS and DSA showed low concordance for detecting ICA stenosis (kappa = 0.390). With increasing age, the incidence of moderate-to-severe ICA stenosis increased. PSV, monocyte count, and MHR were significantly greater in the stenosis group than in the non-stenosis group (P < 0.001), while the HDL-C level was significantly lower (P = 0.001). PSV (OR: 1.020, 95% CI: 1.011-1.029, P < 0.001) and MHR (OR: 5.662, 95% CI: 1.945-16.482, P = 0.002) were independent risk factors for ICA stenosis. The area under the receiver operating characteristic curve of PSV+MHR (0.819) was significantly higher than that of PSV or MHR alone (77.42% sensitivity, P = 0.0207; 73.89% specificity, P = 0.0032). CONCLUSION: The combination of ICA PSV on DUS and MHR is better than PSV alone at identifying ICA stenosis and is well-suited to screen high-risk patients.
RESUMO
Background: Atrial fibrillation (AF) and chronic kidney disease (CKD) often co-occur, and many of the same clinical factors and indicators of socioeconomic status (SES) are associated with both diseases. The effect of the estimated glomerular filtration rate (eGFR) on all-cause mortality in AF patients and the impact of SES on this relationship are uncertain. Materials and methods: This retrospective study examined 968 patients who were admitted for AF. Patients were divided into four groups based on eGFR at admission: eGFR-0 (normal eGFR) to eGFR-3 (severely decreased eGFR). The primary outcome was all-cause mortality. Cox regression analysis was used to identify the effect of eGFR on mortality, and subgroup analyses to determine the impact of confounding factors. Results: A total of 337/968 patients (34.8%) died during follow-up. The average age was 73.70 ± 10.27 years and there were 522 males (53.9%). More than 39% of these patients had CKD (eGFR < 60 mL/min/1.73 m2), 319 patients with moderately decreased eGFR and 67 with severely decreased eGFR. After multivariate adjustment and relative to the eGFR-0 group, the risk for all-cause death was greater in the eGFR-2 group (HR = 2.416, 95% CI = 1.366-4.272, p = 0.002) and the eGFR-3 group (HR = 4.752, 95% CI = 2.443-9.242, p < 0.00001), but not in the eGFR-1 group (p > 0.05). Subgroup analysis showed that moderately to severely decreased eGFR only had a significant effect on all-cause death in patients with low SES. Conclusion: Moderately to severely decreased eGFR in AF patients was independently associated with increased risk of all-cause mortality, especially in those with lower SES.
RESUMO
BACKGROUND: Patients with Parkinson's disease (PD) are at a lower risk of suffering cardiovascular events, but the underlying factors for this decreased risk remain unclear. Serum triglycerides (TG) and total cholesterol (TC), and their expression relative to high-density lipoprotein cholesterol (TG/HDL-C and TC/HDL-C), are independent predictors of cardiovascular events. This study aimed to determine if PD patients have decreased lipid levels and lipid ratios, which may underlie the decreased risk of coronary heart disease (CHD). METHODS: This retrospective study included 92 PD patients (PD group), 450 control subjects with no CHD (OD group), and 450 CHD patients (CHD group). We analyzed serum lipid levels and lipid ratios in each group. RESULTS: There were significant differences in TC (F = 10.459, p < 0.0001), TG (F = 46.856, p < 0.0001), low density lipoprotein cholesterol (LDL-C) (F = 6.910, p = 0.001), high density lipoprotein cholesterol HDL-C (F = 30.694, p < 0.0001), TC/HDL-C (F = 32.675, p < 0.0001), and TG/HDL-C (F = 45.554, p < 0.0001) between all three groups; TC/LDL-C (F = 2.518, p = 0.081) was not significantly different between groups. Compared to the CHD group, PD patients had lower TC (p < 0.0001), TG (p < 0.0001), LDL-C (p = 0.001), TG/HDL-C (p < 0.0001), and TC/HDL-C (p < 0.0001); TC/LDL-C (p = 0.563) and HDL-C (p = 0.196) were not significantly different. TC and LDL-C levels were positively correlated within individual groups (all p < 0.0001). In addition, TG and HDL-C were negatively correlated in the OD and CHD groups (p < 0.0001); no significant negative association was observed in the PD group (p = 0.077). TG/HDL and LDL-C levels were inversely correlated in the CHD group (p < 0.0001) and weakly positively correlated in the PD (p = 0.159) and OD (p = 0.199) groups. CONCLUSIONS: TC/HDL and TG/HDL ratios were significantly lower in PD patients compared to CHD patients, suggesting there is a strong correlation between lipid ratios and incidence of CHD in PD patients.
