Objective: To observe the functional changes of high density lipoprotein (HDL) subclass in patients with aortic dissection and to explore its clinical significance. Methods: Our research included in 2 groups: Aortic dissection group, n=60 patients and Control group, n=60 healthy subjects from regular physical examination. Blood levels of lipids, HDL subclass of HDL2 and HDL3, macrophage [3H] cholesterol efflux rate, intercellular adhesion molecule-1(ICAM-1), intravascular cellular adhesion molecule-1 (IVCAM-1) and paraoxonase 1 (PON-1) activity were examined and compared between 2 groups. Results: Compared with Control group, Aortic dissection group had reduced HDL2 level (41.15±19.02) mmol/L vs (60.48±22.19) mmol/L, P=0.010 and elevated HDL3 level (58.85±29.97) mmol/L vs (39.52±30.15) mmol/L, P=0.013;decreased macrophage [3H] cholesterol efflux rate (5.79±0.97) ％ vs (11.45±2.15) ％, P<0.01 and decreased PON-l activity (125.62±9.90) μ/ml vs (158.72±13.27) μ/ml, P<0.01; increased expressions of ICAM-1 (33571.85±2529.97) vs (17239.52±4330.15) and IVCAM-1 (442.15±119.02) vs (260.48±92.19) by fluorescence intensity, both P<0.05. Conclusion: Aortic dissection patients showed damaged HDL subclass reverse cholesterol transportation function and anti-oxidative function, both of them were lower than healthy population.

Objective To evaluate the impact of insulin resistance (IR) on prognosis in nondiabetic acute coronary syndrome patients.Methods In this prospective study,we enrolled 332 nondiabetic patients suffering from acute coronary syndrome.The patients were divided into three groups by HOMA-IR which calculated by formula:low HOMA-IR group (HOMA-IR ＜ 2),44 cases; moderate HOMA-IR group (2 ≤ HOMA2-IR ＜ 6),99 cases; high HOMA-IR group (HOMA≥6) with HOMA index,179 cases.The in-hospital medical records of patients were compared,and all patients were followed up for one year after discharge.Results Incidence of hypertension (P =0.013),dyslipidemia (P ＜ 0.001),faster resting heart rate (P ＜0.001) and number of triple vessel coronary artery disease (P =0.017)in high HOMA-IR group were significantly higher than in low and moderate HOMA-IR group.During follow-up,the major end-point events increased in proportion to IR grade:64.3％ (26/44) in the high HOMA-IR group,54.7％ (52/99)in moderate HOMA-IR group and 41.3％ (74/199)in low HOMA-IR group (P =0.034).Multivariable logistic regression analysis showed that high sensitivity C reactive protein(OR =1.012,95％CI:1.002-1.022,P =0.022),HOMA-IR (OR =1.250,95％ CI:1.043-1.497,P =0.015),triple vessel coronary artery disease (OR =5.914,95％ CI:2.947-11.868,P ＜ 0.001),ischemic changes on ECG(OR =5.495,95％ CI:2.925-10.324,P ＜ 0.001) and low left ventricular ejection fraction (LVEF ≤40％) (OR =13.205,95％ CI:5.000-34.661,P ＜ 0.001) were independent risk factor for major end-point events during follow-up.Conclusions Increased insulin resistance is linked with poor prognosis of nondiabetic patients with acute coronary syndrome.