Role of novel cardiac biomarkers in prediction, diagnosis, and severity assessment of atherosclerotic coronary artery disease

Atherosclerotic cardiovascular disease is a major health problem around the world. Insulin resistance assessed by homeostatic model assessment of insulin resistance [HOMA-IR], triglyceride/ HDL, serum high sensitive C-reactive protein [hs-CRP], and HbA1c are probably associated with atherosclerosis. The aim of this study was to find if there was an association between HOMA-IR, triglyceride/ HDL ratio and their product as well as hs-CRP and HbA1c with the presence and the severity of coronary artery disease and to find the best cut off value for clinical practice. The study involved 170 consecutive patients with suspected or known CAD referred for coronary angiography divided into two groups; CAD group [Group I] and non CAD group [Group II] based on coronary angiography. The blood samples including HbA1c, hs-c-reactive protein, fasting blood glucose creatinine, urea, insulin and lipid spectrum were obtained after overnight fasting. Patients with CAD had higher HOMA-IR than those no CAD [4.47 +/- 4.26 vs. 2.49 +/- 1.99, p=0.002]. Stepwise multiple logistic regression analysis demonstrated that HOMA-IR > 2.66 was independently associated with CAD [odds ratio: 3.057 ; 95% confidence interval: 1.211-7.717; p=0.018] after adjustment for age, male sex, diabetes and waist circumference. HOMA-IR correlates positively with BMI [p=0.008 and r=0.227], waist circumference [p=0.002 and r=0.267] and HbA1c [p=0.015 and r=0.213]. Also HOMA-IRxTG/HDL was higher in patients with CAD compared to those no CAD [18.35 +/- 22.72 vs, 9.50 +/- 10.50, p=0.018]. However there were insignificant differences in levels of triglyceride/HDL, HbA1c, and hs-CRP among both groups [p= 0.124, 0.523, 0.250 and 0.764 respectively]. HOMI-IR was significantly higher in patients with DVD [Double-vessel Disease] and MVD [Milti-vessel Disease] compared to patients with no CAD [p=0.002 and 0.000 respectively]. Moreover HOMA-IR was significantly higher in patients with DVD and MVD compared to patients with SVD [Single-vessel Disease] [P=0.035, 0.001 respectively]. HOMA-IR x TG/HDL was significantly increased in DVD and MVD patients [P=0.012 and 0.001 respectively] compared to patients with no CAD and also when compared to patients with SVD [P=0.005 and 0.000 respectively]. HOMA-IR is considered as a marker for prediction of CAD and severity assessment

Disturbance of some coagulation and fibrinolytic factors in essential hypertension

Hypertension is an established risk factor for acute coronary events. Growing evidence is now apparent that hypertension is accompanied by hypercoagulable and/or hypofibrinoltic state, both of which can be the cause of several cardiovascular risk factors noticed with hypertension. To show the relationship between hypertension and some components of fibrinolytic and coaguIation systems . In this study, the plasma levels of fibrinogen, FVII, D-dimer, t-PA and PAI-I were studied in three groups of male persons. A hypertensive group of patients [16], complicated hypertensive group [16] and a group of normotensive persons [16] were included in this work Patients were selected from outpatient clinic of Cardiology Department, Assiut University Hospital, during the period from December 2001 until December 2002. The mean plasma levels of fibrinogen, FFVII, t-PA, PAZ-I and D dimer before treatment of the hypertensive and complicated hypertensive groups were significantly higher than that of the normotensive group .The mean plasma levels of these factors [except FVII] in the complicated hypertensive group were significantly higher than that of the hypertensive group. After treatment of these groups, the mean plasma levels of all factors decreased significant and there was no significant difference between the two groups. It is clear from this study that there are disturbances in the levels of coagulation and fibrinolytic factors in hypertensive patients particularly in the complicated hypertensive patients. This indicates severity of disturbance of these factors in hypertensive patients making them risk factors for the development of coronary heart disease, myocardial infarction, unstable angina, etc

Thrombin-antithrombin activity and C1-inactivator in type I diabetics

Previous studies on Diabetes mellitus Type 1 ended in a controversy as to whether there was an increased or decreased fibrinolysis. Also whether fibrinolysis if present was primary or secondary to a hypercoagulable state. The results of screening tests of fibrinolysis are frequently indecisive. C[1]-Inactivator [C[1]-1] [%] as inhibitor of fibrinolysis and thrombin anti-throbmin [TA T] [ug/ml] complex as a sensitive index of the coagulation cascade were determined in 41 male patients with type I diabetes mellitus without complications and in 25 patients of the same disease with microvascular complications [retinopathy, nephropathy and/or neuropathy]. The effect of duration of the disease and the response of the disease to control, were studied. In spite of the fact that screening results of fibrinolysis were not decisive, C[1] -1 and TA T were specific and indicative. TA T was higher in complicated cases [m 9.7 +/- 2.1 SD] than in non-complicated ones [m 5.6 +/- 2.7 SD]; and in uncontrolled complicated cases [m 11.3 +/- 3.0 SD] than in controlled ones [m 9.7 +/- 2.1 SD]. The effect of control was evident also in non-complicated cases where TAT was higher in uncontrolled [m 6.2 +/- 1.9 SD] versus controlled ones [5.6 +/- 2.7 SD]. The longer the duration of the disease the higher the level of TA T, where it was [m 7.2 +/- 2.1 SD] in 1-2 yrs duration and reached m 10.2 +/- 3.1 SD in 5-9 yrs duration. C[1]-l was also higher in complicated diabetes [m 118.6. +/- 18.5 SD] than in non-complicated cases [m 107.5 +/- 16.0 SD] and in both complicated uncontrolled cases [116.3 +/- 15.0 SD] than in complicated controlled ones [118.6 +/- 18.5 SD] also in non-complicated uncontrolled cases [m 115.0 +/- 18.8 SD] than in controlled ones [m 107.5 +/- 160 SD]. The results point to an increased rate of fibrinolysis in response to increased hypercoagulable state in type I Diabetes Mellitus and this is more accentuated the longer the duration of the diseases and that both improve on a better control of the disease

Coxsackie B virus infection and myocardial infarction

This prospective study aimed at finding relation between coxsackie B virus [CBV] infection and myocardial infarction [MI]. This study was carried out for 12 months to cover at least one whole epidemiologic year. Fifty patients [44 males and 6 females] were studied. 30 were diagnosed as MI and 12 were diagnosed as having arrhythmias without MI. All of them were admitted to the CCU of Assiut University Hospital, 20 Normal age matched control subjects, were also studied. Two serum samples acute and convalescent were taken from all patients and only one from the controls. All samples were tested for the presence of the six serotypes of CBV antibodies by the neutralizing complement fixing test to find the relationship between CBV infection and MI. 16 patients [32%] showed a positive test for CBV antibodies. Non of the controls was positive the highest number of infarction occurred at age range 40-60 years, as well as the highest number of positive serology; 13 of 16 patients [81%] were positive for CBV antibodies of whom 10 cases [63%] were positive for B3, B5 and B6 5 cases for B1 [31.5%] and 2 cases [12.3%] for B2. More than one serotype was positive in 10 cases

association between plasma lipids and gall stones in patients with ischaemic coronary heart disease

The study was conducted on seventy five patients and thirty controls. The patients were classified into three groups: Group I included patients with gall stones only, Group II included patients with coronary heart disease CHD only and Group III included those with both diseases. Serum levels of the following lipid fractions were estimated: Total cholesterol, phospholipids, tri-glycerides, high density lipoprotein cholesterol, HDL-phospholipids, low density lipo-protein cholesterol and LDL phospholipids. The results showed that the serum total cholesterol was significantly lower in the patients with gall stones compared to controls. The serum phospholipids revealed no difference between patients controls. On the other hand, the serum HDL-cholesterol was significantly lower in all patients than controls. HDL-phospholipids was also lower in the three patient groups in comparison with the controls but this difference is significant in patients with gall stones and in those with CHD. Lastly, the serum level of LDL-cholesterol is significantly higher in all patients than controls LDL phospholipids. The serum level of the LDL-ph was higher in the 3 groups of patients than controls but this difference was significant in Group I and Group III while it was highly significant in Group II compared to controls. The difference between the three groups of patients was insignificant. There is positive correlation in the patient groups and controls as regard the following lipid fractions: Total cholesterol versus phospholipids, total cholesterol versus triglycerides, HDL-cholesterol versus HDL-phospholipids and LDL-cholesterol versus LDL-phospholipids. We had observed that there was no significant difference between the 3 groups of patients in any of the estimated lipid fractions and also in the correlation between the above mentioned parameters, so, we can predict that the metabolic effect and the behaviour of both CHD gall stones are the same. Both the serum total cholesterol and the serum phospholipids have no longer been a determinant factors for either CHD or gall stone disease as thought before. However, the serum levels of the lipoproteins are the good predictive indicators for the development of both diseases

role of magnesium [Mg] in essential hypertension

The effect of Mg supplementation on blood pressure, the interaction between Mg and other electrolytes as Na, K and Ca, the interaction between Mg and serum lipids and plasma renin activity [PRA] were evaluated in 44 male patients with mild to-moderate essential hypertension.Patients were classified into 2 groups; group I: 11 male patients discovered to be hypertensive for the first time, group II: 33 male hypertensive patients on regular treatment for at least the last 6 months. Control group included 20 normal male subjects age matched. Mg supplementation in the form of Mg chloride capsules in a dose of 210 mg/d were given to all patients for 4 weeks. Measurements of pulse and BP and estimations of Mg, Na, K, Ca, TG, T. cholest., HDL-C, LDL-C and PRA were done before and after Mg supplementalion. The results revealed that all patients were significantly hypomagnesemic in comparison with the controls and after Mg supplementation their serum Mg concentration became significantly higher and their systolic BP [SBP] and diastolic DBP became significantly lower. Mg supplementation led to a significant increase in total serum Ca, but no significant effect on other electrolytes. Besides increased serum concentration of TG, T.cholesterol, HDL-C and LDL-C indicative of hyperlipidemia that may be attributed to alteration in lipoprotein metabolism, further studies are necessary to clarify this effect. The role of Mg supplementation in hypomagnemic patients with essential hypertension is interpreted in the text