Treatment with Biologicals in Rheumatoid Arthritis: An Overview.

Management and therapy of rheumatoid arthritis (RA) has been revolutionized by the development and approval of the first biological disease-modifying antirheumatic drugs (bDMARDs) targeting tumor necrosis factor (TNF) α at the end of the last century. Today, numerous efficacious agents with different modes of action are available and achievement of clinical remission or, at least, low disease activity is the target of therapy. Early therapeutic interventions aiming at a defined goal of therapy (treat to target) are supposed to halt inflammation, improving symptoms and signs, and preserving structural integrity of the joints in RA.

Lipoprotein (a), the Metabolic Syndrome and Vascular Risk in Angiographied Coronary Patients.

Background: Lipoprotein (a) [Lp(a)] especially in young individuals, is an important cardiovascular risk factor. However, data on the vascular risk conferred by Lp(a) in patients with the metabolic syndrome (MetS) are not available.

Methods: Lp(a) was measured in a cohort of 593 consecutive patients undergoing coronary angiography for the evaluation of stable coronary artery disease.

Effects of synthetic and biological disease modifying antirheumatic drugs on lipid and lipoprotein parameters in patients with rheumatoid arthritis.

Background: Dyslipidemia in rheumatoid arthritis (RA) patients is frequently observed, and treatment with anti-rheumatic drugs has an impact on lipid profiles. Pathophysiologically, inflammation leads to decreased blood lipids and lipoproteins; RA treatment reduces inflammation and therefore may increase lipids and lipoproteins. Whether the lipid changes with RA treatment confer an increased risk of cardiovascular disease or just reflect their potentially atheroprotective anti-inflammatory effect is currently unclear due to limited and conflicting data.

Coronary patients with high plasma omentin are at a higher cardiovascular risk.

The adipokine omentin, also known as intelectin, is a secretory protein, expressed in visceral adipose tissue and is highly abundant in plasma. It is involved in the development of chronic inflammatory diseases, but nothing is known about its impact on the cardiovascular event risk. Here, plasma omentin was measured in 295 patients undergoing coronary angiography for the evaluation of established or suspected stable coronary artery disease (CAD).

High plasma omentin predicts cardiovascular events independently from the presence and extent of angiographically determined atherosclerosis.

Background And Aims: No prospective data on the power of the adipocytokine omentin to predict cardiovascular events are available. We aimed at investigating i) the association of plasma omentin with cardiometabolic risk markers, ii) its association with angiographically determined coronary atherosclerosis, and iii) its power to predict cardiovascular events.

Methods: We measured plasma omentin in 295 patients undergoing coronary angiography for the evaluation of established or suspected stable coronary artery disease (CAD), of whom 161 had significant CAD with coronary artery stenoses ≥50% and 134 did not have significant CAD.

High plasma chemerin is associated with renal dysfunction and predictive for cardiovascular events - Insights from phenotype and genotype characterization.

The novel adipokine chemerin, encoded by the RARRES2 gene, has been suggested to be linked to insulin resistance and to the metabolic syndrome (MetS). However, no well-defined cardiovascular profile has been reported and the association with coronary artery disease (CAD) is a matter of debate. Because there is a relation between renal dysfunction and CAD, we analyzed plasma chemerin levels and the estimated glomerular filtration rate (eGFR) in 495 patients undergoing coronary angiography for the evaluation of established or suspected stable CAD.

Lipid parameters in patients with acute coronary syndromes versus stable coronary artery disease.

Background: Differences in lipid parameters between patients with acute coronary syndromes (ACS) and patients with stable coronary artery disease (CAD) are unclear and are addressed in this study.

Methods: We enrolled 582 patients with angiographically proven stable CAD (of whom 26·9% had diabetes mellitus type 2 (T2DM)) and 182 patients with ACS (of whom 35·8% had T2DM).

Results: HDL cholesterol and apolipoprotein A1 levels were significantly lower in patients with ACS than in patients with CAD (46 ± 16 mg/dL vs.

Common single nucleotide polymorphisms at the NPC1L1 gene locus significantly predict cardiovascular risk in coronary patients.

Background: Niemann-Pick C1-like 1 (NPC1L1) is involved in dietary cholesterol absorption and is the direct molecular target of the LDL-lowering drug ezetimibe. Recently, genetic variants in NPC1L1 have been associated with the incidence of cardiovascular events, but it remains unclear if the impact of NPC1L1 on cardiovascular risk is dependent on its role in cholesterol absorption. Furthermore, no direct association of genetic variants in NPC1L1 with coronary atherosclerosis has been established.

Is albuminuria a myocardial infarction risk equivalent for atherothrombotic events?

Objective: People with chronic kidney disease frequently experience cardiovascular events. This study sought to investigate whether the presence of albuminuria displays a vascular risk equivalent to that in patients with prior myocardial infarction.

Methods: Albuminuria was defined as a urinary albumin to creatinine ratio of 30 μg/mg or greater in 852 consecutive patients undergoing coronary angiography.

Systemic inflammation is higher in peripheral artery disease than in stable coronary artery disease.

Objective: The knowledge on the level of systemic inflammation in peripheral artery disease (PAD) is less well established than that in coronary artery disease (CAD). Systemic inflammation frequently coincides with atherosclerosis, but also with various traits of the metabolic syndrome (MetS). The individual contribution of CAD, PAD, and the MetS to inflammation is not known.

Prevalence of type 2 diabetes is higher in peripheral artery disease than in coronary artery disease patients.

Type 2 diabetes mellitus and pre-diabetes are risk factors for atherosclerosis and are highly prevalent in patients with coronary artery disease. However, the prevalence of impaired glucose metabolism in patients with peripheral artery disease is not as well elucidated. We aimed at comparing prevalence rates of type 2 diabetes mellitus and pre-diabetes, which were diagnosed according to the current American Diabetes Association criteria, among 364 patients with peripheral artery disease, 529 patients with coronary artery disease and 383 controls.

Genome-wide association study reveals a polymorphism in the podocyte receptor RANK for the decline of renal function in coronary patients.

Impaired kidney function is a significant health problem and a major concern in clinical routine and is routinely determined by decreased glomerular filtration rate (GFR). In contrast to single assessment of a patients' kidney function providing only limited information on patients' health, serial measurements of GFR clearly improves the validity of diagnosis. The decline of kidney function has recently been reported to be predictive for mortality and vascular events in coronary patients.

Angiopoietin-like protein 4 significantly predicts future cardiovascular events in coronary patients.

Background: Angiopoietin-like protein 4 (ANGPTL4) has been associated with cardiometabolic disorders including dyslipidemia and atherosclerosis in animal studies; in humans, however, its impact on metabolic traits and cardiovascular risk remains unclear.

Methods: We examined the association of plasma ANGPTL4 levels with the metabolic syndrome (harmonized consensus definition), with angiographically determined coronary artery disease (CAD), and with the risk of future cardiovascular events in a cohort of 490 patients undergoing coronary angiography for the evaluation of stable CAD. In addition, we investigated the influence of the tagging single nucleotide polymorphisms (SNPs) rs4076317, rs2278236, rs1044250, and rs11672433 as well as variant rs116843064 (E40K) of the ANGPTL4 gene on cardiovascular risk in a larger sample of 983 angiographied coronary patients including the above mentioned 490 subjects.

Occurrence of the JAK2 V617F mutation in patients with peripheral arterial disease.

The acquired JAK2 V617F mutation is common in patients with myeloproliferative neoplasms. We previously showed that JAK2 V617F is also found in coronary patients, most of them affected by coronary atherosclerosis. Peripheral arterial disease (PAD) is another important manifestation of atherosclerosis.

Impact of the albumin to creatinine ratio and the coronary artery state on vascular events.

Albuminuria is an important indicator of cardiovascular risk. However, whether albuminuria predicts cardiovascular events independently of the baseline coronary artery state has not yet been investigated. We measured urinary albumin and creatinine concentrations in 867 consecutive patients who underwent coronary angiography for the evaluation of suspected or established stable coronary artery disease (CAD).

Evaluation of the prevalence and prospective clinical impact of the JAK2 V617F mutation in coronary patients.

The JAK2 V617F mutation is not only found in the majority of patients with myeloproliferative neoplasms (MPN), including essential thrombocythemia (ET), but also has been reported in individuals without overt MPN. A close relation of the JAK2 V617F mutation to atherothrombotic events has been described, at least in patients with MPN. The prevalence of the JAK2 V617F mutation and its clinical impact in coronary patients is unknown.

Usefulness of serial decline of kidney function to predict mortality and cardiovascular events in patients undergoing coronary angiography.

Chronic kidney disease increases cardiovascular risk and all-cause mortality. However, data on the predictive power of dynamic changes in kidney function are sparse. The aim of this research was to assess the predictive power of serial changes in kidney function on mortality and cardiovascular risk.

Insulin resistance is significantly associated with the metabolic syndrome, but not with sonographically proven peripheral arterial disease.

Objective: Insulin resistance (IR) is the key feature of the metabolic syndrome (MetS); its association with peripheral arterial disease (PAD) is unclear. We hypothesized that IR is associated with both the MetS and sonographically proven PAD.

Methods: IR was determined by the Homeostasis Model Assessment (HOMA) index in 214 patients with sonographically proven PAD as well as in 197 controls, who did not have a history of PAD and in whom coronary artery disease was ruled out angiographically; the MetS was defined according to NCEP-ATPIII criteria.

Current cholesterol guidelines and clinical reality: a comparison of two cohorts of coronary artery disease patients.

Background: Low density lipoprotein (LDL) cholesterol is a causative factor in coronary artery disease, and LDL cholesterol lowering by statins is a cornerstone in cardiovascular risk management. Current guidelines recommend serum LDL cholesterol <70 mg/dl for patients at very high risk, in particular for those with coronary arterial disease (CAD) or type 2 diabetes (T2DM). We aimed to investigate the proportion of patients achieving current lipid goals in two high-risk cohorts of CAD patients.

Eccentric endurance exercise economically improves metabolic and inflammatory risk factors.

Introduction: Exercise is a cornerstone of cardiovascular prevention. Because many individuals are not willing or not able to perform regular exercise, new methods of exercise (like eccentric exercise) are necessary. Eccentric endurance exercise is supposed to be less strenuous than concentric exercise but its effects on glucose and lipid metabolism in relation to energy expenditure are unclear.

Type 2 diabetes and the progression of visualized atherosclerosis to clinical cardiovascular events.

Background/objectives: We prospectively evaluated to what extent pre-existing coronary artery disease (CAD) accounts for the increased vascular event risk of patients with type 2 diabetes (T2DM).

Methods: Vascular events were recorded over 8 years in 750 consecutive patients whose baseline CAD state was verified angiographically.

Results: The baseline prevalence of CAD (87.

Bile acid metabolites in serum: intraindividual variation and associations with coronary heart disease, metabolic syndrome and diabetes mellitus.

Bile acids (BAs) regulate glucose and lipid metabolism. In longitudinal and case-control-studies, we investigated the diurnal variation of serum concentrations of the 15 major BAs as well as the biosynthetic precursor 7α-hydroxy-4-cholesten-3-one (C4) and their associations, respectively, with coronary artery disease (CAD), diabetes mellitus type 2 (T2DM), and non-diabetic metabolic syndrome (MetS). In hourly taken blood samples of four healthy probands, the intraindividual 24 h variation of C4, conjugated and unconjugated BAs ranged from 42% to 72%, from 23% to 91%, and from 49% to 90%, respectively.

Are AHSG polymorphisms directly associated with coronary atherosclerosis?

Background: Fetuin-A (AHSG) has been proposed as a new cardiovascular risk factor. Fetuin-A levels as well as AHSG single nucleotide polymorphisms (SNPs) have been associated with intima media thickness and incident vascular events, respectively. However, the association between AHSG variants and angiographically determined coronary artery disease (CAD) has not been reported yet.

Single nucleotide polymorphisms of TCF7L2 are linked to diabetic coronary atherosclerosis.

Background: Coronary artery disease (CAD) shares common risk factors with type 2 diabetes (T2DM). Variations in the transcription factor 7-like 2 (TCF7L2) gene, particularly rs7903146, increase T2DM risk. Potential links between genetic variants of the TCF7L2 locus and coronary atherosclerosis are uncertain.