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Unadkat SV, Padhi BK, Bhongir AV, Gandhi AP, Shamim MA, Dahiya N, Satapathy P, Rustagi S, Khatib MN, Gaidhane A, Zahiruddin QS, Sah R, Serhan HA. Association between homocysteine and coronary artery disease-trend over time and across the regions: a systematic review and meta-analysis. Egypt Heart J 2024; 76:29. [PMID: 38409614 PMCID: PMC10897093 DOI: 10.1186/s43044-024-00460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/21/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The association of homocysteine with coronary artery disease (CAD) has been explored previously with mixed findings. The present Systematic Review and Meta-Analysis (SRMA) has assessed the pooled estimate of association between homocysteine (Hcy) and CAD, and its variation over the period and geography. METHODS Systematic literature search was done in PubMed, Scopus and Cochrane to identify the observational studies that have reported mean Hcy among cases (CAD) and control. The SRMA was registered in PROSPERO (ID-CRD42023387675). RESULTS Pooled standardized mean difference (SMD) of Hcy levels between the cases and controls was 0.73 (95% CI 0.55-0.91) from 59 studies. Heterogeneity was high (I2 94%). The highest SMD was found among the Asian studies (0.85 [95% CI 0.60-1.10]), while the European studies reported the lowest SMD between the cases and controls (0.32 [95% CI 0.18-0.46]). Meta-regression revealed that the strength of association was increasing over the years (Beta = 0.0227, p = 0.048). CONCLUSIONS Higher homocysteine levels might have a significant association with coronary artery diseases, but the certainty of evidence was rated low, owing to the observational nature of the studies, high heterogeneity, and publication bias. Within the population groups, Asian and African populations showed a greater strength of association than their European and American counterparts, and it also increased over the years.
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Affiliation(s)
- Sumit V Unadkat
- Department of Community Medicine, M. P. Shah Government Medical College, Jamnagar, Gujarat, India
| | - Bijaya K Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Aparna Varma Bhongir
- Department of Biochemistry, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Aravind P Gandhi
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, 441108, India.
| | - Muhammad Aaqib Shamim
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, 342005, India
- Global Center for Evidence Synthesis, Chandigarh, 160036, India
| | - Neelam Dahiya
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- School of Pharmacy, Graphic Era Hill University, Dehradun, 248001, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, DMIHER, Wardha, India
| | - Abhay Gaidhane
- Jawaharlal Nehru Medical College, One Health Centre (COHERD), Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- Division of Evidence Synthesis, School of Epidemiology and Public Health and Research, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu, 46000, Nepal
- Department of Clinical Microbiology, DY Patil Medical College, Hospital and Research Centre, DY Patil Vidyapeeth, Pune, 411000, Maharashtra, India
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Causes, Angiographic Characteristics, and Management of Premature Myocardial Infarction: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:2431-2449. [PMID: 35710195 DOI: 10.1016/j.jacc.2022.04.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/31/2022] [Accepted: 04/13/2022] [Indexed: 12/13/2022]
Abstract
Among patients presenting with acute myocardial infarction (AMI), the proportion of young individuals has increased in recent years. Although coronary atherosclerosis is less extensive in young patients with AMI, with higher prevalence of single-vessel disease and rare left main involvement, the long-term prognosis is not benign. Young patients with AMI with obstructive coronary artery disease have similar risk factors as older patients except for higher prevalence of smoking, lipid disorders, and family history of premature coronary artery disease, and lower prevalence of diabetes mellitus and hypertension. Smoking cessation is by far the most effective secondary preventive measure. Myocardial infarction with nonobstructive coronary arteries is a relatively common clinical entity (10%-20%) among young patients with AMI, with intravascular and cardiac magnetic resonance imaging being key for diagnosis and potentially treatment. Spontaneous coronary artery dissection is a frequent pathogenetic mechanism of AMI among young women, requiring a high degree of suspicion, especially in the peripartum period.
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Rallidis LS, Kosmas N, Stathopoulou E, Rallidi M, Gialeraki A. Homozygosity of the TT methylenetetrahydrofolate reductase C677T genotype is an independent long-term predictor of cardiac death in patients with premature myocardial infarction. Curr Med Res Opin 2021; 37:1079-1084. [PMID: 33813997 DOI: 10.1080/03007995.2021.1912720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism is the main genetic modulator of homocysteine. Data suggest a potential association of homozygosity for the TT MTHFR genotype with premature myocardial infarction (MI). We explored whether TT homozygosity is associated with long-term prognosis in patients with premature ST-segment elevation MI (STEMI). METHODS A total of 265 consecutive patients who had survived their first STEMI ≤35 years of age were followed for a median of 8 years (5-12). Primary endpoints were cardiac death and secondary endpoints were hospitalizations for acute coronary syndrome, myocardial revascularization, arrhythmic event or ischemic stroke. Serum lipids, homocysteine, folate levels were measured at baseline and all patients were also tested for the MTHFR C677T polymorphism. RESULTS During follow-up 14 patients died (cardiac death) [5.3%] while 84 (31.7%) met the secondary endpoints. In univariate Cox regression analysis TT homozygosity predicted the occurrence of cardiac death (Hazard ratio (HR): 4.071; 95% confidence interval (CI): 1.404-11.809, p = .010) but not the occurrence of secondary endpoints (HR: 0.877; 95% CI: 0.479-1.605, p = .669). TT homozygosity remained an independent predictor of cardiac death after adjustment for conventional risk factors (i.e., sex, diabetes mellitus, hypertension, family history of premature coronary artery disease [CAD]) [HR: 4.350; 95% CI: 1.472-12.856, p = .008]. The association also remained after adjustment for left ventricular ejection fraction or the presence of significant CAD. CONCLUSIONS Homozygosity for the TT MTHFR is an independent long-term predictor of cardiac death in patients with premature STEMI.
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Affiliation(s)
- Loukianos S Rallidis
- Second Department of Cardiology, National & Kapodistrian University of Athens School of Medicine, University General Hospital Attikon, Athens, Greece
| | - Nikolaos Kosmas
- Second Department of Cardiology, National & Kapodistrian University of Athens School of Medicine, University General Hospital Attikon, Athens, Greece
| | - Eleni Stathopoulou
- Department of Clinical Biochemistry, National & Kapodistrian University of Athens School of Medicine, University General Hospital Attikon, Athens, Greece
| | - Maria Rallidi
- Harokopio University, Department of Nutrition and Dietetics, Athens, Greece
| | - Argyri Gialeraki
- Laboratory of Haematology and Blood Transfusion Unit, National & Kapodistrian University of Athens School of Medicine, University General Hospital Attikon, Athens, Greece
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Varlamos C, Pappas C, Kiouri E, Kosmas N, Benetou DR, Rallidis LS. Hyperhomocysteinemia as the only risk factor in a young man presenting with ST-elevation myocardial infarction. J Cardiol Cases 2021; 23:112-114. [PMID: 33717374 DOI: 10.1016/j.jccase.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 09/02/2020] [Accepted: 09/27/2020] [Indexed: 11/26/2022] Open
Abstract
Hyperhomocysteinemia has been established as a risk factor for cardiovascular events. This case of a 23-year-old male, presenting with acute coronary thrombosis and unremarkable past medical history, highlights the importance of measuring homocysteine levels in young individuals with acute coronary syndromes, especially those without conventional risk factors. <Learning objective: Hyperhomocysteinemia could be rarely the only risk factor causing an acute coronary syndrome, especially in very young individuals; Optical coherence tomography could provide valuable information regarding the cause of occlusion in an unexpected clinical presentation; Gene testing for thrombophilia should be considered for very young individuals with acute coronary syndrome without conventional risk factors; Randomized controlled trials have failed to prove a clinical benefit in patients treated with folic acid.>.
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Affiliation(s)
| | - Christos Pappas
- Second Department of Cardiology, "Attikon" University Hospital, Athens, Greece
| | - Estela Kiouri
- Second Department of Cardiology, "Attikon" University Hospital, Athens, Greece
| | - Nikolaos Kosmas
- Second Department of Cardiology, "Attikon" University Hospital, Athens, Greece
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Mohammad AM, Othman GO, Saeed CH, Al Allawi S, Gedeon GS, Qadir SM, Al-Allawi N. Genetic polymorphisms in early-onset myocardial infarction in a sample of Iraqi patients: a pilot study. BMC Res Notes 2020; 13:541. [PMID: 33228791 PMCID: PMC7686715 DOI: 10.1186/s13104-020-05367-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/30/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Early-onset myocardial infarction constitutes nearly one third of cases of myocardial infarction among Iraqis, which is rather higher than the proportions reported in many Western countries. Thus this study was initiated to investigate the role of some genetic polymorphisms, as well as acquired risk factors in this condition. RESULTS A total of 102 Iraqi patients with first myocardial infarction aged 50 years, and 77 matched controls were enrolled. The DNAs of participants were screened for nine polymorphisms, namely: β-Fibrinogen (- 455G > A), Factor XIII (V34L), Plasminogen Activator inhibitor-1 (PAI-1, 4G/5G), Human Platelet Antigen-1 (HPA1a/b), 5,10-Methylenetetrahydrofolate Reductase MTHFR (C677T) and MTHFR (A1298C), Angiotensin-Converting Enzyme (ACE) 287 bp insertion/deletion (I/D), Apolipoprotein-B (ApoB: R3500Q), and Apolipoprotein-E (Apo E: E2/E3/E4), using PCR and reverse hybridization technique. Among traditional risk factors, univariate analysis revealed that smoking (OR 2.86 [95%CI 1.53-5.34]), hyperlipidemia (OR 5.23 [95%CI 2.66-10.29]), and diabetes mellitus (OR 4.05 [95% CI 1.57-10.41]) were significantly higher among patients compared to controls (P<0.001, <0.001 and 0.002 respectively), while none of the nine genetic polymorphisms reached significance. Multivariate Logistic regression, however, revealed that only smoking and hyperlipidemia retained significance (P of < 0.001 each). The need to initiate further studies on larger cohorts is paramount to understand the higher than expected frequency of early-onset myocardial infarction in our population.
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Affiliation(s)
- Ameen M. Mohammad
- Department of Internal Medicine, College of Medicine, University of Duhok, 9 Azadi Hospital Rd, Duhok, 1014AM Iraq
| | - Galawezh O. Othman
- Department of Biology, Education College, Salahaddin University, Erbil, Iraq
| | - Chiman H. Saeed
- Medical Research Center, Hawler Medical University, Erbil, Iraq
| | | | - George S. Gedeon
- Consultant Clinical Biochemist, Gedeon Medical Laboratories, Amman, Jordan
| | - Shatha M. Qadir
- Department of Hematology, Azadi Teaching Hospital, Duhok, Iraq
| | - Nasir Al-Allawi
- Department of Pathology, College of Medicine, University of Duhok, Duhok, Iraq
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High prevalence of inherited thrombophilia and antiphospholipid syndrome in myocardial infarction with non-obstructive coronary arteries: Comparison with cryptogenic stroke. Int J Cardiol 2019; 290:1-6. [PMID: 31133433 DOI: 10.1016/j.ijcard.2019.05.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/13/2019] [Accepted: 05/17/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND A role of thrombophilia in myocardial infarction with non-obstructive coronary arteries (MINOCA) is unclear. We investigated thrombophilic factors in MINOCA patients versus those following cryptogenic stroke (CS), a well-established indication for thrombophilia screening. METHODS In a prospective cross-sectional study, we assessed 84 consecutive patients (median age: 45.5 years) at least 3 months after MINOCA. Age-matched CS patients (n = 84) and published data on general population served as controls. Thrombophilia screening involved inherited thrombophilia (factor V Leiden, prothrombin G20210A mutation, deficiency of protein C, protein S or antithrombin), antiphospholipid syndrome (APS), along with factor VIII >150%, homocysteine ≥15 μM and lipoprotein (a) >30 mg/dl. RESULTS Compared to CS, MINOCA were more often males (60.7 vs 33.3%, P < 0.001), obese (34.5 vs 17.9%, P = 0.014), smokers (51.2 vs 35.7%, P = 0.043) and had family history of myocardial infarction (27.4 vs 6.0%, P < 0.001). Inherited thrombophilia occurred in 20 (23.8%) MINOCA patients and in 13 (15.5%) with CS (P = 0.17), without any difference in the parameters except for elevated lipoprotein (a) that was less common in MINOCA (21.4 vs 39.3%, P = 0.012). APS was found in 13 (15.5%) of MINOCA patients, mostly in a single-positive form. APS was diagnosed less frequently in STEMI (2.5 vs 27.3% for NSTEMI, P = 0.002) and MINOCA patients aged ≤50 years (5.7 vs 32.3% for older subjects, P = 0.003). CONCLUSIONS MINOCA patients exhibit high prevalence of thrombophilia including APS, similar to that in CS. Our first comprehensive thrombophilia testing in MINOCA supports its clinical relevance and the need for long-term anticoagulation for some abnormalities, especially APS.
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Rallidis LS, Gialeraki A, Triantafyllis AS, Tsirebolos G, Liakos G, Moutsatsou P, Iliodromitis E. Characteristics and Long-Term Prognosis of Patients ≤35 Years of Age with ST Segment Elevation Myocardial Infarction and "Normal or Near Normal" Coronary Arteries. Am J Cardiol 2017; 120:740-746. [PMID: 28689750 DOI: 10.1016/j.amjcard.2017.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/17/2017] [Accepted: 06/05/2017] [Indexed: 12/14/2022]
Abstract
There are scarce data regarding risk factors and prognosis of patients with premature ST segment elevation myocardial infarction (STEMI) and "normal or near normal" coronary arteries (N/NNCAs). We compared the characteristics and long-term prognosis of patients with premature STEMI and N/NNCAs with their counterparts with significant coronary artery disease (CAD). We recruited 330 patients who had STEMI ≤35 years of age and 167 age- and gender-matched controls. All patients underwent coronary angiography. Coronary arteries with no lesions or lesions causing <30% reduction in lumen diameter were defined as N/NNCAs, whereas narrowings causing ≥50% diameter reduction formed the significant CAD group. Lipid profile, homocysteine levels, and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism were determined. Sixty patients (18%) had N/NNCAs. Patients with N/NNCAs had lower low-density lipoprotein-cholesterol and higher high-density lipoprotein-cholesterol levels, higher homocysteine levels, and higher prevalence of MTHFR TT genotype (34.6 vs 18%, p = 0.008) compared with patients with significant CAD. After a median follow-up of 8 years, cardiovascular events occurred in 105 (36%) of 291 patients with available follow-up data. Significant CAD was associated with higher risk for recurrent cardiovascular events after adjustment for traditional risk factors (hazard ratio 2.095, 95% confidence interval 1.088 to 3.664, p = 0.022) and additional adjustment for the left ventricular ejection fraction, reperfusion therapy, and persistent smoking (hazard ratio 1.869, 95% confidence interval 1.007 to 3.468, p = 0.041). In conclusion, patients with premature STEMI and N/NNCAs have fewer lipid abnormalities, higher homocysteine levels and prevalence of MTHFR TT genotype, and better long-term prognosis compared with their counterparts with significant CAD.
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Affiliation(s)
- Loukianos S Rallidis
- Second Department of Cardiology, University General Hospital Attikon, Athens, Greece.
| | - Argyri Gialeraki
- Laboratory of Hematology and Blood Transfusion Unit, University General Hospital Attikon, Athens, Greece
| | | | - Georgios Tsirebolos
- Second Department of Cardiology, University General Hospital Attikon, Athens, Greece
| | - Georgios Liakos
- Biochemistry Laboratory, General Hospital of Nikea, Piraeus, Greece
| | - Paraskevi Moutsatsou
- Department of Clinical Biochemistry, University General Hospital Attikon, Athens, Greece
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Prothrombotic genetic risk factors in patients with very early ST-segment elevation myocardial infarction. J Thromb Thrombolysis 2017. [DOI: 10.1007/s11239-017-1520-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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The fundamental importance of smoking cessation in those with premature ST-segment elevation acute myocardial infarction. Curr Opin Cardiol 2016; 31:531-6. [DOI: 10.1097/hco.0000000000000320] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Zhang W, Wang M, Zhang P, Xue Z, Fu G, Ge J, Luan Y. Role of methylenetetrahydrofolate reductase 677C→T polymorphism in the development of myocardial infarction: evidence from an original study and updated meta-analysis. Genes Genomics 2016. [DOI: 10.1007/s13258-016-0424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Liu Y, Li K, Venners SA, Hsu YH, Jiang S, Weinstock J, Wang B, Tang G, Xu X. Individual and Joint Associations of Methylenetetrahydrofolate Reductase C677T Genotype and Plasma Homocysteine With Dyslipidemia in a Chinese Population With Hypertension. Clin Appl Thromb Hemost 2016; 23:287-293. [PMID: 26442927 DOI: 10.1177/1076029615609686] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We aimed to examine the cross-sectional associations of plasma total homocysteine (tHcy) concentrations and methylenetetrahydrofolate reductase ( MTHFR) C677T genotype with dyslipidemia. A total of 231 patients with mild-to-moderate essential hypertension were enrolled from the Huoqiu and Yuexi communities in Anhui Province, China. Plasma tHcy levels were measured by high-performance liquid chromatography. Genotyping was performed by TaqMan allelic discrimination technique. Compared with MTHFR 677 CC + CT genotype carriers, TT genotype carriers had higher odds of hypercholesterolemia (adjusted odds ratio [OR] [95% confidence interval (CI)]: 2.7 [1.4-5.2]; P = .004) and higher odds of abnormal low-density lipoprotein cholesterol (adjusted OR [95% CI]: 2.3 [1.1-4.8]; P = .030). The individuals with the TT genotype had higher concentrations of log(tHcy) than those with the 677 CC + CT genotype (adjusted β [standard error]: .2 [0.03]; P < .001). Patients with tHcy ≥ 10 μmol/L had significantly higher odds of hypercholesterolemia (adjusted OR [95% CI]: 2.4 [1.2-4.7]; P = .010). Furthermore, patients with both the TT genotype and the tHcy ≥ 10 μmol/L had the highest odds of hypercholesterolemia (adjusted OR [95% CI]: 4.1 [1.8-9.4]; P = .001) and low-density lipoprotein cholesterol (adjusted OR [95% CI]: 2.4 [1.0-6.0]; P = .064). This study suggests that both tHcy and the MTHFR C677T gene polymorphism may be important determinants of the incidence of dyslipidemia in Chinese patients with essential hypertension. Further studies are needed to confirm the role of tHcy and the MTHFR C677T mutation in the development of dyslipidemia in a larger sample.
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Affiliation(s)
- Yanhong Liu
- 1 School of Life Sciences, Anhui University, Hefei, China
| | - Kang Li
- 1 School of Life Sciences, Anhui University, Hefei, China
| | - Scott A Venners
- 2 Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Yi-Hsiang Hsu
- 3 HSL, Institute for Aging Research, Harvard Medical School, Boston, MA, USA.,4 Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA, USA
| | - Shanqun Jiang
- 1 School of Life Sciences, Anhui University, Hefei, China.,5 Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Justin Weinstock
- 6 Department of Statistics, University of Virginia, Charlottesville, VA, USA
| | - Binyan Wang
- 5 Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Genfu Tang
- 5 Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Xiping Xu
- 5 Institute of Biomedicine, Anhui Medical University, Hefei, China.,7 Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
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Qian G, Zhou Y, Liu HB, Chen YD. Clinical Profile and Long-Term Prognostic Factors of a Young Chinese Han Population (≤ 40 Years) Having ST-Segment Elevation Myocardial Infarction. ACTA CARDIOLOGICA SINICA 2016; 31:390-7. [PMID: 27122898 DOI: 10.6515/acs20140929d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The proportion of the mainland Chinese population with premature ST-segment elevation myocardial infarction is significantly elevated. Young patients with ST-segment elevation myocardial infarction have a different risk factor profile and clinical outcome compared with elder patients, and may also differ as compared to young patients in Western populations. METHODS We analyzed a total of 9462 consecutive ST-segment elevation myocardial infarction patients, and recruited 341 consecutive cases who had survived their first ST-segment elevation myocardial infarction at the age less than 40 years, and followed-up these patients for 5 years. RESULTS The most prevalent risk factor in young Chinese ST-segment elevation myocardial infarction patients was smoking (307/341, 90.03%) and male gender (328/341, 96.19%), although young patients had fewer traditional risk factors of acute myocardial infarction than the control group [(1.63 ± 1.03) vs. (2.38 ± 1.15), p < 0.01]. The number of affected vessels in cases was significantly less than in the elder control group (p < 0.01). During the follow-up, blood lipids and blood pressure of most patients reached the target level, while 42.10% of patients reported continuation of smoking. Multivariable data analysis showed that persistence of smoking (OR: 3.784, 95% CI: 1.636-8.751, p < 0.01) was the most significant prognostic factor of cardiac events after adjusting for various confounding factors. CONCLUSIONS We demonstrated that cigarette smoking is the most prevalent factor among the avoidable cardiovascular risk factors for young ST-segment elevation myocardial infarctions in China. Accordingly, continued smoking is the most powerful predictor for the recurrence of cardiac events in young Chinese patients with ST-segment elevation myocardial infarction. KEY WORDS Premature myocardial infarction; Prognosis; Risk factor.
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Affiliation(s)
- Geng Qian
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Ying Zhou
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Hong-Bin Liu
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Yun-Dai Chen
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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Rallidis LS, Triantafyllis AS, Sakadakis EA, Gialeraki A, Varounis C, Rallidi M, Tsirebolos G, Liakos G, Dagres N, Lekakis J. Circadian pattern of symptoms onset in patients ≤35 years presenting with ST-segment elevation acute myocardial infarction. Eur J Intern Med 2015; 26:607-10. [PMID: 26076942 DOI: 10.1016/j.ejim.2015.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/17/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND There are scarce data regarding the circadian pattern of symptoms onset in young patients presenting with acute myocardial infarction (AMI). We explored whether young patients with ST-segment elevation AMI exhibit a circadian variation in symptoms onset. METHODS We recruited prospectively 256 consecutive patients who had survived their first ST-segment elevation AMI ≤35 years of age. Patients were categorized into 4 groups by 6-h intervals over 24 h. RESULTS In 49 patients (19.1%) the clinical presentation of AMI was atypical. The symptoms onset was as follows: 00:01 to 06:00, 19.1%, 06:01 to 12:00, 32.4%; 12:01 to 18:00, 28.1%; and 18:01 to 24:00, 20.3%. There was a significant association between the time of day and the likelihood of symptoms onset (Rayleigh test, p<0.001). Between 00:01 and 06:00 the incidence of AMI onset was lower than expected and between 06:01 and 12:00 was higher (p=0.034 and p=0.011, respectively), whereas in the other 6-h period groups no difference was found between expected and observed AMI incidence (p=0.280 and p=0.131). No significant differences were found regarding clinical characteristics, i.e. traditional risk factors, reperfusion treatment of AMI, ejection fraction of left ventricle, time interval from pain onset to hospital arrival, dietary habits and physical activity, among the 6-h period groups. CONCLUSIONS ST-segment elevation AMI in individuals ≤35 years of age follows a circadian pattern with a morning peak. This information might be useful for the prompt diagnosis and treatment of AMI in very young patients which occurs rarely and frequently with atypical clinical presentation.
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Affiliation(s)
- Loukianos S Rallidis
- Second Department of Cardiology, University General Hospital Attikon, Athens, Greece.
| | | | | | - Argyri Gialeraki
- Laboratory of Haematology and Blood Transfusion Unit, University General Hospital Attikon, Athens, Greece
| | - Christos Varounis
- Second Department of Cardiology, University General Hospital Attikon, Athens, Greece
| | - Maria Rallidi
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Georgios Tsirebolos
- Second Department of Cardiology, University General Hospital Attikon, Athens, Greece
| | - Georgios Liakos
- Biochemistry Laboratory, General Hospital of Nikea, Piraeus, Greece
| | - Nikolaos Dagres
- Second Department of Cardiology, University General Hospital Attikon, Athens, Greece
| | - Jonh Lekakis
- Second Department of Cardiology, University General Hospital Attikon, Athens, Greece
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Rallidis LS, Sakadakis EA, Tympas K, Varounis C, Zolindaki M, Dagres N, Lekakis J. The impact of smoking on long-term outcome of patients with premature (≤35years) ST-segment elevation acute myocardial infarction. Am Heart J 2015; 169:356-62. [PMID: 25728725 DOI: 10.1016/j.ahj.2014.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND There are few data regarding the long-term prognosis of young survivors of acute myocardial infarction (AMI). We explored the long-term outcome in individuals who had sustained a premature ST-segment elevation AMI. METHODS We recruited 257 consecutive patients who had survived their first AMI ≤35years of age. Patients were followed up for up to 18years. Clinical end points included all major adverse coronary events (MACE): cardiac death, readmission for acute coronary syndrome, arrhythmias, or coronary revascularization due to clinical deterioration. RESULTS The most prevalent risk factor at presentation was smoking (93.7%). Follow-up data were obtained from 237 patients (32.2±3.7years old). The median follow-up period was 9.1years. During follow-up, 139 (58.6%) patients reported continuation of smoking. Ninety-one (38.4%) patients had recurrent MACE (13 deaths, 59 acute coronary syndromes, 2 arrhythmias, and 17 revascularizations). Multivariable Cox regression analysis showed that persistence of smoking, left ventricular ejection fraction (LVEF), and reperfusion therapy (fibrinolysis or primary coronary angioplasty) were independent predictors of MACE after adjustment for conventional risk factors. Continuation of smoking remained an independent predictor for MACE after additional adjustments for LVEF (hazard ratio 2.154, 95% CI 1.313-3.535, P=.002) or reperfusion treatment (hazard ratio 2.327, 95% CI 1.423-3.804, P=.001). Harrell c statistic showed that the model with persistent smoking had the best discriminatory power compared with models with LVEF or reperfusion treatment. CONCLUSIONS In the era of statins and reperfusion treatment, continuation of smoking is the strongest independent long-term predictor for recurrent MACE in young survivors of premature AMI.
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Jiang S, Pan M, Wu S, Venners SA, Zhong G, Hsu YH, Weinstock J, Wang B, Tang G, Liu D, Xu X. Elevation in Total Homocysteine Levels in Chinese Patients With Essential Hypertension Treated With Antihypertensive Benazepril. Clin Appl Thromb Hemost 2014; 22:191-8. [PMID: 25550183 DOI: 10.1177/1076029614565881] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To investigate the effect of benazepril on plasma homocysteine (Hcy) levels and to analyze the correlation between the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and changes in Hcy levels in response to benazepril. METHODS A total of 231 patients with mild to moderate essential hypertension were enrolled, and benazepril was orally administered at a dose of 10 mg/d for 2 weeks. Plasma Hcy levels were measured by high-performance liquid chromatography at baseline and after 2 weeks of treatment. Genotyping of the MTHFR C677T polymorphism was performed by TaqMan probe technique. RESULTS There was no significant change in Hcy level after benazepril treatment for 2 weeks (P = .97). However, stratified by baseline Hcy levels, the patients with baseline Hcy <10 μmol/L had a significant increase in plasma Hcy levels (P = .003). The results from the multivariable linear regression analysis demonstrated a significant correlation between baseline Hcy levels and the changes in Hcy levels found in both the unadjusted (P = .002) and the adjusted model (P = .004). Strikingly, we found no significant effect modification by the MTHFR C677T polymorphism on the Hcy changes after benazepril treatment. There were also no statistically significant interactions of gene and environment factors (ie, gene smoking and drinking) on the changes in Hcy levels after benazepril treatment. CONCLUSION Benazepril may cause an increase in plasma Hcy levels among patients with hypertension with low baseline Hcy levels, while effect modification by MTHFR C677T genotypes on the changes in Hcy levels in response to benazepril was not significant among patients with essential hypertension.
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Affiliation(s)
- Shanqun Jiang
- School of Life Sciences, Anhui University, Hefei, China Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Mingluo Pan
- School of Life Sciences, Anhui University, Hefei, China
| | - Suwen Wu
- School of Life Sciences, Anhui University, Hefei, China
| | - Scott A Venners
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Guisheng Zhong
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA
| | - Yi-Hsiang Hsu
- Institute for Aging Research, HSL and Harvard Medical School, Boston, MA, USA Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA, USA
| | - Justin Weinstock
- Department of Statistics, University of Virginia, Charlottesville, VA, USA
| | - Binyan Wang
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Genfu Tang
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Dahai Liu
- School of Life Sciences, Anhui University, Hefei, China
| | - Xiping Xu
- Institute of Biomedicine, Anhui Medical University, Hefei, China Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
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Scaglione F, Panzavolta G. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing. Xenobiotica 2014; 44:480-8. [PMID: 24494987 DOI: 10.3109/00498254.2013.845705] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
1. Folate, an essential micronutrient, is a critical cofactor in one-carbon metabolism. Mammals cannot synthesize folate and depend on supplementation to maintain normal levels. Low folate status may be caused by low dietary intake, poor absorption of ingested folate and alteration of folate metabolism due to genetic defects or drug interactions. 2. Folate deficiency has been linked with an increased risk of neural tube defects, cardiovascular disease, cancer and cognitive dysfunction. Most countries have established recommended intakes of folate through folic acid supplements or fortified foods. External supplementation of folate may occur as folic acid, folinic acid or 5-methyltetrahydrofolate (5-MTHF). 3. Naturally occurring 5-MTHF has important advantages over synthetic folic acid - it is well absorbed even when gastrointestinal pH is altered and its bioavailability is not affected by metabolic defects. Using 5-MTHF instead of folic acid reduces the potential for masking haematological symptoms of vitamin B12 deficiency, reduces interactions with drugs that inhibit dihydrofolate reductase and overcomes metabolic defects caused by methylenetetrahydrofolate reductase polymorphism. Use of 5-MTHF also prevents the potential negative effects of unconverted folic acid in the peripheral circulation. 4. We review the evidence for the use of 5-MTHF in preventing folate deficiency.
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Affiliation(s)
- Francesco Scaglione
- Department of Medical Biotechnology and Translational Medicine, University of Milan , Milan , Italy
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Slama DBB, Fekih Mrissa N, Haggui A, Nsiri B, Haouala H, Gritli N. Association of methylenetetrahydrofolate reductase C677T and A1298C polymorphisms with myocardial infarction in Tunisian young patients. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s00580-013-1836-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Davis LA, Cannon GW, Pointer LF, Haverhals LM, Wolff RK, Mikuls TR, Reimold AM, Kerr GS, Richards JS, Johnson DS, Valuck R, Prochazka A, Caplan L. Cardiovascular events are not associated with MTHFR polymorphisms, but are associated with methotrexate use and traditional risk factors in US veterans with rheumatoid arthritis. J Rheumatol 2013; 40:809-17. [PMID: 23547211 DOI: 10.3899/jrheum.121012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE C677T and A1298C polymorphisms in the enzyme methylenetetrahydrofolate reductase (MTHFR) have been associated with increased cardiovascular (CV) events in non-rheumatoid arthritis (RA) populations. We investigated potential associations of MTHFR polymorphisms and use of methotrexate (MTX) with time-to-CV event in data from the Veterans Affairs Rheumatoid Arthritis (VARA) registry. METHODS VARA participants were genotyped for MTHFR polymorphisms. Variables included demographic information, baseline comorbidities, RA duration, autoantibody status, and disease activity. Patients' comorbidities and outcome variables were defined using International Classification of Diseases-9 and Current Procedural Terminology codes. The combined CV event outcome included myocardial infarction (MI), percutaneous coronary intervention, coronary artery bypass graft surgery, and stroke. Cox proportional hazards regression was used to model the time-to-CV event. RESULTS Data were available for 1047 subjects. Post-enrollment CV events occurred in 97 patients (9.26%). Although there was a trend toward reduced risk of CV events, MTHFR polymorphisms were not significantly associated with time-to-CV event. Time-to-CV event was associated with prior stroke (HR 2.01, 95% CI 1.03-3.90), prior MI (HR 1.70, 95% CI 1.06-2.71), hyperlipidemia (HR 1.57, 95% CI 1.01-2.43), and increased modified Charlson-Deyo index (HR 1.23, 95% CI 1.13-1.34). MTX use (HR 0.66, 95% CI 0.44-0.99) and increasing education (HR 0.87, 95% CI 0.80-0.95) were associated with a lower risk for CV events. CONCLUSION Although MTHFR polymorphisms were previously associated with CV events in non-RA populations, we found only a trend toward decreased association with CV events in RA. Traditional risk factors conferred substantial CV risk, while MTX use and increasing years of education were protective.
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Affiliation(s)
- Lisa A Davis
- Department of Rheumatology, University of Colorado School of Medicine, Denver, CO, USA.
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Jiang S, Zhao R, Pan M, Venners SA, Zhong G, Hsu YH. Associations of MTHFR and MTRR polymorphisms with serum lipid levels in Chinese hypertensive patients. Clin Appl Thromb Hemost 2012. [PMID: 23188888 DOI: 10.1177/1076029612467226] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the effects of the methylenetetrahydrofolate reductase (MTHFR) and methionine synthase reductase (MTRR) gene polymorphisms and their interactions with environmental factors on serum lipid levels. METHODS We investigated totally 340 patients with essential hypertension, from Dongzhi community, Anhui, China. High-throughput TaqMan allelic discrimination assay was used for the genotyping of MTHFR C677T (Ala222Val), MTHFR A1298C (Glu429Ala), MTRR A66G (Ile22Met), and MTRR His595Tyr. RESULTS Compared with the MTRR 66AA genotype carriers, the GG genotype carriers had lower serum total cholesterol (TC) levels (adjusted β ± standard error [SE]: -0.5 ± 0.2 mmol/L; P = .003) and low-density lipoprotein cholesterol (LDL-C) levels (adjusted β ± SE: -0.4 ± 0.2 mmol/L; P = .005). Their false discovery rate (FDR)-adjusted P values were 0.056 and 0.056, respectively. We further found that there was a statistically significant interaction between 677TT genotype and sex in their associations with LDL levels (P interaction = .020), and significant interaction between 677TT genotype and smoking on LDL levels (P interaction = .036). A similar pattern of interaction was found between 66GG and drinking on levels of TC (P interaction = .034) and LDL (P interaction = .020). However, there were no significant interactions observed after FDR adjustment. CONCLUSION Both MTHFR and MTRR gene polymorphisms could be important genetic determinants of serum lipid levels in Chinese patients with hypertension. These findings need to be replicated in a larger sample.
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Affiliation(s)
- Shanqun Jiang
- 1School of Life Sciences, Anhui University, Hefei, China
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Lambrinoudaki I, Papadimitriou D, Kaparos G, Rizos D, Panoulis C, Deligeoroglou E, Alexandrou A, Auguolea A, Apostolakis M, Creatsa M, Kouskouni E. MTHFR C677T polymorphism modifies the effect of HRT on metabolic parameters in postmenopausal women. Climacteric 2012; 16:568-75. [PMID: 23145891 DOI: 10.3109/13697137.2012.738722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the interaction of the MTHFR C677T polymorphism with changes in lipid and glucose metabolism effected by oral hormone replacement therapy (HRT) in postmenopausal women. METHODS In this open-label, prospective, interventional study, parameters of lipid and glucose metabolism, as well as homocysteine, were assessed in 97 postmenopausal women at baseline and 1 year after the initiation of HRT. Participants were stratified into three subgroups, according to the MTHFR C677T polymorphism (wild-type: CC genotype; heterozygous: CT genotype; homozygous for the mutant variable: TT genotype). RESULTS The TT genotype was associated with an elevation of total and low density lipoprotein (LDL) cholesterol, while CT and CC genotypes were associated with a reduction of total cholesterol and LDL cholesterol after 1 year of HRT (p = 0.032 for total cholesterol and p = 0.002 for LDL cholesterol). Women with the TT genotype had higher glucose levels in contrast to women with the CC genotype who had lower glucose levels after 1 year of HRT (p = 0.011). Additionally, CC carriers under HRT had a significant elevation of apolipoprotein A1 levels (p = 0.018), contrarily to CT and TT genotypes. CONCLUSION While HRT was associated with favorable changes in lipid and metabolic parameters in carriers of the CC genotype, this effect was not evident in carriers of the T allele. The MTHFR C677T polymorphism may modify the effect of HRT on lipid and metabolic parameters in postmenopausal women.
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Affiliation(s)
- I Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, University of Athens , Aretaieio Hospital, Athens
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21
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The rs1801133 polymorphism of methylenetetrahydrofolate reductase gene- the association with 5-year survival in patients with ST-elevation myocardial infarction. Adv Med Sci 2012; 57:106-11. [PMID: 22440940 DOI: 10.2478/v10039-012-0010-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Methylenetetrahydrofolate reductase (MTHFR) is an enzyme involved in endothelial nitric oxide synthase (eNOS) coupling and homocysteine metabolism. The rs1801133 polymorphism of the MTHFR gene affects risk of coronary artery disease. We assessed its influence on 5-year survival of patients with ST-elevation acute myocardial infarction (STEMI). MATERIAL/METHODS The study group comprised consecutive patients with STEMI. Genotyping was performed with a TaqMan SNP Genotyping Assay using the ABI 7500 Real Time PCR System (Applied Biosystems). The analyzed end-point was all-cause 5-year survival. RESULTS The study group comprised 637 patients (mean age 62.3 ± 11.9 years; 25.1% females, n=160; 5-year mortality 16.3%, n=104). The percentages of TT, CT and CC genotypes were: 10.8 (n=69), 39.7 (n=253) and 49.45 (n=315), respectively. No significant differences in clinical characteristics were identified between the genotypes (p>0.05 for all parameters). Eleven (15.9%) TT homozygotes, 40 (15.8%) heterozygotes and 53 (16.8%) CC homozygotes died during follow up (p=0.99 log-rank test). TT homozygotes presented only weak and insignificant tendency towards higher mortality rates in subgroups of patients ≤75 years old (15.6 vs. 11.54%, p=0.35) or with intermediate risk according to the GRACE risk score (13.3% vs. 8.76%, p=0.42). CONCLUSIONS The rs1801133 polymorphism did not show significant association with 5-year survival.
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de las Fuentes L, Yang W, Dávila-Román VG, Gu CC. Pathway-based genome-wide association analysis of coronary heart disease identifies biologically important gene sets. Eur J Hum Genet 2012; 20:1168-73. [PMID: 22510845 DOI: 10.1038/ejhg.2012.66] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Genome-wide association (GWA) studies of complex diseases including coronary heart disease (CHD) challenge investigators attempting to identify relevant genetic variants among hundreds of thousands of markers being tested. A selection strategy based purely on statistical significance will result in many false negative findings after adjustment for multiple testing. Thus, an integrated analysis using information from the learned genetic pathways, molecular functions, and biological processes is desirable. In this study, we applied a customized method, variable set enrichment analysis (VSEA), to the Framingham Heart Study data (404,467 variants, n=6421) to evaluate enrichment of genetic association in 1395 gene sets for their contribution to CHD. We identified 25 gene sets with nominal P<0.01; at least four sets are previously known for their roles in CHD: vascular genesis (GO:0001570), fatty-acid biosynthetic process (GO:0006633), fatty-acid metabolic process (GO:0006631), and glycerolipid metabolic process (GO:0046486). Although the four gene sets include 170 genes, only three of the genes contain a variant ranked among the top 100 in single-variant association tests of the 404,467 variants tested. Significant enrichment for novel gene sets less known for their importance to CHD were also identified: Rac 1 cell-motility signaling pathway (h_rac1 Pathway, P<0.001) and sulfur amino-acid metabolic process (GO:0000096, P<0.001). In summary, we showed that the pathway-based VSEA can help prioritize association signals in GWA studies by identifying biologically plausible targets for downstream searches of genetic variants associated with CHD.
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Affiliation(s)
- Lisa de las Fuentes
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA
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Kavo AE, Rallidis LS, Sakellaropoulos GC, Lehr S, Hartwig S, Eckel J, Bozatzi PI, Anastasiou-Nana M, Tsikrika P, Kypreos KE. Qualitative characteristics of HDL in young patients of an acute myocardial infarction. Atherosclerosis 2011; 220:257-64. [PMID: 22056215 DOI: 10.1016/j.atherosclerosis.2011.10.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/17/2011] [Accepted: 10/13/2011] [Indexed: 11/27/2022]
Abstract
AIM Recently, the concept that high density lipoprotein (HDL) quality is an important parameter for atheroprotection is gaining ground, though little data exists so far to support it. In an attempt to identify measurable qualitative parameters of HDL associated with increased risk for premature myocardial infarction (MI), we studied the structural characteristics of HDL from patients who survived an MI at a young age (≤35 years). METHODS AND RESULTS We studied 20 MI patients and 20 healthy control subjects. HDL of patients had reduced apolipoprotein A-I (apoA-I), apolipoprotein M, and paraoxonase 1 levels and significantly elevated apolipoprotein C-III (apoCIII) levels (all p<0.05). Specifically, the HDL apoA-I/apoC-III ratio was 0.24±0.01 in patients versus 4.88±0.90 in controls (p<0.001). These structural alterations correlated with increased oxidation potential of HDL of the MI group compared to controls (2.5-fold, p=0.026). Electron microscopy showed no significant difference in average HDL particle diameter between the two groups though a significant difference existed in HDL diameter distribution, suggesting the presence of different HDL subpopulations in MI and control subjects. Indeed, non-denaturing two-dimensional electrophoresis revealed that MI patients had reduced pre-β1(α), pre-β1(b) and α(2), and elevated α(1), α(3), and pre-α(4) HDL. CONCLUSIONS Reduction in the HDL apoA-I/apoC-III ratio, changes in the HDL subpopulation distribution and an increase in HDL oxidation potential correlated with the development of MI in young patients. The possibility that such changes may serve as markers for the early identification of young individuals at high risk for an acute coronary event should be further explored.
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Affiliation(s)
- Anthula E Kavo
- Pharmacology Unit, Department of Medicine, University of Patras School of Health Sciences, Patras, Greece
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Isordia-Salas I, Trejo-Aguilar A, Valadés-Mejía MG, Santiago-Germán D, Leaños-Miranda A, Mendoza-Valdéz L, Jáuregui-Aguilar R, Borrayo-Sánchez G, Majluf-Cruz A. C677T polymorphism of the 5,10 MTHFR gene in young Mexican subjects with ST-elevation myocardial infarction. Arch Med Res 2010; 41:246-50. [PMID: 20637366 DOI: 10.1016/j.arcmed.2010.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 04/13/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS The C677T polymorphism of 5,10 methylenetetrahydrofolate reductase (MTHFR) gene has been associated with hypertension and coronary artery disease in several populations worldwide, but results are still controversial. The aim of this study was to examine the possible association of C677T polymorphism with ST-elevation myocardial infarction (STEMI) in young Mexican subjects. METHODS In a case-control study, 167 unrelated patients < or = 45 years of age with diagnosis of STEMI who were admitted to a cardiovascular intense care unit and 167 unrelated controls subjects matched by age and gender were recruited from January 2006 and June 2009. The C677T polymorphism was determined in all participants by a polymerase chain reaction-restriction fragment length polymorphism assay (PCR-RFLP). RESULTS There was no significant difference in the genotype distribution between groups (p = 0.69) or allele frequency (p = 0.40). There were independent factors for STEMI: smoking (OR 4.9, 95% CI 3.0-8.1, p = 0.001), hypertension (OR 1.8, 95% CI 1.0-3.3, p = 0.03), family history of atherothrombotic disease (OR 2.3, 95% CI 2.0-4.6, p = 0.02), and dyslipidemia (OR 3.2, 95% CI 1.8-5.6, p <0.001). Diabetes mellitus did not represent an independent risk factor for STEMI (OR 1.2, 95% CI 0.2-2.2, p = 0.82). CONCLUSIONS The TT genotype from the C677T of 5,10 MTHFR gene is not an independent risk factor for STEMI in the Mexican population. However, more studies are needed to determine the possible "protective effect" of the C677T polymorphism in our population.
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Affiliation(s)
- Irma Isordia-Salas
- Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, H.G.R. No. 1, Dr. Carlos MacGregor Sánchez Navarro, Instituto Mexicano del Seguro Social, México, D.F., México.
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Zhang L, Yin RX, Liu WY, Miao L, Wu DF, Aung LHH, Hu XJ, Cao XL, Wu JZ, Pan SL. Association of methylenetetrahydrofolate reductase C677T polymorphism and serum lipid levels in the Guangxi Bai Ku Yao and Han populations. Lipids Health Dis 2010; 9:123. [PMID: 20977771 PMCID: PMC2987990 DOI: 10.1186/1476-511x-9-123] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 10/27/2010] [Indexed: 12/02/2022] Open
Abstract
Background The association of methylenetetrahydrofolate reductase (MTHFR) gene polymorphism and serum lipid profiles is still controversial in diverse ethnics. Bai Ku Yao is an isolated subgroup of the Yao minority in China. The aim of the present study was to eveluate the association of MTHFR C677T polymorphism and several environmental factors with serum lipid levels in the Guangxi Bai Ku Yao and Han populations. Methods A total of 780 subjects of Bai Ku Yao and 686 participants of Han Chinese were randomly selected from our previous stratified randomized cluster samples. Genotyping of the MTHFR C677T was performed by polymerase chain reaction and restriction fragment length polymorphism combined with gel electrophoresis, and then confirmed by direct sequencing. Results The levels of serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein (Apo) AI and ApoB were lower in Bai Ku Yao than in Han (P < 0.05-0.001). The frequency of C and T alleles was 77.4% and 22.6% in Bai Ku Yao, and 60.9% and 39.1% in Han (P < 0.001); respectively. The frequency of CC, CT and TT genotypes was 58.7%, 37.3% and 4.0% in Bai Ku Yao, and 32.6%, 56.4% and 11.0% in Han (P < 0.001); respectively. The levels of TC and LDL-C in both ethnic groups were significant differences among the three genotypes (P < 0.05-0.01). The T allele carriers had higher serum TC and LDL-C levels than the T allele noncarriers. The levels of ApoB in Han were significant differences among the three genotypes (P < 0.05). The T allele carriers had higher serum ApoB levels as compared with the T allele noncarriers. The levels of TC, TG and LDL-C in Bai Ku Yao were correlated with genotypes (P < 0.05-0.001), whereas the levels of LDL-C in Han were associated with genotypes (P < 0.001). Serum lipid parameters were also correlated with sex, age, body mass index, alcohol consumption, cigarette smoking, and blood pressure in the both ethnic groups. Conclusions The differences in serum TC, TG, LDL-C and ApoB levels between the two ethnic groups might partly result from different genotypic and allelic frequencies of the MTHFR C677T or different MTHFR gene-enviromental interactions.
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Affiliation(s)
- Lin Zhang
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China
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Rallidis LS, Gialeraki A, Merkouri E, Liakos G, Dagres N, Sionis D, Travlou A, Lekakis J, Kremastinos DT. Reduced carriership of 4G allele of plasminogen activator inhibitor-1 4G/5G polymorphism in very young survivors of myocardial infarction. J Thromb Thrombolysis 2009; 29:497-502. [DOI: 10.1007/s11239-009-0398-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gialeraki A, Politou M, Rallidis L, Merkouri E, Markatos C, Kremastinos D, Travlou A. Prevalence of prothrombotic polymorphisms in Greece. ACTA ACUST UNITED AC 2009; 12:541-7. [PMID: 19072566 DOI: 10.1089/gte.2008.0060] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to assess the prevalence of several polymorphisms in genes that are involved in several pathways such as hemostasis, fibrinolysis, platelet membrane receptor activity, endothelial integrity and function, lipid metabolism, and regulation of blood pressure in healthy subjects of Greek origin. Most of these polymorphisms are mainly associated with conditions such as venous thromboembolism and atherothrombosis, and their prevalence has not been studied yet in Greece. We tested 140 healthy individuals for factor V (FV)1691G/A, FV4070G/A, FII 20210G/A, factor XIII (FXIII) exon 2G/T, fibrinogen beta-455G/A, plasminogen activator inhibitor-1 (PAI-1)-675 4G/5G, human platelet antigens 1 (HPA1) a/b, apolipoprotein B (ApoB) 10708 G/A, apolipoprotein E (ApoE) E2, E3, and E4, angiotensin-converting enzyme (ACE) D/I, 5,10 methylenetetrahydrofolate reductase (MTHFR) 677C/T, and MTHFR 1298A/C polymorphisms using a PCR and reverse hybridization technique that detects all of them simultaneously. The allele frequencies observed are in accordance with those reported in other Caucasian populations and almost identical to those of East Mediterranean populations. This first report from Greece may serve as a baseline for planning further investigations of these polymorphisms in association with several clinical entities and for launching guidelines for patient testing of various disease settings in this population.
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Affiliation(s)
- Argyri Gialeraki
- Haematology Laboratory, Attikon Hospital, School of Medicine, University of Athens, Athens, Greece.
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