C-565T polymorphism [rs2422493] of the ATP-binding cassette transporter A1 gene contributes to the development and severity of coronary rrtery disease in an Iranian population

Objectives: ATP-binding cassette transporter A1 [ABCA1] plays a pivotal role in reverse cholesterol transport from peripheral tissues back to the liver. Abnormalities in ABCA1 function may lead to dyslipidemia and coronary artery disease [CAD]. We investigated the role of C-565T [rs2422493] promoter polymorphism of ABCA1 gene in the development and severity of CAD in an Iranian subpopulation

Methods: Our study population consisted of 110 angiographically-confirmed CAD patients and 110 matched controls. The severity of CAD was expressed based on the number of stenotic vessels. Genotyping of C-565T promoter polymorphism was performed using the polymerase chain reaction followed by restriction fragments length polymorphism analysis methods. Lipid profile was determined by routine colorimetric methods

Results: The distribution of ABCA1 C-565T genotypes [p = 0.035] and alleles [p = 0.017] was significantly different between the CAD and control groups. In univariate analysis [with genotype CC as reference], the TT genotype was significantly associated with an increased risk of CAD [odds ratio = 3.83; 95% confidence interval: 1.29-11.30, p = 0.014], but the CT genotype was not [p = 0.321]. A multiple binary logistic regression analysis revealed that smoking, hypertension, triglyceride, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and ABCA1 C-565T dominant genotype were significant and independent risk factors for CAD development [p < 0.050]. The ABCA1 C-565T polymorphism affected the severity of CAD in TT homozygote state [p = 0.028]. However, no significant correlation was seen between this common polymorphism and lipid profile in the study population [p > 0.050].

Conclusions: Our study indicated that ABCA1 C-565T polymorphism is a significant risk factor for development and severity of CAD in our population.

Association of Nitric Oxide Levels and Endothelial Nitric Oxide Synthase G894T Polymorphism with Coronary Artery Disease in the Iranian Population

PURPOSE: The endothelial nitric oxide synthase (eNOS) G894T polymorphism has been reported to cause endothelial dysfunction and may have a role in the development of coronary artery disease (CAD). The aim of the present study was to investigate the association of eNOS G894T genetic polymorphism and plasma levels of nitric oxide (NO) with CAD risk in an Iranian population. MATERIALS AND METHODS: We studied 200 patients with angiographically documented CAD and 100 matched controls. Analysis of G894T genetic polymorphism of eNOS was performed by polymerase chain reaction-restriction fragment length polymorphism method. Plasma levels of NO were determined using Griess method. Biochemical analysis was conducted by routine colorimetric methods. RESULTS: Plasma levels of NO were significantly lower in CAD patients than control subjects (41.60±12.70 vs. 55.48±16.57, P=0.001). Also, the mean plasma levels of NO were significantly lower in T allele carriers of eNOS G894T polymorphism than G allele carriers (P0.05). CONCLUSION: Reduced plasma level of NO is associated with increased risk of CAD in our population. Moreover, eNOS G894T polymorphism is a significant risk factor for CAD development via reducing the plasma levels of NO. However, eNOS G894T polymorphism is not a contributing factor for the severity of CAD.

efficacy of hydration with normal saline versus hydration with sodium bicarbonate in the prevention of contrast-induced nephropathy

Contrast-induced acute kidney injury [contrast-induced nephropathy [CIN]] is one of the major causes of hospital-acquired acute renal failure. Volume supplementation is the most effective strategy to prevent acute renal failure caused by contrast; but the effects of sodium bicarbonate regimens are unknown in CIN prevention. The aim of this survey is to compare the efficacy of hydration with normal saline versus hydration with sodium bicarbonate in the prevention of the CIN in patients undergoing coronary angiography. In a clinical trial, 350 patients undergoing coronary interventions were randomized into two groups: One group received normal saline and another group received sodium bicarbonate before and after infusion of the contrast. Patients in both the groups had received N-acetylcysteine. CIN was defined as relative increase in serum creatinine equal to or more than 25% of baseline or increase to 0.5 mg/dl in 48 h after the injection of the contrast. CIN was seen in 46 patients [13.1%] after coronary interventions. Incidence of CIN in patients receiving normal saline [19.4%] was more than in patients receiving sodium bicarbonate [6.9%] [P = 0.001]. Hemodialysis was needed only in one patient who received saline normal. Relative risk to induce CIN in both groups was as 2.8 and was in the range of 1.50-5.25 with confidence interval of 95% and P = 0.001. Thus, the probability of CIN was significantly more in the usage of normal saline. This survey showed that hydration with sodium bicarbonate is superior to hydration with normal saline and has better protection effects

impact of stepwise stent deployment on the angiographic and clinical outcome of coronary angioplasty in the setting of an acute myocardial infarction

To detect a reduction in the incidence of no-reflow, and a possible improvement in angiographic and clinical outcome after stepwise stenting in comparison with conventional method in the percutaneous coronary intervention [PCI] of patients with anterior ST elevation myocardial infarction. Between March 2007 and December 2009, patients with anterior acute myocardial infarction [AMI] treated with streptokinase less than 6 hours from presentation who underwent early PCI were enrolled in this multicenter randomized clinical trial. The study was carried out in the Cardiology Departments of Valiasr Hospital of Zanjan, Imam Reza, and Shahid Madani Heart Hospitals, Tabriz, Iran. Four hundred and three patients were enrolled in this study. Patients were randomly divided into 2 groups: Group I [n=202] with stepwise stent deployment [SSD], and Group II [n=201] with routine conventional stent deployment [CSD]. The patients' mean age was 57.7 +/- 10.7 years. After PCI, thrombolysis in myocardial infarction myocardial perfusion grade [TMPG] 0/1, suggestive of no-reflow was significantly higher in CSD group [p=0.0001]. In hospital based, death occurred in 15 patients [7.5%] from CSD group while 4 [2%] from the SSD group [p=0.01]. The TMPG was also significantly higher in SSD group [average 2.32 +/- 0.18] compared with CSD group, [average 1.66 +/- 0.24] [p=0.0001]. Conventional stenting technique was an independent predictor of no-reflow in multivariate logistic regression analysis [hazard ratio - 1.43; 95% confidence interval: 1.15-1.73; p=0.01]. The SSD was associated with improved angiographic reperfusion indices and reduced mortality in early PCI for AMI