Association of the GPIa C807T and GPIIIa PlA1/A2 polymorphisms with premature myocardial infarction in men.

Aims Recent studies have reported an association between the platelet glycoprotein (GP) Ia C807T polymorphism and myocardial infarction, whereas other studies have reported contradictory results concerning the platelet GPIIIa PlA1/A2 polymorphism. In most of these studies the patients were older than 45 years. Thus we decided to examine both genotypes in 287 men who had their first myocardial infarction before age 45, and a group of 138 healthy controls. Methods and Results The frequency of T807 allele carriers was similar among myocardial infarction patients and among controls (54.6% vs 62.3%; odds ratio (OR) 0.73; 95% confidence interval (CI), 0.47-1.12). The frequency of PlA2 carriers was higher in cases than in controls (26.5% vs 15.2%; OR 1.65; CI, 1.09-2.54). After performing a logistic regression analysis, taking into account other cardiovascular risk factors, this difference did not remain significant. The combination of the risk alleles of both genotypes had no major effect on the myocardial infarction risk. Conclusions The GPIIIa PlA2 allele is not independently associated with the risk of premature myocardial infarction. The T807 allele of the GPIa gene alone or in combination with the PlA2 allele had no major effect on premature myocardial infarction risk.

Plasma fibrinogen in relation to the severity of arteriosclerosis in patients with stable angina pectoris after myocardial infarction.

BACKGROUND: Authors both of retrospective and of prospective studies have demonstrated that there is a relationship between concentration of fibrinogen in plasma and the angiographically determined severity of coronary heart disease (CHD). OBJECTIVE: To determine the relevance of the plasma fibrinogen concentration for the severity of CHD, particularly in cases with additional arteriosclerotic changes in the extracranial arteries supplying the brain [cerebrovascular disease (CVD)], in the pelvic/leg arteries [peripheral occlusive arterial disease (POAD)], or in both. PATIENTS AND METHODS: In a retrospective cross-sectional survey the cardiological and angiographical status of a total of 1112 male and 299 female patients with stable angina pectoris after sustained myocardial infarction and an age-matched control group of 326 male and 138 female subjects with no clinical symptoms of CHD was determined, together with measurements of plasma fibrinogen, dynamic plasma viscosity and D-dimers. RESULTS: More than two-thirds of the patients with arteriosclerosis had plasma fibrinogen concentrations in the uppermost tertile of the control range (men > 2.75; women > 2.83 g/l). Plasma fibrinogen concentration was correlated to the severity of CHD (for men r = 0.173, P < 0.001; for women r= 0.144, P < 0.013). Patients with generalized arteriosclerosis had higher plasma fibrinogen concentrations than did those suffering from CHD only (for men, control 2.65 +/- 0.51, CHD 3.07 +/- 0.73, CHD plus POAD 3.17 +/- 0.77 and CHD plus POAD plus CVD 3.45 +/- 0.78 g/l; for women, control 2.69 +/- 0.44, CHD 3.25 +/- 0.67, CHD plus POAD 3.19 +/- 0.77, CHD plus POAD plus CVD 3.60 +/- 0.84 g/l). Multivariate analysis showed that C-reactive protein, D-dimers and dynamic plasma viscosity accounted for 48.2% (for men) and 49.4% (for women) of the variance in plasma fibrinogen concentration. CONCLUSIONS: Our findings demonstrate that there is not only a correlation between plasma fibrinogen concentration and the severity of CHD, but also a correlation to the incidence of additional POAD or CVD.

C-reactive protein and the severity of atherosclerosis in myocardial infarction patients with stable angina pectoris.

BACKGROUND: Recent findings provide evidence for the importance of inflammatory processes in the pathogenesis of atherosclerosis. C-reactive protein was elevated in patients with peripheral artery disease, coronary heart disease and myocardial infarction compared to normal subjects. METHODS: In 1112 male and 299 female survivors of myocardial infarction (mean age +/- SD, men, 50.4 +/- 9.5, women, 56.1 +/- 9.3), we investigated whether plasma C-reactive protein concentration is associated with the severity of coronary heart disease and generalized pre-clinical or clinically manifest arteriopathy. The control group consisted of 326 male and 138 female individuals matched for age without clinical symptoms of coronary disease. The severity of arteriosclerotic changes was determined for the extra-cranial brain-supplying arteries, abdominal aorta, pelvis and leg arteries. In myocardial infarction patients coronary angiography was performed. Laboratory analyses included determination of C-reactive protein, fibrinogen, D-dimer, HDL-cholesterol, LDL-cholesterol and triglycerides. RESULTS: The following ranking of C-reactive protein concentrations was found: controls < or = patients after myocardial infarction without atherosclerosis < or = patients with myocardial infarction and pre-clinical atherosclerosis < or = patients with myocardial infarction and clinically manifest atherosclerosis. Additionally, our data showed a significant association between C-reactive protein concentrations and the angiographically detected degree of coronary heart disease. CONCLUSIONS: As C-reactive protein is a marker of inflammatory processes, our results in patients with clinically manifest and early pre-clinical atherosclerosis support the hypothesis that inflammatory processes in the vessel wall participate in atherogenesis. Moreover, they support the hypothesis of a causal relationship between an acute phase reaction and the pathogenesis of atherosclerosis in coronary arteries and other parts of the arterial vessel system.

D-dimers in relation to the severity of arteriosclerosis in patients with stable angina pectoris after myocardial infarction.

BACKGROUND: Plasma concentrations of D-dimers show the extent of intravascular fibrinolysis of cross-linked fibrin. Higher concentrations of D-dimers are found in the plasma of arteriosclerosis patients with increased fibrin metabolism. The present study was performed in order to investigate whether there is a relationship between the severity of arteriosclerosis and fibrinolytic activity indicated by plasma levels of D-dimer. METHODS: The study populations consisted of 1112 men and 299 women with stable angina pectoris, on average 36+/-5.6 days after a myocardial infarction, as well as 326 men and 138 women with no clinical signs of cardiovascular disease. In addition to cardiological and angiological examinations, the lipid status and levels of fibrinogen, plasma viscosity, F 1+2, plasminogen, plasminogen activator inhibitor-1, D-dimer, and C-reactive protein of the participants were determined. RESULTS: The plasma concentration of D-dimers increases with age, both in the group with coronary artery disease and in the control group, with the female gender showing consistently higher concentrations in both groups. D-dimers correlate with other parameters of the lipid and coagulation systems, which explains 32.0% and 39.2% of the variance in D-dimer values in men and women, respectively. A significant increase in the level of D-dimers can be found in participants with generalized arteriosclerosis, with a left ventricular ejection fraction

[Inpatient length of stay and physical capacity after aortocoronary bypass operation, after heart valve replacement and myocardial infarct]. / Stationäre Behandlungszeiten und körperliches Leistungsvermögen nach aorto-koronarer Bypassoperation, nach Herzklappenersatz sowie nach Myokardinfarkt.

The present investigation was performed to determine the dependence of the length of stay in community hospitals and rehabilitation clinics from patient characteristics and physical activity at the end of treatment. Comparing age, end-diastolic volume index, left ventricular ejection fraction, number of stenosed coronary arteries, number of bypass grafts, levels of physical exercise, body mass index and the ratio total cholesterol/HDL-cholesterol, no significant differences were found in patients, who reached the rehabilitation clinic in the early postoperative period (7.4 +/- 2.0 days, n = 98), after 15-28 days (n = 74) or later than 28 days (n = 156) after bypass-surgery. Similar results were observed in 103 patients after heart-valve replacement, who arrived at the rehabilitation clinic after a corresponding length of hospital care like the bypass patients. Also, no significant differences in the clinical characteristics and physical activity appeared in patients who were admitted in the early phase (9.2 +/- 4.5 days) after transmural myocardial infarction (n = 37) and those entering the rehabilitation clinic after 26.7 +/- 9.4 days of hospital stay (n = 32). The absence of any relationship between the length of stay in hospitals on the one hand and severity of the heart disease on the other hand points out that the whole duration of stay in community hospitals and rehabilitation clinics after surgical intervention and also after transmural myocardial infarction could be drastically shortened by an optimal cooperation of both, hospitals and rehabilitation clinics, without any impairment of clinical results.

[Correlation between risk profile and severity and age at manifestation of coronary heart disease--findings in 3,715 patients]. / Untersuchungen über den Zusammenhang zwischen dem Risikoprofil und dem Schweregrad bzw. dem Manifestationsalter der koronaren Herzkrankheit (KHK)--Befunde von 3715 Patienten.

In 3715 survivors (pts) of an acute myocardial infarction (3343 males and 372 females), of ages between 20 and 80 years (mean 52.9 +/- 7.7 years), lipid-metabolism, amount of cigarette-smoking, severity of coronary artery disease (CHD) by selective coronary arteriography, and age at first manifestation of CHD documented by myocardial infarction were investigated. In contrast to normals, there is a significant reduction of disorders of lipid-metabolism with increasing age. The rate of cigarette-smoking is lower in the elderly. Females are affected by MI 3.6 to 5.3 years later than are males. There was a strong correlation between the degree of lipid-disorders and the severity of CHD, whereas the lipid-disturbances were mostly marked in the younger pts. Dependent on the degree of the underlying lipid-disorder, CHD strikes pts at a younger age, whereby the Chol/HDL-Chol-ratio is most sensitive. In a similar manner, cigarette-smoking transfers the manifestation-date of CHD "dose-dependent" to a younger age. Smokers with a daily consumption of more than 40 cigarettes are 9.2 years younger at the time of first myocardial infarction than are non-smokers. In older pts the influence of lipid-disorders and smoking becomes smaller, compared with the risk-factor "age", but it is also significant. The proven correlation between the risk-profile and the age at first myocardial event stresses the need for preventive and educative strategies.