value of lipoprotein [a], homocysteine and doppler of carotid and femoral arteries in assessment of atherosclerosis in asymptomatic cardiovascular risk patients

Atherosclerosis is a major health problem and a common cause of death in our locality. Traditional cardiovascular risk factors do not predict most future cardiovascular events. The aim of this study is to evaluate role of non traditional biochemical markers, carotid and femoral doppler in early detection of atherosclerosis in asymptomatic cardiovascular risk patients. This study was conducted on seventy two patients with various cardiovascular risk factors [22 diabetic. 15 hypertensive, 20 smokers and 15 obese], in addition to eighteen apparently healthy subjects as a control group. All patients and controls were subjected to complete history, physical examination anthropometric measurements, calculation of Framingham risk score [FS]. Measurement of serum levels of lipoproteln [a] [Lp[a]], homocysteine, insulin and C-reactive protein [CRP] as well as microalbumin in urine [UAER], in addition to lipid profile, serum glucose and calculation of insulin sensitivity [QUICKI] were done for all subjects. Also intinia-media thickness [IMT] and plaque formation were assessed in both carotid and femoral arteries using high resolution ultrasound [B mode]. According to FS patients were classified into 3 groups: group [A] 40 patients FS< 10, group [B] 25 patients FS 10-<20% and group [C] 7 patients FS >/= 20%. Also according to presence of atheroma patients were classified into two groups, group I patients without atheroma [62 patients] and group II patients with atheroma [10 patients]. Mean values of serum insulin, homocysteine, CRP, UAER and left common carotid IMT revealed significant elevation in diabetic, hypertensive, obese and smoker groups compared to controls [P<0.01 for all and P <0.05 for CRP in smoker group]. Insulin sensitivity [QUICKI] showed significant reduction in all studied groups compared to controls [P<0.01 for all]. Mean value of Lp[a] showed significant elevation in smoker group compared to controls [P<0.01], but in other groups the mean values of Lp[a] were higher but statistically insignificant. In group C [FS >/= 20%] the mean values of triglycerides, Lp[a] and IMT of both right femoral and right carotid showed significant elevation compared to group [A] FS < 10% [P<0.01 for all]. In group II [patients with atheroma] mean values of systolic blood pressure, serum insulin, triglycerides and CRP revealed significant elevation compared to patients group I [without atheroma] [P< 0.05 for all], while insulin sensitivity showed significant reduction [P<0.05]. Univariate analysis showed significant positive correlations between IMT of left carotid artery and BMI, systolic and diastolic blood pressure, cholesterol, LDL-c., triglycerides, CRP, homocysteine and FS and negative correlation with HDL-c, Also there were positive correlations between triglycerides with CRP and between Lp [a] with homocysteine. Age, waist circumference, waist/hip ratio, homocysteine, triglycerides and CRP were predictors of IMT of carotid artery: while age, CRP and triglycerides were predictors of atheroma. Non traditional biochemical markers were elevated in all cardiovascular risk groups. IMT of carotid artery correlated positively with traditional risk factors [systolic and diastolic blood pressure, BMI lipogram and FS] and negatively with HDL-c. Also it correlated positively with non traditional risk factors [CRP and homocysteine]