Biomedical subjects

Hsin-Bang Leu

Publications and source records attributed to Hsin-Bang Leu.

24 records · Page 2Linked to original sources

PubMed2004

Risk stratification and prognostic implication of plasma biomarkers in nondiabetic patients with stable coronary artery disease: the role of high-sensitivity C-reactive protein.

STUDY OBJECTIVES: To evaluate the implication of plasma biomarkers to future cardiovascular events in nondiabetic patients with stable coronary artery disease (CAD). Designs and settings: Prospective, follow-up study at a tertiary referral center. Patients and measurement: Serial plasma biomarkers including high-sensitivity C-reactive protein (hsCRP), homocysteine, soluble adhesion molecules, von Willebrand factor, and lipid profiles were determined before coronary angiograms in a series of nondiabetic CAD patients with stable angina. Among them, 75 consecutive patients who received coronary revascularization (48 coronary interventions and 27 coronary bypass surgeries) later and another 75 age- and gender-matched patients who preferred medical treatment were both enrolled. In patients of each group, major cardiovascular events including cardiac death, nonfatal myocardial infarction, new or repeated coronary revascularization, and hospitalization for unstable angina, stroke, or peripheral artery disease were prospectively followed up for at least 6 months. RESULTS: Patients were followed up to 40 months (median, 18 months). The incidences of major cardiovascular events were similar between the two groups. For patients with medical treatment, plasma levels of hsCRP, homocysteine, low-density lipoprotein, and the ratio of total cholesterol (TC) to high-density lipoprotein cholesterol (HDL-C) were significantly higher in those with cardiovascular events than those without. However, only hsCRP > 0.1 mg/dL (relative risk [RR], 2.78; 95% confidence interval [CI], 1.21 to 6.41; p = 0.016) and TC/HDL-C ratio > 4.8 (RR, 2.42; 95% CI, 1.04 to 5.65; p = 0.041) were independent predictors by multivariable analysis. For patients with revascularization, basal plasma hsCRP levels were higher in those with cardiovascular events than those without (p = 0.04). However, no biochemical markers could predict future major cardiovascular events in these patients. CONCLUSIONS: In nondiabetic patients with CAD, basal plasma hsCRP levels were increased with future cardiovascular events regardless of different treatment strategies. Both plasma hsCRP level and TC/HDL-C ratio independently predict future cardiovascular events, confirming the role of plasma biomarkers in clinical risk stratification especially in patients with medical treatment.

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PubMed2004

A double blind randomized trial to compare the effects of eprosartan and enalapril on blood pressure, platelets, and endothelium function in patients with essential hypertension.

The renin-angiotensin system is the major contributor to development of hypertension, atherosclerosis, and many other cardiovascular diseases. Angiotensin II, one of the main effectors of this system, contributes to the pathogenesis of hypertension and plays an important role in monocyte, platelet, and endothelium interactions. The effects on platelet and endothelial function, either by angiotensin converting enzyme inhibitors or angiotensin receptor antagonists, are still not well understood. A double-blind, randomized, prospective trial of either enalapril (10-20 mg daily) or eprosartan (400-800 mg daily) over a 10-week period was conducted in 42 patients (27 males, 15 females). Platelet activation was evaluated by measuring platelet factor 4 (PF-4), beta-thromboglobulin (beta-TG), the ratio of platelet factor 4 to beta-thromboglobulin, and endothelial function by measuring total plasma nitrate levels, von Willebrand factor (vWF) levels, and blood flow using venous occlusive plethysmography. After a 10-week treatment with enalapril or eprosartan, the sitting blood pressure in both the enalapril group (from 152.2 +/- 18.7 mmHg to 141.9 +/- 23.5 mmHg, P < 0.05) and eprosartan group (from 151 +/- 10.0 mmHg to 142.3 +/- 12.9 mmHg, P < 0.05) was significantly reduced. Significant diastolic blood pressure (DPB) reduction (from 94 +/- 8.7 to 84.5 +/- 9.6 mmHg, P < 0.05) and a greater DBP reduction response were found in the eprosartan group (63% in eprosartan versus 25% in enalapril). Additionally, dose-dependent reductions in the indices of platelet activation and endothelial dysfunction were observed in patients administered high dose treatments of eprosartan and enalapril, and the beneficial effects of these agents were not correlated with the reduction of blood pressure using both agents. Eprosartan is effective and well-tolerated in the treatment of mid-to-moderate hypertension, and the DBP response reduction to eprosartin was better than that to enalapril. A high dose of either eprosartan or enalapril significantly decreased the indices of platelet activation and endothelial dysfunction in hypertensive patients. The benefits of both agents cannot be explained solely by their antihypertensive effects and possibly may be mediated through their unique effect on angiotensin blockade.

Acrylates↗

PubMed2004

Endovascular stenting treatment for drug-refractory hypertension due to ostial stenosis of transplanted renal artery.

Transplanted renal artery stenosis (TRAS) is one of the major causes of poor blood pressure control, progressive renal dysfunction and finally renal graft failure in uremic patients receiving renal allograft transplantation. Percutaneous transluminal balloon angioplasty (PTA) with stenting is an effective treatment for TRAS but has rarely had validation for the ostial lesions of TRAS. We reported 2 patients developing drug-refractory hypertension along with impaired renal function who received PTA plus stent deployment therapy for severe ostial stenosis of graft renal artery. Both of the patients had improved allograft function gradually, and satisfactory blood pressure control after 3 months follow-up. In conjugation with balloon angioplasty, stenting could provide a safe and effective revascularization strategy in conjunction with balloon angioplasty for ostial lesions of TRAS.

Angiography↗

PubMed2004

Fluvastatin reduces oxidative stress, decreases serum monocyte chemotactic protein-1 level and improves endothelial function in patients with hypercholesterolemia.

BACKGROUND AND PURPOSE: Statins may have anti-inflammatory properties and exert endothelial protection independently of their lipid-lowering effect. However, data are scarce concerning the co-existence of these lipid-lowering-independent effects in humans. METHODS: Forty three patients with hypercholesterolemia were randomly assigned in a 2:1 ratio to receive either fluvastatin 80 mg/day (n = 30) or placebo (n = 13) for 12 weeks. Plasma levels of monocyte chemotactic protein-1 (MCP-1), thiobarbituric acid reactive substances (TBARS)--an index of oxidative stress, and flow-mediated vasodilatation (FMD)--an index of endothelial function, were measured before and after statin therapy. RESULTS: Fluvastatin significantly reduced the serum level of total cholesterol (201.8 +/- 25.2 vs 271.6 +/- 24.7 mg/dL; p < 0.001), low-density lipoprotein cholesterol (129.4 +/- 5.1 vs 190.2 +/- 19 mg/dL; p < 0.001), MCP-1 (190.3 +/- 40 vs 217.6 +/- 61 pg/mL; p = 0.001), and TBARS (3.7 +/- 1.3 vs 5.2 +/- 1.4 nmol/mL; p < 0.001). FMD was significantly increased, from 3.7 +/- 2.5% to 5.9 +/- 2.9% (p < 0.001) in the fluvastatin group. The reduction of serum MCP-1 or TBARS level was not correlated with the improvement of either plasma cholesterol level or FMD. No significant changes of these markers were observed in the placebo group. CONCLUSIONS: Fluvastatin reduced oxidative stress and inflammatory marker levels, and improved endothelial function, in addition to its lipid-lowering effect. These observations provide a clinical rationale for the co-existence of complex and multiple vascular protective mechanisms of statins.

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PubMed2003

Differential mononuclear cell activity and endothelial inflammation in coronary artery disease and cardiac syndrome X.

BACKGROUND: Circulating mononuclear cells could be activated with endothelial inflammation in patients with coronary artery disease (CAD). In some patients with normal coronary angiograms, myocardial ischemia could also present with coronary microvascular dysfunction (cardiac syndrome X). This study was undertaken to investigate whether mononuclear cell activation and endothelial inflammation can present in syndrome X patients. METHODS: We evaluated the biochemical parameters, circulating soluble adhesion molecules, circulating superoxide free radicals, and mononuclear cell activity in 32 patients with syndrome X, 34 with angiographically documented CAD, and 17 age- and gender-matched healthy control subjects. RESULTS: Compared to that in control subjects, plasma high-density lipoprotein was reduced (P<0.001) and insulin to glucose ratio increased (P=0.02) in CAD patients. Circulating level of soluble intracellular adhesion molecule-1 was significantly higher in both syndrome X and CAD patients than in control subjects (P<0.01), whereas the levels of soluble vascular cell adhesion molecule (P=0.02) and von Willebrand factor (P=0.01) were increased in CAD patients only. The peak (P<0.001) and total counts of superoxide free radicals in whole blood (P<0.001) was significantly higher in syndrome X patients than in the other two groups. However, phorbol-12-myristate-13-acetate-induced superoxide free radical generation of mononuclear cells was increased in CAD (10.5+/-4.6%, P=0.01) but not in syndrome X patients (8.7+/-2.0%) as compared with control subjects (7.7+/-0.5%). CONCLUSIONS: The results indicated that the activity of mononuclear cells was increased with significant endothelial inflammation and injury in CAD patients. In syndrome X patients, though circulating superoxide free radicals were increased, there was minimal endothelial inflammation without mononuclear cell activation. The relatively preserved lipid and metabolic profiles might contribute to less vascular inflammation in syndrome X patients.

Analysis of Variance↗

PubMed2003

Acute and late clinical outcomes of coronary balloon angioplasty with or without stenting in diabetes--the fact in the "real world".

BACKGROUND: Diabetes mellitus (DM) is one of the major risk factors of coronary artery disease (CAD). Both short- and long-term prognoses of plain old balloon angioplasty (POBA) are poorer in CAD patients with DM than in those without. Recent evidence indicates that coronary stenting significantly improves clinical results of POBA in CAD patients. However, the benefit of coronary stenting remains controversial in DM patients. The purpose of this study was to evaluate the acute and late clinical outcomes of coronary stenting as compared with POBA in diabetic patients with CAD in the real setting of our daily practice. METHODS: Between June 1997 and September 1998, more than 400 consecutive CAD patients receiving POBA with or without coronary stenting were evaluated. The patients were those who had definite clinical diagnosis of DM and received coronary intervention for the first time on their de novo, native lesion(s). Patients were divided into 2 groups according to POBA alone or balloon dilatation followed by coronary stenting. The immediate angiographic results and clinical outcomes, including major adverse cardiovascular events (MACE) as well as recurrent angina within 24 hours after the procedure (acute) and more than 6 months (late) after the procedure were evaluated in the both groups of patients. RESULTS: A total of 124 DM patients, aged 68 +/- 8 years with 85% male and 60% multivessel disease, were studied. There was no difference in baseline demographic data between those patients receiving POBA alone (POBA, n = 79) and in combination with coronary stenting (stent, n = 45). The minimal luminal diameter of the target lesion immediately after balloon dilatation was smaller in the stent group than in POBA group (1.36 +/- 0.67 vs. 1.96 +/- 1.31 mm, p < 0.001). However, the final luminal gain was much larger (1.60 +/- 0.64 vs. 0.80 +/- 0.88 mm, p < 0.001) and the acute event-free survival rate was higher (97.7% vs. 82.9%, p = 0.019) in stent group than in POBA group. While the percutaneous revascularization rate tended to be less in patients with stent than with POBA (31.8% vs. 49.3%, p = 0.08), the total late MACE rate was similar between both groups (50% vs. 64.7%, p = NS). However, the late event-free survival rates were significantly higher in stenting patients than in those with POBA (34.9% vs. 16.4%, p = 0.037). CONCLUSIONS: Diabetic patients with significant CAD were clinically found to be old and largely with multivessel disease for coronary intervention. The immediate angiographic results were better if treated with stenting than with POBA alone. Though the rate of late MACE was similarly high in both groups, coronary stenting rendered a better acute event-free survival rate and especially late event-free survival rate, suggesting its benefit for percutaneous coronary revascularization in diabetic patients.

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