BACKGROUND Sacubitril/valsartan (S/V) has been shown to be an effective antihypertensive drug combination. However, its therapeutic effects on blood pressure (BP), hemodynamics, and left ventricular (LV) remodeling in resistant hypertension (RHTN) remain unclear. METHODS Eighty-six patients completed this self-control study, during which olmesartan was administered within the first 8 weeks (phase 1), followed by S/V within the second 8 weeks (phase 2), with nifedipine and hydrochlorothiazide taken as background medications. Office BP, echocardiography, and hemodynamics assessment using impedance cardiography were performed at baseline and at the eighth and sixteenth weeks. RESULTS The reduction in office BP was larger in phase 2 than in phase 1 (19.59/11.66 mmHg vs. 2.88/1.15 mmHg). Furthermore, the treatment in phase 2 provided greater reductions in systemic vascular resistance index (SVRI) and thoracic blood saturation ratio (TBR), with differences between the two phases of-226.59 (-1212.80 to 509.55) dyn$s/ cm(5)/m(2) and-0.02 (-0.04 to 0.02). Switching from olmesartan to S/V also significantly reduced E/E', LV mass index, LV end-diastolic volume index, and LV end-systolic volume index (all P < 0.05). Decreases in arterial stiffness, SVRI, and TBR were correlated with changes in indicators of LV remodeling (all P < 0.05). This correlation persisted even after adjusting for confounders including changes in BP. CONCLUSIONS Switching from olmesartan to S/V effectively lowered BP and reversed ventricular remodeling in RHTN. In addition, hemodynamic improvement was also observed. Changes in hemodynamics played an important role in reversing LV remodeling of S/V, and were independent of its antihypertensive effect. (Hellenic Journal of Cardiology 2025;84:51-60) (c) 2024 Hellenic Society of Cardiology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Purpose Enhanced external counterpulsation (EECP) is a new non-drug treatment for coronary artery disease (CAD). However, the long-term effect of EECP on endothelial dysfunction and exercise tolerance, and the relationship between the changes in the endothelial dysfunction and exercise tolerance in the patients with coronary heart disease are still unclear. Methods A total of 240 patients with CAD were randomly divided into EECP group (n = 120) and control group (n = 120). All patients received routine treatment of CAD as the basic therapy. Patients in the EECP group received 35 1-h daily sessions of EECP during 7 consecutive weeks while the control group received the same treatment course, but the cuff inflation pressure was 0–10 mmHg. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI), and inner diameter (ID) of the right carotid artery were examined using a Color Doppler Ultrasound and used to calculate the fluid shear stress (FSS). Serum levels of human vascular endothelial cell growth factor (VEGF), vascular endothelial cell growth factor receptor 2 (VEGFR2), and human angiotensin 2 (Ang2) were determined by enzyme-linked immunosorbent assay (ELISA). Exercise load time, maximal oxygen uptake (VO2max), metabolic equivalent (METs), anaerobic threshold (AT), peak oxygen pulse (VO2max/HR) were assessed using cardiopulmonary exercise tests. Results After 1 year follow-up, the EDV, PSV, ID, and FSS were significantly increased in the EECP group (P < 0.05 and 0.01, respectively), whereas there were no significant changes in these parameters in the control group. The serum levels of VEGF and VEGFR2 were elevated in the EECP and control groups (all P < 0.05). However, the changes in VEGF and VEGFR2 were significantly higher in the EECP group than in the control group (P < 0.01). The serum level of Ang2 was decreased in the EECP group (P < 0.05) and no obvious changes in the control group. As for exercise tolerance of patients, there were significant increases in the exercise load time, VO2max, VO2max/HR, AT and METs in the EECP group (all P < 0.05) and VO2max and METs in the control group (all P < 0.05). Correlation analyses showed a significant and positive correlations of VEGF and VEGFR2 levels with the changes in FSS (all P < 0.001). The correlations were still remained even after adjustment for confounders (all Padjustment < 0.001). Linear regression displays the age, the medication of ACEI (angiotensin-converting enzyme inhibitors) or ARB (angiotensin receptor blockers), the diabetes and the changes in VEGF and VEGFR2 were positively and independently associated with the changes in METs after adjustment for confounders (all Padjustment < 0.05). Conclusion The data of our study suggested that EECP is a useful therapeutic measurement for amelioration of endothelial dysfunction and long-term elevation of exercise tolerance for patients with coronary heart disease. Clinical trial registration [http://www.chictr.org.cn/], identifier [ChiCTR1800020102].

Background This study aimed to explore the relationship between the Sirtuin 3 (SIRT3) gene and endothelial cell dysfunction, contributing to the progression of coronary atherosclerosis driven by hyperglycemia. Methods We measured serum SIRT3 levels using enzyme-linked immunosorbent assay in 95 patients with type 2 diabetes mellitus (T2DM) who underwent diagnostic coronary angiography. The patients were divided into two groups according to the presence (n = 45) or absence (n = 50) of coronary artery disease (CAD). Human aortic endothelial cells (HAECs) grown in vitro in a medium with various concentrations of glucose (5.5, 11, 16.5, 22, 27.5, 33, and 38.5 mM) for 24 h were assessed for protein expression of SIRT3, peroxisome proliferator-activated receptor alpha (PPAR-alpha), endothelial nitric oxide (NO) synthase (eNOS), and inducible NO synthase (iNOS) using Western blot analysis. HAECs were subjected to SIRT3 overexpression or inhibition through SIRT3 adenovirus and siRNA transfection. Results Serum SIRT3 levels were significantly lower in T2DM patients with CAD than in those without CAD (p = 0.048). The in vitro results showed that HG significantly increased SIRT3, PPAR-alpha, and eNOS protein expression in a concentration-dependent manner. Moreover, iNOS expression was decreased in HAECs in response to HG. Reduced PPAR-alpha and eNOS levels and increased iNOS levels were observed in SIRT3 silenced HAECs cells. In contrast, SIRT3 overexpression significantly improved PPAR-alpha and eNOS expression and suppressed iNOS expression. Conclusion SIRT3 was associated with the progression of atherosclerosis in T2DM patients through upregulation of PPAR-alpha and eNOS and downregulation of iNOS, which are involved in endothelial dysfunction under hyperglycemic conditions.

Ursolic acid (UA) has been reported to possess several biological benefits, such as anti-cancer, anti-inflammation, antibacterial, and neuroprotective functions. This study detects the function and molecular mechanism of UA in H9c2 cells under hypoxia and reoxygenation (H/R) conditions.Under H/R stimulation, the effects of UA on H9c2 cells were examined using ELISA and western blot assays. The Comparative Toxicogenomics Database was employed to analyze the target molecule of UA. Small interfering RNA was used to knock down CXCL2 expression, further exploring the function of CXCL2 in H/R-induced H9c2 cells. The genes related to the nuclear factor-kappa B (NF-κB) pathway were assessed using western blot analysis.Significant effects of UA on H/R-induced H9c2 cell damage were observed, accompanied by reduced inflammation and oxidative stress injury. Additionally, the increased level of CXCL2 in H/R-induced H9c2 cells was reduced after UA stimulation. Moreover, CXCL2 knockdown strengthened the beneficial effect of UA on H/R-induced H9c2 cells. HY-18739, an activator of the NF-κB pathway, can increase CXCL2 expression. Moreover, the increased levels of p-P65 NF-κB and p-IκBα in H/R-induced H9c2 cells were remarkably attenuated by UA treatment.In summary, the results indicated that UA may alleviate the damage of H9c2 cells by targeting the CXCL2/NF-κB pathway under H/R conditions.

A mechanism-based structure-activity relationship (SAR) study examines the structural basis for a chemical/biological activity by targeting a single or a few stages in a postulated mechanism of action. Computational chemistry approaches provide a valuable complement to experiment for probing such associations, but require a highly focused viewpoint that neglects much of the full biological and chemical interaction problem. Research questions are formulated in terms of fundamental structure and reactivity properties and are designed to test key assumptions of a postulated mechanism of activity. The results of such studies can aid in the generation of new hypotheses, suggest new experiments, and provide scientific rationale for extrapolation in hazard identification (ID). Toxicologists and computational chemists bring very different, yet complementary viewpoints, approaches: and expertise to bear on the hazard ID problem. However, improved communication and interaction between these two groups is needed to most productively address hazard ID issues.

Chitosan is a natural polysaccharide, mainly derived from the shell of marine organisms. At present, chitosan has been widely used in the field of biomedicine due to its special characteristics of low toxicity, biocompatibility, biodegradation and low immunogenicity. Chitosan nanoparticles can be easily prepared. Chitosan nanoparticles with positive charge can enhance the adhesion of antigens in nasal mucosa and promote its absorption, which is expected to be used for intranasal vaccine delivery. In this study, we prepared chitosan nanoparticles by a gelation method, and modified the chitosan nanoparticles with mannose by hybridization. Bovine serum albumin (BSA) was used as the model antigen for development of an intranasal vaccine. The preparation technology of the chitosan nanoparticle-based intranasal vaccine delivery system was optimized by design of experiment (DoE). The DoE results showed that mannose-modified chitosan nanoparticles (Man-BSA-CS-NPs) had high modification tolerance and the mean particle size and the surface charge with optimized Man-BSA-CS-NPs were 156 nm and +33.5 mV. FTIR and DSC results confirmed the presence of Man in Man-BSA-CS-NPs. The BSA released from Man-BSA-CS-NPs had no irreversible aggregation or degradation. In addition, the analysis of fluorescence spectroscopy of BSA confirmed an appropriate binding constant between CS and BSA in this study, which could improve the stability of BSA. The cell study in vitro demonstrated the low toxicity and biocompatibility of Man-BSA-CS-NPs. Confocal results showed that the Man-modified BSA-FITC-CS-NPs promote the endocytosis and internalization of BSA-FITC in DC2.4 cells. In vivo studies of mice, Man-BSA-CS-NPs intranasally immunized showed a significantly improvement of BSA-specific serum IgG response and the highest level of BSA-specific IgA expression in nasal lavage fluid. Overall, our study provides a promising method to modify BSA-loaded CS-NPs with mannose, which is worthy of further study.

Meloxicam (MLX) is a non-steroidal anti-inflammatory drug used to treat rheumatoid arthritis and osteoarthritis. However, its poor water solubility limits the dissolution process and influences absorption. In order to solve this problem and improve its bioavailability, we prepared it in nanocrystals with three different particle sizes to improve solubility and compare the differences between various particle sizes. The nanocrystal particle sizes were studied through dynamic light scattering (DLS) and laser scattering (LS). Transmission electron microscopy (TEM) was used to characterize the morphology of nanocrystals. The sizes of meloxicam-nanocrystals-A (MLX-NCs-A), meloxicam-nanocrystals-B (MLX-NCs-B), and meloxicam-nanocrystals-C (MLX-NCs-C) were 3.262 ± 0.016 μm, 460.2 ± 9.5 nm, and 204.9 ± 2.8 nm, respectively. Molecular simulation was used to explore the distribution and interaction energy of MLX molecules and stabilizer molecules in water. The results of differential scanning calorimetry (DSC) and powder X-ray diffraction (PXRD) proved that the crystalline state did not change in the preparation process. Transport studies of the Caco-2 cell model indicated that the cumulative degree of transport would increase as the particle size decreased. Additionally, plasma concentration–time curves showed that the AUC0–∞ of MLX-NCs-C were 3.58- and 2.92-fold greater than those of MLX-NCs-A and MLX-NCs-B, respectively. These results indicate that preparing MLX in nanocrystals can effectively improve the bioavailability, and the particle size of nanocrystals is an important factor in transmission and absorption.

通过纳米晶技术将难溶性药物姜黄素制备成方便给药的口服纳米晶固体制剂,以提高姜黄素的溶解度及溶出速率,进而提高生物利用度.采用介质研磨法制备姜黄素纳米晶混悬液,得到两种稳定的姜黄素纳米晶混悬液处方,稳定剂分别为聚乙烯吡咯烷酮(PVP K30)/十二烷基硫酸钠(SDS)(1∶1),以及吐温80;通过流化床底喷包衣工艺将姜黄素纳米晶负载于丸芯上得到载药微丸,灌装后得到纳米晶胶囊.纳米晶再分散稳定性实验和扫描电镜(SEM)实验结果表明,以PVPK30/SDS为稳定剂时载药微丸形态均一且再分散前后纳米晶粒径均在200nm左右,为最优处方.体外溶出研究表明,粒径为200 nm时显著提高了溶出速率和溶出度;X射线粉末衍射(XRPD)和差示扫描量热(DSC)分析结果表明,纳米晶制备过程中少部分晶型转变为无定型;大鼠体内药代动力学研究显示,姜黄素制成纳米晶后生物利用度达到原料药的9.3倍.本研究开发的姜黄素纳米晶胶囊可显著提高药物的体外溶出速率和溶出度、体内吸收速度和生物利用度,在改善药物难溶性方面具有重要意义.

The present review sets out to discuss recent developments of the effects and mechanisms of carrier properties on their circulation time. For most drugs, sufficient in vivo circulation time is the basis of high bioavailability. Drug carrier plays an irreplaceable role in helping drug avoid being quickly recognized and cleared by mononuclear phagocyte system, to give drug enough time to arrive at targeted organ and tissue to play its therapeutic effect. The physical and chemical properties of drug carriers, such as size, shape, surface charge and surface modification, would affect their in vivo circulation time, metabolic behavior and biodistribution. The final circulation time of carriers is determined by the balance between macrophage recognitions, blood vessel penetration and urine excretion. Therefore, when designing the drug delivery system, we should pay much attention to the properties of drug carriers to get enough in vivo circulation time to arrive at target site eventually. This article mainly reviews the effect of carrier size, size, surface charge and surface properties on its circulation time in vivo, and discusses the mechanism of these properties affecting circulation time. This review has reference significance for the research of long-circulation drug delivery system.

为了解医学生对慕课的认识、接受程度及存在问题,采用问卷调查法对在山东大学第二医院进行临床学习的山东大学医学院大四和大五学生进行问卷调查.结果显示:学生对慕课的总体学习体验感到满意,学生的慕课学习完成率高;但对慕课的学习兴趣在男女生之间存在差异;学生之间和师生之间互动以及临床技能等方面尚存在不足.慕课作为一种新的教学方式,在医学教育基础课程的教学改革中发挥了重要作用.

Brain-targeting delivery of 1,1 '-methylenebis[4-[(hydroxyimino)methyl]-pyridinium] dimethanesulfonate (MMB4 DMS) is limited by its hydrophilic property and chemical instability. In order to solve this problem, herein, we develop a facile protocol through combining antisolvent precipitation and emulsion-solvent evaporation method to synthesize midazolam (MDZ) coated MMB4 DMS (MMB4@MDZ) nanoparticles. The as-prepared MMB4@MDZ had a MMB4 DMS nanocrystal (MMB4-NC) core and a MDZ shell. The MDZ shell prevented the MMB4-NC core from contacting the aqueous environment, and thus, guaranteed the chemical stability of MMB4 DMS. Most charmingly, the iron mimic cyclic peptide CRTIGPSVC (CRT) was modified on MMB4@MDZ surfaces to produce CRT-MMB4@MDZ which was endowed with ability to absorb transferrin (Tf)-abundant corona. Taking advantages of the Tf-abundant corona, CRT-MMB4@MDZ achieved transferrin receptor (TfR)-mediated brain-targeting delivery. With the fascinating chemical stability and brain-targeting delivery effect, CRT-MMB4@MDZ showed great clinical transform prospect as a brand-new nanomedicine. Of particular importance, this work promised not only a core-shell carrier-free nanomedicine platform for effective delivery of unstable water-soluble drug, but also a protein corona-manipulating strategy for targeting delivery.

For efficient intranasal transport of parathyroid hormone (1-34) [PTH(1-34)], there is a great medical need to investigate permeation enhancers for intranasal formulations. In this study, the development of PTH(1-34) intranasal formulations was conducted. Based on conformation and chemical stability studies, the most preferable aqueous environment was determined to be 0.008 M acetate buffer solution (ABS). Subsequently, citric acid and Kolliphor® HS·15 were compared as permeation enhancers. The mechanisms of action of citric acid and Kolliphor® HS·15 were investigated using an in vitro model of nasal mucosa, and Kolliphor® HS·15 led to higher permeability of fluorescein isothiocyanate-labeled PTH(1-34) (FITC-PTH) by enhancing both the transcellular and paracellular routes. Moreover, citric acid showed severe mucosal toxicity resulting in cilia shedding, while Kolliphor® HS·15 did not cause obvious mucosa damage. Finally, Kolliphor® HS·15 was studied as a permeation enhancer using a liquid chromatography tandem mass spectrometry (LC-MS/MS) method. The results showed that 5% and 10% Kolliphor® HS·15 increased the bioavailability of PTH(1-34) to 14.76% and 30.87%, respectively. In conclusion, an effective and biosafe PTH(1-34) intranasal formulation was developed by using 10% Kolliphor® HS·15 as a permeation enhancer. Intranasal formulations with higher concentrations of Kolliphor® HS·15 for higher bioavailability of PTH(1-34) could be further researched.

目的 基于质量源于设计(QbD)理念开发一种用于3D打印技术的半固体材料,满足儿童咀嚼制剂的批量生产和医院个性化调配的需求.方法 苯磺酸氨氯地平作为模型药物,羧甲基纤维素钠(CMC-Na)、羧甲基淀粉钠(CMS-Na)和甘油作为自变量,所制备片剂的硬度、脆碎度、崩解时限和溶出度作为因变量,利用23全因子设计建立处方设计空间,并进行放大研究.结果 实际制备所得的半固体材料具有良好的可打印性,设计空间中选取最优处方1.0％ CMC-Na、7.0％ CMS-Na和10.0％甘油进行放大,各项指标与模型预测值接近,均符合要求.结论 全因子设计可以用于3D打印半固体材料的处方优化,所制备的3D打印咀嚼片性能良好,本研究为挤出式3D打印的规模化生产和个性化定制药物的实现提供理论指导.

As one of the most prospective delivery systems of insoluble drugs, nanocrystal has attracted more and more attention from pharmaceutical researchers. Nanoparticles with prominent different particle diameters were obtained to solve the problem of solubility and evaluate the positive effects of quercetin in vitro. The newly prepared nanocrystals were investigated by several methods including dynamic light scattering (DLS) and transmission electron microscopy (TEM). The particle sizes of the quercetin nanocrystals A (quercetin/NCs-A), quercetin nanocrystals B (quercetin/NCs-B) and quercetin nanocrystals C (quercetin/NCs-C) were 3.089±0.162 μm, 677.2±9.7 nm and 169.8± 0.3 nm respectively. The crystalline state of quercetin was detected by X-ray powder diffraction (XRPD) and differential scanning calorimetry (DSC) analyses and no change was observed after the process of reducing sizes. An accelerated quercetin dissolution rate was achieved through the nanocrystal technique. In conclusion, nanocrystals could significantly increase the equilibrium solubility of quercetin In Vitro. In addition, the particle size also had an important effect on the dissolution behavior of quercetin.

The purpose of this study was to investigate the nasal absorption rate and nasal mucosal toxicity of thermosensitive ketamine in situ gels containing various absorption enhancers. The optimal composition ratio for the gel matrix was determined to be 17.2% Poloxamer 407 and 2% Poloxamer 188, as this combination resulted in solutions with a gelation point within the range found in the nasal cavity. Ketamine gels containing the tested enhancers, namely, ethylenediaminetetraacetic acid disodium salt, hydroxypropyl-beta-cyclodextrin, propylene glycol, or Tween-80, were compared with enhancer-free counterparts to determine the absorption of the drug, in vivo by measuring its plasma levels in rats and in vitro using a Franz diffusion cell. Moreover, the toxicity of each gel type was assessed by microscopic observation of the morphology of rat nasal mucosa as well as by determining the mobility of the mucosal cilia using an established toad model. The results showed that gels containing hydroxypropyl-beta-cyclodextrin could promote the absorption of ketamine without added toxicity compared to enhancer-free gels. Thus, we consider hydroxypropyl-beta-cyclodextrin as the most promising absorption enhancer for the nasal administration of ketamine using in situ gels.

近年来逐层自组装(layer-by-layer self-assembly,LbL)技术快速发展,因其制备简单、灵活和可控,已经在医药、冶金等各行业得到广泛应用.在药物递送系统研究中,采用LbL方法构建的中空微胶囊作为药物递送载体,在药物释放、体内循环及生物利用度方面具有很大的优势,为药物靶向释放提供了技术平台.本文总结了应用于LbL的成膜材料及自组装成膜的驱动力类型,简述了中空微囊的载药方式和载药种类,综述了自组装膜作为药物载体的释放机制、体内外评价和安全性评价,表明了LbL技术在药物递送方面的巨大应用前景.

Myocardial infarction (MI) is the leading cause of morbidity and mortality worldwide. Nanoparticle systems carrying drugs have already been developed to treat MI. To improve the efficiency of tanshinone (TAN), and to achieve the synergistic effect of TAN and puerarin (PUE), PUE-prodrug and TAN co-loaded solid lipid nanoparticles (SLN) was structured and utilized for MI treatment in the present research. PUE-prodrug was synthesized by an esterification reaction. PUE-prodrug and TAN co-loaded SLN (PUEp/TAN-SLN) were prepared by a single emulsification followed by a solvent evaporation method. The physicochemical properties of SLN were characterized and the in vivo infarct therapy effects were evaluated in MI rats. PUE-prodrug and TAN contained SLN showed a size of 112.6 ± 3.1 nm. The SLN encapsulation reduced the cytotoxicity of drugs and was a safer system. PUEp-SLN exhibited a 1.7-fold increase in comparison to PUE-SLN (21.2 ± 2.1 versus 12.5 ± 1.5 mg/L), in the mean time a 3.4-fold increase compared with free PUE in heart drug concentration (21.2 ± 2.1 versus 6.3 ± 0.9 mg/L). In vivo infarct therapy efficiency of double drugs loaded PUEp/TAN-SLN (17 ± 1.9%) was significantly better than the single drug loaded PUEp-SLN (31 ± 1.6%) and TAN-SLN (40 ± 2.2%). PUE-prodrug contained, double drugs co-loaded SLN can be utilized as promising candidate delivery system for cardioprotective drugs in treatment of myocardial infarction.

目的 探讨高敏C反应蛋白(hs-CRP)与急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后非靶病变进展之间的关系.方法 行初始PCI的STEMI患者286例,采集入院初始、PCI术后24、48 h、随访期血样标本,测定hs-CRP及血清生化指标,并收集入院初始和随访期冠状动脉造影和PCI临床资料.比较介入治疗前后上述指标的变化情况,并应用Pear-son相关和Logistic回归分析其与非靶病变进展的关系.结果 与非进展组相比,进展组hs-CRP水平在入院初始、PCI术后24、48 h均显著升高(P均<0.01);随访期,进展组低密度脂蛋白胆固醇(LDL-C)显著增高(P<0.01)及冠脉复杂病变发生率明显增高(P<0.05).多因素Logistic回归分析显示住院初始hs-CRP、PCI术后24、48 h hs-CRP、LDL-C均是急性心肌梗死(AMI)患者初次PCI术后非靶病变进展的预测因素.结论 CRP水平与STEMI患者PCI术后非靶病变的进展密切相关.

Objectives: To investigate the association between variability of self-measured blood pressure at home (home BPV), heart rate variability (HRV) and the balance of autonomic nervous system activity. Methods: From August 2015 to June 2017, we enrolled 127 normotensive to moderate hypertensive subjects. Based on home BPV (assessed using SD) level, the 127 subjects were categorized into three groups: low home BPV group (Low group), middle home BPV group (Middle group), and high home BPV group (High group). cold pressor test norepinephrine (CPT), epinephrine plasma concentration, norepinephrine plasma concentration, angiotensin II plasma concentration, and HRV were determined. Results: Compared to Low group, systolic BP response to CPT, norepinephrine plasma concentration, and angiotensin II plasma concentration were higher in Middle group, and highest in High group. The opposite trends were found in time domain parameters of HRV (SDNN, SDANN, and rMSSD), and frequency domain parameter (LF). The results of Spearman correlation and multivariate linear regression analyses showed that home systolic BPV was significantly and positively correlated with systolic BP response to CPT, norepinephrine plasma concentration, angiotensin II plasma concentration, and VLF, and negatively correlated with SDNN, SDANN, rMSSD, and LF. Home diastolic BPV was significantly and positively correlated with systolic BP response to CPT, diastolic BP response to CPT and norepinephrine plasma concentration, and negatively correlated with SDNN. Conclusion: Aggressive home BPV and HRV may be tightly associated with the imbalance of autonomic nervous system activity.

Objective To determine if high fasting blood glucose (FBG) level is an independent predictor of serious coronary lesions in patients with coronary artery disease (CAD). Methods We enrolled 64 patients who had symptoms of chest discomfort and who underwent coronary angiography. FBG was determined from blood samples and the extent of coronary artery lesions was analyzed according to Gensini score. We examined the relationships among diabetes, FBG, and coronary artery severity. Results Diabetes and FBG were significantly and positively related to Gensini score. Diabetes, but not FBG, was independently correlated with the occurrence of a Gensini score >41. However, FBG was significantly associated with Gensini score >41 in non-diabetic patients. Conclusion Hyperglycemia is an independent predictor of severe CAD in non-diabetic patients. Clinicians should be aware of this and should carry out appropriate early interventions.