Relationship of tissue plasminogen activator, plasminogen activator inhibitor-1 and fibrinogen with coronary artery disease in South Indian male subjects.

AIM: Prevalence rates of coronary artery disease (CAD) are reported to be very high in Asian Indians. Conventional risk factors do not explain the high rates of CAD among Indians. Recently, several newer risk factors have been reported to be associated with CAD. We measured tissue plasminogen activator (tPA) antigen, plasminogen activator inhibitor-1 (PAI-1) and fibrinogen levels in South Indian diabetic and non-diabetic subjects with and without CAD. METHODS: Four groups of subjects were studied (all males); Group 1 comprised of non-diabetic subjects without CAD (n=50). Non-diabetic subjects with CAD formed group 2 (n=50); group 3 comprised of type 2 diabetic patients without CAD (n=50) and group 4 consisted of type 2 diabetic patients with CAD (n=50). CAD was diagnosed based on coronary angiographic evidence of severe double or triple vessel disease. RESULTS: Both diabetic and non-diabetic patients with CAD had significantly higher levels of tPA, PAI-1 and fibrinogen compared to non-diabetic without CAD (p < 0.05). Patients with CAD were distributed more in the upper tertiles of these risk factors compared to those without CAD. A strong association between tPA and PAI-1 was noted in the Pearson's correlation analysis (p < 0.001). Univariate regression analysis showed tPA (Odds ratio--1.12, p = 0.03), PAI-1 (Odds ratio--1.03, p = 0.008), fibrinogen (Odds ratio--1.01, p < 0.0001), serum cholesterol (Odds ratio--1.008, p = 0.04) and hypertension (Odds ratio--3.7, p = 0.0001) to be associated with CAD. Multiple logistic regression analysis revealed hypertension (Odds ratio--4.6, 95% confidence interval--2.113-9.950, p = 0.0001) and fibrinogen (Odds ratio--1.012, 95% confidence interval--1.007-1.018, p = 0.0001) as risk factors for CAD. CONCLUSION: Our study suggests that prothrombogenic risk factors particularly fibrinogen may be associated with CAD in South Indians.

Lipoprotein(a) in South Indian type 2 diabetic subjects in relation to diabetic vascular complications.

OBJECTIVES: Lipoprotein(a) [LP(a)] has been reported to be an independent risk factor for coronary artery disease (CAD). However, its relationship with other vascular complications is not clear. The aim of the study was to determine the relation of lipoprotein(a) with micro- and macrovascular complications seen in type 2 diabetic patients. METHODS: We studied 725 type 2 diabetic patients with and without diabetic complications at the MV Diabetes Specialities Centre, Chennai. The mean age of the study group was 54 +/- 10 years and 70% were males. Diabetic complications viz retinopathy, proteinuria, peripheral vascular disease and coronary artery disease were diagnosed using standardized definitions. Lipoprotein(a) levels were measured using enzyme linked immunosorbant assay (ELISA). Since the frequency distribution of Lp(a) was skewed Lp(a) values were log transformed and geometric mean was used for statistical analysis. RESULTS: The mean Lp(a) level of patients with any vascular complication was significantly higher compared to the subjects without any complications. Multiple logistic regression analysis revealed that lipoprotein(a) had as independent association with CAD (Odds Ratio -1.16, p=0.04) and proteinuria (Odds Ratio -1.69, p < 0.001). The association of Lp(a) with retinopathy and PVD turned out to be non-significant when CAD and proteinuria was introduced as cofactors in the regression model. CONCLUSION: Lp(a) concentrations are found to be higher in those with CAD and proteinuria. There appears to be no association between Lp(a) and retinopathy or PVD in South Indian type 2 diabetic patients.

Absence of association between serum homocysteine levels and coronary artery disease in south Indian males.

BACKGROUND: Asian Indians are reported to have a very high prevalence of premature coronary artery disease. However, traditional risk factors do not explain this excess of coronary artery disease. Elevated levels of homocysteine are reported to be associated with coronary artery disease among Europeans. This study looked at the association of serum homocysteine levels with coronary artery disease in South Indians. METHODS AND RESULTS: Four groups of patients were studied: Group 1 consisted of healthy nondiabetic subjects without coronary artery disease (n=18): Group 2 consisted of nondiabetic subjects with coronary artery disease (n=21); Group 3 consisted of type 2 diabetic patients without coronary artery disease (n=18) and Group 4 consisted of type 2 diabetic patients with coronary artery disease (n=20). The mean homocysteine value was 12.4+/-3.4 micromol/L in Group 1; 12.6+/-4.6 micromol/L in Group 2; 10.1+/-4.4 micromol/L in Group 3; and 10.4+/-3.9 micromol/ L in Group 4. There was no significant difference in the homocysteine levels between the groups studied. The prevalence of hyperhomocysteinemia, defined as a level of 17.1 micromol/L (the 95th percentile for serum homocysteine in the control group) was not significantly different among the groups. CONCLUSIONS: Elevated serum homocysteine levels are not associated with coronary artery disease in South Indian male subjects with or without diabetes. However, the results must be interpreted with caution because of the small numbers studied.