Circulating adhesion molecules as predictors of atherosclerosis and coronary heart disease

Adhesion of leukocytes to endothelial cells via cell adhesion molecules is thought to be pivotal in the initiation of atherosclerosis. This study was designed to determine the value of circulating cell adhesion molecules as a predictors of coronary heart disease and atherosclerosis. This study was conducted on 25 patients with coronary heart disease [CHD], 21 patients with carotid artery atherosclerosis [CAA] and 20 healthy individuals served as control group. The levels of serum soluble[s] adhesion molecules: E-selectin [sE-selectin], intracellular adhesion molecule-l [sICAM-1] and vascular cell adhesion molecule-l [sVCAM-1] were measured in addition to the serum lipids, total cholesterol and triglyceride, HDL-c and LDL-c. The concentration of sE-selectin was significantly higher in the patient groups when compared with the control subjects [CHD 34.9 +/- 19.2 ng/ml; CAA 43.0 +/- 16.7 ng/ml vs. control 18.5 +/- 7.4 ng/ml, p<0.05 and p< 0.001 respectivly]. While there were non significant statistical difference between CHD and CAA [p> 0.05]. The serum level of sICAM-1 was significantly higher in CHD than control [p< 0.05], while there were non significant changes in their values in CAA and control [CHD 318 +/- 85.1 ng/ml, CAA 292.3 +/- 64.2 ng/ml vs. control 240 +/- 68.1 ng/ml]. A significant increase was found in sVCAM-1 among the patient groups when compared with the control [CHD 535 + 227.1ng/ml, CAA 445 + 139.6 ng/ml, control 115+19.7 ng/ml p < 0.001 and p< 0.01 for CHD and CAA respectivly]. The levels of the studied serum lipids were significantly increased in the patient groups when compared with the control [p < 0.001]. When these serum lipids were correlated with the studied adhesion molecules, there were positive correlation between the sE-selectin and LDL-c [r = 0.5, p < 0.02], between sICAM-1 and both of LDL-c [r = 0.51, p< 0.02] and TG [r = 0.39, p<0.05] and between sVCAM-1 and TG [r = 0.62, p< 0.01]. In conclusion, the increase of sE-selectin, sICAM-1 and sVCAM-I levels in patients with CHD and CAA suggests that they would be of beneficial value as markers for preclinical prediction of atherosclerosis and CHD

Depression after myocardial infarction: incidence and prognostic impact

Depressive disorder may often not be recognized or may be viewed as unavoidable concomitants of MI. The study had been carried out at the Department of Cardiology of the Zagazig University Hospital during 18 months period to assess the incidence of depression in patients in the hospital after a myocardial infarction [MI] and to study the impact of depression on cardiac mortality during one year follow up period. Our final study sample includes 191 patients with first time acute myocardial infarction. A psychiatric interview was conducted to them 7-10 days after admission. Psychiatric diagnosis based on the criteria of the Diagnostic and Statistical Manual of mental disorders, fourth edition [DSM IV]. The Beck Depression Inventory [BDI] was completed by all of them. All patients were subjected to Echo-Doppler assessment and 24 hour Holter monitoring. All patients and / or families were contacted at 12 months to determine survival status. The results showed that about [13%] of our patients met the modified DSM IV criteria for major in-hospital depression after the MI, and about [27%] had BDI scores? 10 indicative of mild to moderate symptoms of depression. There were [23] deaths during the follow up period, including [20] from cardiac causes. The results also showed that depression in hospital and depressive symptomatology were significantly related to one year cardiac mortality, and that the elevated BDI scores had ss significant prognostic impact independent of traditional post MI risk factors. Our results support the key prognostic role of depression in post-MI patients and underscore the importance of further exploring the links between the brain and the heart