PubMed Health⌕ Search

Biomedical subjects

H Daida

Publications and source records attributed to H Daida.

At least 37 records · Page 2Linked to original sources
PubMed1999

Effects of intensive lipid lowering by low-density lipoprotein apheresis on regression of coronary atherosclerosis in patients with familial hypercholesterolemia: Japan Low-density Lipoprotein Apheresis Coronary Atherosclerosis Prospective Study (L-CAPS).

Twenty-five heterozygous familial hypercholesterolemic patients treated with LDL-apheresis and drugs and 11 patients treated with drugs underwent follow-up angiography 2.3 years later. One-hundred thirteen lesions were measured by quantitative angiography. Mean LDL-cholesterol levels during the trial were 140 +/- 34 mg/dl in the apheresis group and 170 +/- 58 mg/dl (P < 0.05) in the control group. The mean changes in minimal lumen diameter of lesions were +0.19 +/- 0.30 mm (improved) in the apheresis group (n = 76) and -0.44 +/- 0.40 mm (worsened) in the control group (n = 37) (P < 0.0001). When progression and regression were defined as a change in minimal lumen diameter of +/- 0.67 mm, in the apheresis group, two (8%) patients had progression, 19 (76%) stayed unchanged and four (16%) had regression, but in the control group seven (64%) patients had progression and four (36%) stayed unchanged. The frequency of regression or no change was significantly higher in the apheresis group than in the control group (P < 0.004). Intensive cholesterol lowering therapy with LDL-apheresis and lipid lowering drugs can achieve a substantial decrease in LDL-cholesterol levels to induce regression of coronary lesions in familial hypercholesterolemic patients with advanced coronary artery disease.

Adult↗
PubMed1999

Effects of troglitazone on atherogenic lipoprotein phenotype in coronary patients with insulin resistance.

Insulin resistance is associated with atherogenic lipoprotein phenotype, including small dense LDL particle, hypertriglycemia and low HDL cholesterol levels. Troglitazone, a novel insulin sensitizing agent, may improve the associated lipid profile in patients with insulin resistance. We examined the effects of troglitazone (400 mg daily for 12 weeks) in 12 non-diabetic coronary patients (60+/-10 years), all of whom had hyperinsulinemic response to an oral glucose load. Troglitazone markedly reduced the insulin response. After the treatment, plasma triglycerides decreased by 32% (P<0.05), HDL cholesterol increased by 11%, (P<0.05) and LDL peak particle diameter increased from 24.7+/-0.3 to 25.5+/-0.5 nm (P<0.01). These lipidic improvements were associated with a significant rise in postheparin lipoprotein lipase levels (175+/-52 to 217+/-69 ng/ml, P<0.01). In patients with insulin resistance syndrome, troglitazone improved the atherogenic lipoprotein phenotype as well as hyperinsulinemia. Our data suggest that troglitazone therapy could reduce the atherosclerotic risk due to insulin resistance even in non-diabetic patients.

Aged↗
PubMed1999

Giant aneurysm of the left main coronary artery in Takayasu aortitis.

Takayasu aortitis is a chronic inflammatory vasculitis characterised by stenosis or obliteration of large and medium sized arteries. Although coronary arteries are affected in approximately 10% of cases, most of the lesions are luminal narrowing, and coronary aneurysm formation is extremely rare. A case is described of giant aneurysm of the left main coronary artery complicated with Takayasu aortitis in a 46 year old Japanese woman who was followed until her death at age 71. Pronounced intimal proliferation and adventitial fibrous thickening of the involved arterial wall usually induce constriction or occlusion at the orifice of the main branch of the aorta in Takayasu aortitis. However, systemic hypertension, which resulted from renovascular stenoses in this case, is likely to have enlarged the vessel lumen before replacement of medial and adventitial fibrosis after extensive destruction of medial elastic fibres in the left main coronary artery. Moreover, associations such as autoimmune hepatitis, chronic thyroiditis, and Sjögren syndrome strongly suggests that Takayasu aortitis may be an autoimmune disease.

Aorta↗
PubMed1999

Effects of the thromboxane A2 receptor antagonist on platelet deposition and intimal hyperplasia after balloon injury.

Thromboxane A2 (TXA2) after vascular injury plays an important role in the process of restenosis. S-1452, a potent and selective TXA2 receptor antagonist, blocks the receptors of vascular smooth muscle cells (VSMC) as well as platelets. The purpose of this study was to determine whether S-1452 could reduce platelet deposition and intimal hyperplasia in vascular injury models. New Zealand White Rabbits (n = 41) were fed a 0.5% cholesterol diet. For the short-term study, eighteen rabbits after balloon injury of iliac artery were assigned to 3 groups; systemic administration of S-1452, single local administration of S-1452 using a local delivery balloon, and single local administration of saline solution. Platelet deposition in injured artery using 111In-labeled platelets was reduced by 50% in systemic administration and by 60% in local administration compared to saline infusion. For the long-term study, balloon injury of the iliac artery was performed 4 weeks after starting the 0.5% cholesterol diet. Twenty-three rabbits were classified into 4 groups; systemic administration of S-1452, oral placebo administration, single local administration of S-1452, and local administration of saline solution (control group). The platelet aggregation induced by U-46619 was significantly lower in the S-1452 group than in the control group. Systemic administration of S-1452 significantly reduced the intimal area (152 +/- 33 vs 735 +/- 135 microm2, p < 0.001) and number of cells in the intima (513 +/- 57 vs 993 +/- 57, p < 0.01) compared to controls. In contrast, a single local administration failed to reduce neointimal thickness. Systemic administration of S-1452 reduced intimal hyperplasia as well as platelet deposition in a rabbit injury model, but its single local administration inhibited only platelet deposition.

Angioplasty, Balloon↗
PubMed1999

[Association between chlamydial infection and coronary artery disease].

Recent epidemiological studies have demonstrated the association between Chlamydia pneumoniae infection and coronary atherosclerosis. However, the relationship is less clear in the Japanese population. Serum IgA and IgG antibodies to Chlamydia-specific lipopolysaccharide were measured by enzyme-linked immunosorbent assay in 152 consecutive patients(112 males, 40 females, mean age 57 years)who underwent coronary angiography. Patients(n = 123)with coronary artery disease(CAD)were defined as having more than 50% diameter stenosis in at least one major coronary artery. The control group(n = 29) had normal coronary angiograms. In the CAD group, there was a high tendency of prevalence of IgA(20% vs 7%, p = 0.08)and IgG(54% vs 34%, p = 0.052). Prevalence of either IgA or IgG was significantly higher (59% vs 38%, p = 0.045) compared with the control group. Although the index of IgA antibody was not significantly different between the CAD and control groups(median 0.52 vs 0.36, p = 0.19), the index of IgG antibody was significantly higher in the CAD group than in the control group(median 1.29 vs 0.82, p = 0.026). The odds ratios for CAD were 3.4[95% confidence interval(CI)0.6-18.7]for the prevalence of IgA, 2.3(95% CI 0.9-5.2)for the prevalence of IgG, and 2.3(95% CI 1.0-5.2)for the prevalence of either IgA or IgG. Patients with CAD tended to have high prevalence of antibodies to Chlamydia spp, and these findings suggest an association between chlamydial infection and coronary atherosclerosis in the Japanese population.

Antibodies, Bacterial↗
PubMed1998

Agreement and coding reliability of the Minnesota and Mayo electrocardiographic coding systems.

PROBLEM: To determine whether diagnoses of myocardial infarction assigned by a system that uses Marquette 12SL electrocardiographic (ECG) codes with manual over-reading agree with diagnoses assigned by Minnesota ECG codes. STUDIES UNDERTAKEN: Agreement and recode reliability of Minnesota and Mayo coding systems based on 768 ECGs plus chest pain history and serum enzyme values were analyzed for a stratified random sample of 141 patients with an event in 1990 or 1991 coded as HICDA 410.x, 411, 413 or 796.9. The population was reconstructed from the stratified random sample so that population-based inferences could be made from the analysis. RESULTS: For the stratified random sample, exact agreement on 4 categories (evolving diagnostic, diagnostic, equivocal, or other ECG) between Mayo and Minnesota ECG coding was 53.9% (kappa = 0.37 +/- 0.05). Code-recode agreement was higher for Minnesota coding (83.0%; kappa = 0.74 +/- 0.05) compared with Mayo coding (73.8%; kappa = 0.64 +/- 0.05). The same pattern was present for the reconstructed population. For coding myocardial infarction based on the ECG, serum enzyme levels, and the presence or absence of ischemic chest pain, agreement between Mayo and Minnesota coding was 84.4% (kappa = 0.72 +/- 0.05) based on the stratified random sample and 81.7% (kappa = 0.67 +/- 0.06) based on the reconstructed population. For the stratified random sample, reliability of diagnosis of myocardial infarction was 93.6% (kappa = 0.88 +/- 0.04) for the Minnesota system and 94.3% (kappa = 0.90 +/- 0.03) for the Mayo system. CONCLUSION: ECG interpretation by the Mayo and Minnesota coding systems differs significantly, and Mayo ECG coding is less reliable than Minnesota ECG coding. Coding of myocardial infarction on the basis of ECGs, serum enzymes, and ischemic chest pain, however, is equally reliable for both systems.

Chest Pain↗
PubMed1998

Local delivery infusion pressure is a key determinant of vascular damage and intimal thickening.

Local drug delivery following percutaneous transluminal coronary angioplasty (PTCA) may prevent restenosis by achieving higher local tissue concentrations of drugs than systemic administration. However, it remains unknown whether vascular damage and the ensuing intimal thickening is associated with the degree of infusion pressure achieved by local delivery. Therefore, local delivery of normal saline was performed using a channeled balloon catheter (Transport) to the rabbit iliac artery with different infusion pressures of 0, 3, 5, 7, and 12 atm (n=4 for each). The extent of vascular damage and the development of intimal thickening were determined histopathologically 14 days after the procedure. In 10 additional rabbits, to assess the degree of vessel penetration, local delivery of indocyanine green dye solution was performed in a similar fashion. After 1 h, the green dye penetrated deeply at the higher infusion pressures of 7 and 12 atm. The incidence of internal clastic lamina laceration and occurrence of total occlusion as a result of thrombus formation demonstrated an increase proportional to the degree of local infusion pressure. When the vascular injury score in each arterial section was plotted against the infusion pressure, a significant relation was observed (r=0.717, p<0.0001). At 0, 3, 5, 7, and 12 atm, neointimal areas of 0.160+/-0.005, 0.163+/-0.008, 0.189+/-0.017, 0.260+/-0.027, and 0.329+/-0.033 mm2, respectively, were observed. Smooth muscle cell (SMC) proliferative activity also increased in proportion to the local infusion pressure. We have demonstrated for the first time that local delivery infusion pressure itself is related to the severity of vascular damage, resulting in the development of intimal thickening and an associated increase in SMC proliferative activity. Therefore, we suggest that infusion pressure is a key determinant of vascular injury during local drug delivery, with lower pressure causing the least neointimal response.

Angioplasty, Balloon, Coronary↗
PubMed1998

High level of lipoprotein(a) is a strong predictor for progression of coronary artery disease.

Elevated levels of serum lipoprotein(a) [Lp(a)] are reported to be associated with risk of atherosclerosis and thrombosis. Little is known about the influence of Lp(a) on the progression of coronary artery disease. We evaluated the association of serum Lp(a) and the long-term changes of angiographic severity in patients who underwent repeated coronary angiography at intervals of more than 2 years. We evaluated 70 patients, and divided them into 3 groups by angiographic findings. Median Lp(a) concentration was significantly higher in the progression group (N=36) than in the no-change group (N=23) or the regression group (N=11) (32.4 vs 22, 19.3 mg/dl, p<0.05). Furthermore, the progression group had more patients whose Lp(a) levels were greater than 30 mg/dl (p=0.006), while in the regression group all patients were under 30 mg/dl. Stepwise logistic regression analysis for progression of lesions showed that Lp(a) > or =30 mg/dl remained significant, giving an estimated odds ratio (OR) of 2.46 (p= 0.005). In the subgroup analysis, OR in patients with mild lesions was reduced to 2.05 (p<0.05) while in patients with severe lesions OR was increased to 3.39 (p=0.003). The serum Lp(a) level has a close correlation with angiographic progression, and may be an important predictor for progression.

Aged↗
PubMed1998

[Elevated levels of plasma homocysteine related to saphenous vein graft disease after coronary artery bypass graft surgery].

Elevated levels of plasma homocysteine may be an independent risk factor for coronary atherosclerosis. This study investigated whether plasma homocysteine levels are related to atherosclerotic lesions of saphenous vein grafts after coronary artery bypass surgery. Homocysteine levels were measured in fasting plasma by high-performance liquid chromatography and total cholesterol, triglyceride, high density lipoprotein cholesterol and lipoprotein (a) were also evaluated in 40 patients (mean age 65 +/- 8 years, mean interval after bypass surgery: 6.1 +/- 3.1 years, range 1-13 years). The vein graft disease group was defined as patients with angiographical stenosis of > or = 50% in any vein graft (n = 23). The other patients were defined as the no-vein graft disease group (n = 17). Patients who had a history of chronic renal failure or anatomic lesions of saphenous vein grafts were excluded. The distributions of homocysteine were skewed. Median homocysteine levels were 11.9 nmol/ml in all subjects. Homocysteine levels in the vein graft disease group were significantly higher than in the no-vein graft disease group (median 15.1 vs 10.6 nmol/ml, p = 0.01). In the analysis of plasma lipids, high-density lipoprotein cholesterol levels were significantly lower in the vein graft disease group than in the no-vein graft disease group (mean 37 +/- 11 vs 48 +/- 13 mg/dl, p = 0.01). Multiple regression analysis showed that elevated levels of homocysteine were an independent risk factor for saphenous vein graft disease after coronary artery bypass surgery. These findings indicate that elevated levels of plasma homocysteine are related to atherosclerotic lesions of saphenous vein grafts after coronary artery bypass surgery as well as coronary atherosclerosis.

Aged↗
PubMed1997

Comparison of peak exercise oxygen uptake in men versus women in chronic heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.

Results of exercise testing in 150 patients with chronic heart failure show that women were characterized by shorter exercise time, peak oxygen consumption, and lower peak oxygen pulse than men. There was a 4.1-ml/kg/min difference in peak oxygen uptake between genders after the adjustment of age, peak heart rate, respiratory exchange ratio, ejection fraction, and etiology of heart failure.

Adult↗
PubMed1997

Relationship between HLA-C locus and restenosis after coronary artery balloon angioplasty.

OBJECTIVES: To determine the relationship between human leukocyte antigen (HLA) loci and restenosis after percutaneous transluminal coronary angioplasty (PTCA). DESIGN AND SETTING: Cross-sectional study in patients treated by PTCA at Juntendo University Hospital, Tokyo, Japan. PATIENTS: A total of 65 patients (58 males and 7 females) with coronary artery stenosis who were consecutively selected between October 1994 and June 1995. MAIN OUTCOME MEASURES: Significant relationships between the restenosis and the HLA-Cw1. RESULTS: Among HLA-C locus, Cw1 was negatively related to restenosis (multivariate adjusted odds ratio, 0.19; 95% confidence interval, 0.06-0.63; P=.007). CONCLUSIONS: In HLA typing, Cw1 may be a useful marker for the prediction of restenosis after PTCA.

Aged↗
PubMed1997

Effectiveness of an antioxidant in preventing restenosis after percutaneous transluminal coronary angioplasty: the Probucol Angioplasty Restenosis Trial.

OBJECTIVES: The Probucol Angioplasty Restenosis Trial was a prospective, randomized, controlled study that investigated the effectiveness of probucol therapy in reducing the rate of restenosis after percutaneous transluminal coronary angioplasty (PTCA). BACKGROUND: Antioxidants have an inhibitory effect on smooth muscle cell growth in experiments in vitro and in vivo, which suggests a possible pharmacologic effect on restenosis after PTCA. METHODS: One hundred one patients were randomly assigned to receive 1,000 mg/day of probucol or control (no lipid-lowering) therapy 4 weeks before PTCA. After 4 weeks of premedication, both groups underwent PTCA. Probucol was continued until follow-up angiography 24 weeks after PTCA. Angiographic results were analyzed at a core laboratory by quantitative coronary angiography. RESULTS: Dilation was successful in 46 of 50 patients in the probucol group and 45 of 51 in the control group. At follow-up angiography 24 weeks after angioplasty, angiographic restenosis occurred in 9 (23%) of 40 patients in the probucol group and 22 (58%) of 38 in the control group (p = 0.001). Minimal lumen diameter was 1.49 +/- 0.75 mm (mean +/- SD) in the probucol group and 1.13 +/- 0.65 mm in the control group (p = 0.02). Percent diameter stenosis at follow-up angiography in the probucol group was significantly lower than that in the control group (43.9% vs. 56.4%, p = 0.009). The late loss was 0.37 +/- 0.69 mm in the probucol group and 0.60 +/- 0.62 mm in the control group (p = 0.13). The loss/gain ratio was 0.32 +/- 0.74 in the probucol group and 0.56 +/- 0.81 in the control group (p = 0.059). Net gain was greater in the probucol group than in the control group (0.77 +/- 0.70 vs. 0.48 +/- 0.59 mm, p = 0.053). CONCLUSIONS: Probucol administered beginning 4 weeks before PTCA appears to reduce restenosis rates.

Aged↗
PubMed1997

Clinical application and effectiveness of low-density lipoprotein apheresis in the treatment of coronary artery disease.

The Low-Density Lipoprotein Apheresis Coronary Atherosclerosis Prospective Study (L-CAPS) examined whether or not combined low-density lipoprotein (LDL) apheresis and drug therapy apheresis could induce the regression of coronary atherosclerotic lesions in patients with familial hypercholesterolemia. Twenty-eight patients treated with LDL apheresis and drugs and 11 patients treated with drugs alone underwent sequential coronary angiography 2.5 years apart. The frequency of cases with regression or no change was significantly higher for the apheresis group than for the control group (p = 0.004). The LDL apheresis Angioplasty Restenosis Trial (LART) investigated the hypothesis that high plasma lipoprotein (a) (Lp[a]) levels were associated with increased incidences of restenosis after coronary angioplasty. Two days before and 5 days after angioplasty, 66 patients underwent LDL apheresis. The restenosis rates were 21% in the 42 patients whose Lp(a) levels were reduced > or = 50% and 50% in the 24 patients whose Lp(a) levels were reduced < 50% (p < 0.05). LDL apheresis is effective in the prevention of the progression of coronary atherosclerosis. Its potential application in restenosis prevention should be further investigated.

Angioplasty, Balloon, Coronary↗
PubMed1997

Are coronary-care unit changes in therapy associated with improved survival of elderly patients with acute myocardial infarction?

OBJECTIVE: To determine whether changes in coronary-care unit therapy for elderly patients with acute myocardial infarction have been associated with improved survival. MATERIAL AND METHODS: We conducted a retrospective cohort analysis of all patients 70 years of age or older from Olmsted County, Minnesota, who were hospitalized in a coronary-care unit in this county for the treatment of acute myocardial infarction during one of three periods: 1976 through 1978, 1987 through 1989, and 1991. The effect of aspirin, heparin, beta-blockers, thrombolysis, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting on these elderly patients with acute myocardial infarction was assessed. RESULTS: Improvement in 30-day survival was significant for patients 80 years of age or older (45%, 69%, and 78% in 1976 through 1978, 1987 through 1989, and 1991, respectively; P = 0.01 for the trend) but not for patients 70 to 79 years of age (77%, 76%, and 81% for the three time periods, respectively; P = 0.65 for the trend). The opposite pattern was observed for survival in the period more than 30 days after the event. More intensive treatment in the hospital was associated with better 30-day survival (P < 0.0001). CONCLUSION: The improved survival of the elderly patients with acute myocardial infarction in these cohorts can be accounted for by changes in the therapy they received in the coronary-care units.

Age Factors↗
PubMed1997

[Percutaneous transluminal coronary angioplasty in patients with multivessel coronary disease: does complete revascularization improve the long-term survival?].

The influence of complete revascularization on long-term outcome of patients with multivessel coronary artery disease undergoing percutaneous transluminal coronary angioplasty (PTCA) was determined by analysis of 10-year survival in 167 consecutive patients treated at Juntendo University Hospital during 1984-1993. Forty-nine patients were completely revascularized and 118 had incomplete revascularization according to the anatomical classification. Among patients with anatomically incomplete revascularization, 56 were categorized as functionally adequate revascularization and 62 as functionally inadequate revascularization according to Faxon's criteria. Baseline characteristics showed incompletely revascularized patients had a higher incidence of prior myocardial infarction triple-vessel disease and/or chronic total occlusion in at least one lesion. The 10-year survival was slightly better in patients with complete (100%) than in those with incomplete revascularization (79%), but not statistically significant (p = 0.089). Event-free survival was not significantly different between the two groups. However, the need for coronary artery bypass surgery was higher in the incomplete revascularization group than that in the complete revascularization group (100% vs 81%, p = 0.013). The influence of the degree of functional revascularization on outcome was not clear in the present study. Long-term survival appeared to be better in patients with complete revascularization than that in patients with incomplete revascularization, but even in the latter, coronary artery bypass grafting in the later period could improve outcome. The effect of functional revascularization status should be further investigated in a larger population.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Ultrasonographic assessment of carotid atherosclerosis emphasizing the variety of intimal-medial thickness and the relationship with coronary risk factors].

Intimal-medial thickness (IMT) of the extracranial carotid arteries measured by B-mode ultrasonography has been used as a marker of systemic and coronary atherosclerosis. Previous studies have indicated that maximum and mean carotid IMT are significantly correlated with the extent and severity of coronary artery disease (CAD), but the clinical usefulness of these markers is limited because they are neither specific nor sensitive enough to identify patients with or without significant CAD. The correlation of a new IMT marker, variance of IMT, with coronary risk factors and coronary atherosclerosis was investigated in 200 patients who underwent carotid ultrasonography and coronary angiography. IMT was measured in 16 sites of the extracranial carotid arteries for the calculation of mean, maximum and variance of IMT. Univariate analysis showed that these three indexes were significantly correlated with age, serum lipoprotein (a) and hypertension. However, age was correlated weakly with variance of IMT. There were significant gender differences in the mean and maximum IMT but not in the variance. There were also significant correlations of mean IMT with smoking, and maximum and variance of IMT with high-density lipoprotein. Multiple logistic regression analysis in 100 age and sex matched patients indicated that the only significant predictor for CAD in this subgroup was variance of IMT (odds ratio = 1.6). These results indicated that each risk factor causes different morphologic manifestations in the carotid atherosclerotic lesion. Variance of IMT, which represents the irregularity of carotid IMT, was correlated well with CAD and appears to be useful for assessing systemic and coronary atherosclerosis.

Aged↗
PubMed1996

Lack of increased coronary atherosclerotic risk due to elevated lipoprotein(a) in women > or = 55 years of age.

BACKGROUND: Numerous studies have indicated that there is an association between lipoprotein(a) [Lp(a)] and coronary artery disease (CAD) in middle-aged men; however, few studies have addressed this issue in women or the elderly. METHODS AND RESULTS: Serum Lp(a) concentrations were determined in 354 women and 706 men with or without angiographically defined CAD (one or more coronary arteries with narrowing of > or = 75%). The age-specific impact of elevated Lp(a) (> or = 30 mg/dL) on CAD was examined in each sex. In the younger age group (< 55 years old), elevated Lp(a) was independently associated with CAD in both sexes (adjusted odds ratio [OR]: women, 6.90, P < .01; men, 2.63, P < .05). The age-specific ORs declined with age, and elevated Lp(a) no longer conferred an increased CAD risk in either elderly men or women > or = 65 years old. In the age group of 55 to 64 years, elevated Lp(a) was positively associated with CAD for men (adjusted OR: 2.45, P < .05) but not for women (adjusted OR: 0.56, P = NS). CONCLUSIONS: For both sexes, elevated Lp(a) appears to be an independent risk factor for premature CAD and the importance of Lp(a) appears to decrease with age. However, for women, the risk estimate of Lp(a) began to decline at an age approximately 10 years younger than for men. These data suggest that not only age- but also sex-specific factors such as menstrual status may interact with the association between Lp(a) and CAD.

Aged↗