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Purpose: To evaluate the risk factors for acute atherothrombotic events in patients with exudative age-related macular degeneration (AMD) without a history of coronary artery disease or stroke. Methods: Two hundred fifty-nine patents with exudative AMD were evaluated for carotid atherosclerosis, peripheral arterial disease, and chronic kidney disease (CKD). Results: A mean intima-media thickness of ≥1.0 mm was found in 28.2% of patients; 8.9% of patients had severe carotid artery stenosis. The prevalence rates of severe atherosclerosis with a plaque score >10, peripheral arterial disease, and CKD were 16.6, 5.4, and 32%, respectively. Diabetes mellitus and AMD affecting eyes bilaterally were identified as risk factors for abnormal carotid artery thickening, and age and body mass index were identified as risk factors for CKD. Conclusion: The current study confirmed that potentially 30% of patients with exudative AMD without a history of coronary artery disease or stroke have a high risk of acute atherothrombotic events. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the relationship between nocturnal dipping in heart rates and iris and/or angle neovascularization (NV) in patients with proliferative diabetic retinopathy(PDR)., Subjects and Method: One hundred fifty-one patients with PDR who underwent surgery were divided into groups based on either the presence or absence of iris and/or angle NV (NV group, 37; non-NV group, 114 patients). Pulse oximetry was conducted overnight and the heart rates were measured both before and during sleep; the resting and nocturnal heart rates and the resting-nocturnal heart rate dip ratio were calculated., Results: The resting and nocturnal heart rates did not differ significantly between the two groups. The resting-nocturnal heart rate dip ratio was significantly lower in the NV group than in the non-NV group (p = 0.006). In the NV group, the frequency of insulin therapy (p = 0.003) and a history of coronary artery disease were significantly (p = 0.033) higher than in the non-NV group. Pearson's correlation analysis showed that only the NV group was significantly negatively correlated with the resting-nocturnal heart rate dip ratio (r = -0.18, t value = -2.2, p = 0.028)., Conclusion: In patients with PDR, the non-occurrent of nocturnal dip in heart rate may be a related factor for iris and/or angle neovascularization.

Purpose: To investigate the prevalence of sleep-disordered breathing (SDB) in retinal vein occlusion (RVO) patients., Subject and Method: Forty RVO patients who had undergone either vitreous surgery or anti-coagulation therapy were included in this study. Pulse oximetry was conducted during the night and 4% oxygen desaturation index (4% ODI times/hour) and mean SpO2 (%) were calculated. If 4% ODI > or = 5, SDB was diagnosed. The results were compared between branch retinal vein occlusion (BRVO), and central retinal vein occlusion (CRVO). In addition, simple linear regression analyses were conducted to investigate whether 4% ODI related to systemic factors for RVO patients, i.e., incidences of hypertension and diabetes and body mass index(BMI kg/m2)., Results: Forty two percent of the men, 33% of the women and 37% of all the RVO patients were diagnosed as having SDB. The prevalence of SDB and 4% ODI, and the mean SpO2 were not significantly different between the BRVO and CRVO cases. The incidences of diabetes tended to correlate to the 4% ODI, however, neither proved significant. The BMI had a statistic correlation with the 4% ODI., Conclusion: The results of our study suggested that RVO cases have a high frequency of SDB. We believe that at the time of ophthalmic medical examinations or during the treatment of RVO, ophthalmologists should be aware of the possibility of SDB.

Purposes: To investigate the prevalence of sleep-disordered breathing (SDB) in proliferative diabetic retinopathy (PDR) patients and clarify the relationship between SDB and PDR., Subject and Methods: Sixty-four PDR patients who had undergone vitrectomy in our hospital were included in this study. Forty-two patients were male, and 22 were female. Pulseoximetry was conducted during the nighttime; the sleeping 3% oxygen desaturation index (ODI/h) was calculated. If ODI was > or = 10/h, SDB was diagnosed. Blood glucose control and the presence of hypertension and albuminuria were evaluated and compared between the SDB and non-SDB groups., Results: Fifty percent of male patients, 27% of female patients and 42% of all PDR patients were diagnosed as having SDB. The presence of hypertension and albuminuria was 96% and 74%, respectively, in the SDB group, both significantly higher than in the non-SDB group. There were no significant differences between the two groups in preoperative HbAlc levels. However, compared with the non-SDB group, the prevalence of insulin therapy was significantly higher in the SDB group., Conclusion: PDR cases had a high frequency of SDB. It appears that SDB might hamper blood glucose control, raise the occurrence of hypertension and albuminuria, and is thus related to the progression of diabetic retinopathy.

Objectives: Insulin resistance or inflammation is known to be related with lipoprotein lipase activity and these factors are also closely associated with the pathogenesis of bare-metal stent restenosis. This study examined the relationship between preheparin lipoprotein lipase protein (preheparin LpL mass) concentration in serum and bare-metal stent restenosis., Methods: A total of 121 lesions in 112 patients who underwent bare-metal stent implantation using NIR stent or S660/670 stent were examined. Subjects were divided into two groups (N group; patients with normal preheparin LpL mass concentration, n = 50 or L group; patients with low preheparin LpL mass concentration, n = 71) according to the mean levels of preheparin LpL mass concentration (male 39.3 ng/ml, female 50.6 ng/ml)., Results: There were no differences in percutaneous coronary intervention or angiographical characteristics. The L group had a significantly higher incidence of restenosis rate and target lesion revascularization than the N group (N group vs L group: 8.0% vs 42.3%, p < 0.0001; 8.0% vs 33.8%, p = 0.0008, respectively). Homeostatic model assessment of insulin resistance as a marker of insulin resistance and high sensitive C-reactive protein concentration were significantly higher in the L group than the N group. Multiple regression analysis showed that only low preheparin LpL mass concentration was an independent factor for restenosis (t value = 3.6, p = 0.0005)., Conclusions: Preheparin LpL mass concentration is closely associated with bare-metal stent restenosis and preheparin LpL mass concentration may be an important marker for the selection of bare-metal stent or drug-eluting stent.

A 46-year-old male with asthma bronchiale and eosinophilia was admitted to our hospital because of continuous severe chest pain. Electrocardiography showed ST segment elevation in leads II, III and aVF during chest pain. Emergency coronary angiography showed a series of coronary arterial narrowings in segments 1 and 2. After injection of nitroglycerin 0.1 mg and nicorandil 2 mg into the right coronary artery, the coronary arterial narrowing was gradually relieved. The artery became completely normal after 10 min. Left coronary arterial angiography showed no abnormalities. The diagnosis was spontaneous coronary arterial spasm based on the coronary angiographic findings. The spasm occurred as multiple short narrow arterial segments. Normalization of the coronary artery took a long time. In a case like this, thrombus is easily formed that may cause acute myocardial infarction and unnecessary coronary angioplasty may be performed.

Objectives: The cause of exercise-induced ST depression was studied by assessing left ventricular end-diastolic pressure (LVEDP)., Methods: This study included 28 patients with normal coronary artery, 24 patients with vasospastic angina pectoris and 28 patients with fixed organic lesion who underwent both treadmill exercise testing and selective coronary arteriography. Exercise-induced ST deviation was considered as maximal ST deviation during the exercise test and maximum LVEDP was considered as the pressure measured 1 min after left ventriculography., Results: The degree of exercise-induced ST depression in aVF showed no significant differences between the three groups. Exercise-induced ST elevation occurred in the intracardiac leads and exercise-induced ST depression occurred in the epicardial leads. These electrocardiographic changes were not contradictory to subendocardial ischemia. In addition, there was a good correlation (r = - 0.465, p < 0.01) between exercise-induced ST depression and maximum LVEDP elevation., Conclusions: Exercise-induced ST depression was caused by subendocardial ischemia due to increased LVEDP.

Objectives: Indicators of ischemic heart disease were studied for the practice of preventive medicine., Methods: Intravascular ultrasonography was performed in 97 patients with no abnormalities by left anterior descending artery angiography. Coronary risk factors were evaluated based on the relationship between plaque formation and lipoprotein levels., Results: Plaque was observed in 81% of patients. The relationship between mean plaque area(%) and the low-density lipoprotein/high-density lipoprotein(LDL/HDL)ratio was examined. Mean plaque area(%) was significantly higher at LDL/HDL < or = 2.5 than at LDL/HDL > 2.5. The border of significant change level of mean plaque area(%)was LDL/HDL = 2.5. There was a good correlation between mean plaque area (%) and LDL/HDL (r = 0.65, p < 0.01). Mean plaque area (%) at LDL/HDL 2.5 was calculated at 15%. Patients with coronary risk factors had LDL/HDL lower than 2.5 at mean plaque area of 15%., Conclusions: Maintaining LDL/HDL at 2.5 is very important for preventive medicine. However, LDL/HDL should be managed at under 2.5 in patients with coronary risk factors.

Objectives: To examine the relationship between insulin resistance (IR) and the reduction of oxidative stress in vivo by the statin atorvastatin., Methods: This study included 40 patients with hypercholesterolemia without a history of diabetes mellitus (21 males, 19 females, mean age 62 +/- 11 years). Homeostasis assessment insulin resistance (HOMA-IR) was used as a marker for insulin resistance. The patients were divided into two groups [IR group (n = 24) and non-IR group (n = 16), using the cut off level of 1.73]. Urinary 8-iso-prostaglandin F2alpha (U-8-iso) excretion was used as an oxidative stress marker. The subjects were treated with atorvastatin (10 mg/day) for 12 weeks., Results: The IR group had significantly higher U-8-iso levels than the non-IR group before atorvastatin administration (211 +/- 112 vs 137 +/- 33 pg/mg Cr, p = 0.01). Low-density lipoprotein cholesterol, triglyceride, and 8-iso levels were significantly reduced in both groups after 12 weeks, U-8-iso levels were significantly higher in the IR group than the non-IR group (178 +/- 61 vs 110 +/- 38 pg/mg Cr, p = 0.003), and HOMA-IR showed no significant change. Multiple regression analysis after 12 weeks showed that HOMA-IR and triglyceride levels were independent variables for U-8-iso levels (standard regression coefficient = 0.60, 0.59, p < 0.0001, p = 0.0002)., Conclusions: Insulin resistance is important in the occurrence of oxidative stress in patients with hypercholesterolemia. Since atorvastatin does not reduce insulin resistance, further therapy to reduce insulin resistance is necessary for early prevention of cardiovascular events during atorvastatin treatment.

Objectives: The relationship between oxidative stress in vivo and insulin resistance was examined., Methods: This study included 87 patients, 46 males and 41 females (mean age 63 +/- 10 years), without coronary artery disease. The homeostasis assessment insulin resistance (HOMA-IR) (fasting blood sugar x fasting immunoreactive insulin/405), a marker for insulin resistance, was measured. The patients were divided into three groups: the noninsulin resistance group (N-IR group) without diabetes mellitus (DM) and with fasting blood glucose level of 126 mg/dl and HOMA-IR < or = 1.73 (n = 44), the insulin resistance group (IR group) without diabetes mellitus and with fasting blood glucose level of 126 mg/dl and HOMA-IR > 1.73 (n = 29), and the DM group (type 2 diabetes mellitus) (n = 14). Urinary 8-iso-prostaglandin F2 alpha (U-8-iso-PGF2 alpha) excretion was measured as a marker of in vivo oxidative stress., Results: There were significantly more obese patients in the IR group than in the N-IR group (62% vs 25%, p = 0.001), and the remnant-like particle cholesterol level was significantly higher in the IR group than in the N-IR group (7.6 +/- 5.2 vs 4.6 +/- 1.5 mg/dl, p < 0.01). Patients in the IR group had a significantly larger number of coronary risk factors. U-8-iso-PGF2 alpha excretion was significantly higher in the IR group and DM groups (201 +/- 86, 191 +/- 136 vs 129 +/- 50 pg/mg. Cr, p < 0.0001, p = 0.01), and there was a significantly positive correlation between the number of coronary risk factors, fasting blood sugar and U-8-iso-PGF2 alpha concentration (correlation coefficient = 0.32, 0.37, p = 0.002, p = 0.0003). Multiple regression analysis showed that remnant-like particle cholesterol, fasting blood sugar and insulin resistance were independent factors for U-8-iso-PGF2 alpha concentration (p < 0.0001, p = 0.0007, p = 0.02)., Conclusions: Insulin resistance, remnant lipoprotein and hyperglyceridemia are deeply involved in oxidative stress in vivo.

Objectives: The preventive effect of pemirolast against restenosis after coronary stent placement was evaluated., Methods: Eighty-four patients with 89 de novo lesions who underwent successful coronary stenting were assigned to the pemirolast group(40 patients, 45 lesions) and the control group(44 patients, 44 lesions). Administration of pemirolast(20 mg/day) was initiated from the next morning after stenting and continued for 6 months of follow-up. Quantitative coronary angiography was performed immediately after stenting and at follow-up. Angiographic restenosis was defined as diameter stenosis > or = 50% at follow-up. Intravascular ultrasound study conducted at follow-up angiography was used to measure vessel cross-sectional area(CSA), stent CSA, lumen CSA, neointima CSA(stent CSA--lumen CSA), and percentage neointima CSA(neointima CSA/stent CSA x 100%) at the minimal lumen site., Results: There were no significant differences in baseline characteristics between the two groups. Restenosis rate was significantly lower in the pemirolast group than in the control group(15.0% vs 34.1% of patients, 13.3% vs 34.1% of lesions, p < 0.05, respectively). The intravascular ultrasound study at follow-up(36 lesions in the pemirolast group, 33 in the control group) found no significant differences in vessel CSA and stent CSA between the two groups(17.3 +/- 2.2 vs 16.8 +/- 2.4 mm2, 8.6 +/- 1.9 vs 8.4 +/- 1.7 mm2, respectively). However, lumen CSA was significantly larger in the pemirolast group than in the control group(5.5 +/- 1.3 vs 4.4 +/- 1.1 mm2, p < 0.05). Moreover, neointima CSA and percentage neointima CSA were significantly smaller in the pemirolast group(3.1 +/- 1.1 vs 4.0 +/- 1.2 mm2, p < 0.05 and 36.2 +/- 15.9% vs 47.4 +/- 15.6%, p < 0.01)., Conclusions: Pemirolast has a preventive effect against restenosis after stent placement, possibly by inhibiting neointimal hyperplasia.