![]() Dyslipidemia was defined according to National Cholesterol Education Program Adult Treatment Panel III guidelines or by treatment with lipid lowering medication. Diabetes mellitus was defined by fasting glucose of ≥ 126 mg/dl and/or use of insulin or oral hypoglycemic agents. Hypertension was defined as a history of untreated blood pressure ≥ 140/90 mmHg and/or treatment with anti-hypertensive medications. Prior to ICA in the Discovery cohort, cardiac medical histories were examined by their attending cardiologists to determine CAD risk factors, as defined by the 2013 ACC/AHA Guidelines on the Assessment of Cardiovascular Risk. This subset of TRACs is consistent with extensive accumulating evidence for a role of regulatory T cell (Treg) dysfunction as an important component in the etiology of CAD. ![]() Using RNAseq of whole blood RNA, a novel pattern of gene expression changes was identified that is associated with the presence of CAD, but essentially unrelated to other known risks for CAD. Thus, the present studies employed a more advanced, single-molecule RNA sequencing (RNAseq) methodology to identify diagnostic transcripts associated with CAD (TRACs). Such discrepancies could have several explanations, but likely arise from cross-hybridization noise created by highly abundant signals, such as globins, which can overwhelm true signals in microarrays, and likely mask changes of low magnitude, or larger changes in a small subset of cells. However, the agreement between these studies on exactly which transcripts are modulated is quite low. Several prior microarray studies suggested that there is an RNA signature in blood associated with CAD. Thus, reliable blood-based biomarkers of CAD would have the potential to reduce the number of cardiac catheterizations on relatively low risk individuals. The American College of Cardiology’s Registry, covering 398,978 patients, identified 39.2% of patients undergoing invasive coronary angiography (ICA) as having less than 20% stenosis. ![]() ![]() Despite the presence of CAD symptoms and other clinical tests suggestive of CAD, 20–40% of angiograms do not detect any occluded arteries. From the more than one million cardiac catheterizations yearly, 622,000 result in interventions such as stent placement. Thus, there is a tremendous need for improvement in the diagnosis of CAD. risk, C statistic = 0.803), but they are far less accurate in acute clinical settings at determining whether a person has CAD or not (C statistic = 0.667, where 0.5 is random chance). The Framingham risk factors of advanced age, male sex, elevated cholesterol, smoking, and hypertension, are good predictors of long term risk (30 yr. In a prospective analysis of patients presenting with chest pain, ultimately, many cases were determined to be musculoskeletal (20%) or gastroesophageal reflux disease (GERD) (13%), while CAD was diagnosed in only 11% of cases, and the remaining cases were either pulmonary, neurological, or idiopathic. However, chest pain and dyspnea alone are not particularly specific warning signs. Outward symptoms of coronary artery disease (CAD) are chest pain, typically radiating down the left arm, and shortness of breath upon exertion. There are more than a million heart attacks each year, and 2200 Americans die of cardiovascular disease each day, about one person every 40 s. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
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