relationship between age and risk profile in patients with acute coronary syndrome

There is general agreement on multi factorial etiology of coronary artery disease [CAD] and that the incidence of disease increases with age. Nevertheless, it has been recognized in young age groups more frequently in recent years. Worldwide, about 4% of patients with myocardial infarction [MI] are younger than 40 years of age. These patients frequently have characteristics that are different from those seen in older patients. The relationship between age categories and risk profile in ACS patients remain to be identified. 298 patients with ACS, [230 males and 68 females], with age ranged from [32-85 years] with mean age 51.9 years, were included in the study. The risk factors, lipid profile, cardiac enzymes, ejection fraction [EF%] and angiographic data were analyzed and were compared in different age groups. The study groups were classified as group I [n=83] with age <40 years, group II [n=125] with age >/= 40-<75 years and group Ill [n=90] >/= 75 years. Young ACS patients [group I had more prevalence of male sex, smoking, family history, hyper triglyceridemia and low levels of HDL, higher incidence of ST elevation acute myocardial infarction [STEMI] and lower prevalence of unstable angina pectoris [UA] compared with group II and III. Diabetes Mellitus, hypertension, obesity and female sex were more common in older groups [II and Ill]. As regards angiographic analysis group I showed a preponderance of single-vessel disease and prevalent left anterior descending coronary vessel [LAD] involvement compared with older age groups. Male gender and smoking were correlated positively with more severe CAD in young patients, while diabetes was related significantly to CAD extent in patients >40 years. Stepwise multiple regression analysis showed that age, male gender, cardiac enzymes and EF% were common predictors of multi vessel disease. Smoking was independent predictors in young patients <40 while Diabetes was the key predictors in older patient groups. In acute coronary syndrome there is an ageassociated difference in patient's related variables including different clinical and risk factors in addition to angiographic data. These variables might improve risk stratification

Low lipoprotein [a] level as a protective factor against coronary heart disease in patients with liver cirrhosis

Patients with liver cirrhosis are known to be at a low risk to develop coronary heart disease [CHD]. Lipoprotein [a] [LP[a]] concentration was studied in twenty patients with liver cirrhosis, twenty patients with established CHD, and ten age-matched controls. Serum levels of total cholesterol, triglycerides, high density lipoprotein [HDL] cholesterol, and low density lipoprotein [LDL] cholesterol were measured in all patients and controls. Lp[a] concentration was found to be reduced in patients with liver cirrhosis in comparison with patients with [CHD] and controls. No correlation was found between Lp[a] level and age of the patient, cigarette smoking, obesity, arterial blood pressure, or serum lipids. These data suggest that an increased concentration of Lp[a] constitutes a strong and independent risk factor for CHD. A low concentration of Lp[a] may be one reason why patients liver cirrhosis are less prone to CHD