Extent of coronary atherosclerosis and homocysteine affect endothelial markers

Association between homocysteine and coronary artery disease-trend over time and across the regions: a systematic review and meta-analysis

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.

Circulating ICAM‐1, VCAM‐1, E‐Selectin, P‐Selectin, and TNFRII in Patients with Coronary Artery Disease

OBJECTIVE

To evaluate the relationship between the serum concentration of tumor necrosis factor receptor 2 (TNFRII) and some adhesion molecules [including intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), P-Selectin, and E-Selectin] and coronary artery stenosis.

DESIGN AND SETTING

Observational (cross-sectional) study in a University Heart Hospital in Tehran, Iran.

PATIENTS

75 patients with angiographically proven coronary artery disease were compared with 81 individuals who had undergone coronary angiography with no significant evidence of stenosis (control subjects).

METHODS

Soluble adhesion molecules and TNFRII were determined by enzyme-linked immunosorbent assay technique. sICAM-1 and sP-selectin values were significantly higher in patients with coronary artery disease than in control subjects [146(38) vs. 132(48) p < 0.04 and 275(107) vs. 241(104) ng/ml p < 0.04 respectively]. Multiple logistic regression analysis showed sICAM-1 an independent discriminating risk factor for coronary artery disease (p < 0.03). Prediction models that incorporated sICAM-1 in addition to other established coronary risk factors were significantly better at predicting risk than the models based on the other risk factors alone. Multiple regression analysis indicated that sP-selectin levels were greater in patients with single-vessel disease than in the respective normal (p < 0.01).

CONCLUSIONS

Our findings suggest that sICAM-1 has an association with s1 coronary artery disease as such; the evaluation of this marker may improve the coronary risk assessment in Iranian patients.

Increments in circulating homocysteine before and after coronary artery bypass surgery in diabetic and non-diabetic patients

This study aims to assess total plasma homocysteine levels in diabetic and non-diabetic patients who underwent coronary artery bypass grafting (CABG) and to determine the effect of cardiopulmonary bypass (CPB) on homocysteine levels. Twenty diabetic and twenty non-diabetic patients who had CABG were enrolled in the study. Plasma samples for the assays were obtained before and after the CPB and on sixth day following the operation. Diabetic patients seemed to have higher levels of plasma total homocysteine in pre-CPB, post-CPB, and postoperative sixth day blood samples. There was a significant difference in total homocysteine levels between pre-CPB and post-CPB both in diabetic and non-diabetic patients. Although an association between the preoperative plasma total homocysteine levels and the frequency of 1-year graft occlusion could not be demonstrated, our data claims attention to the increased homocysteine levels during CPB, which sustained until the sixth day after the surgery.

Angiogenesis, thrombogenesis, endothelial dysfunction and angiographic severity of coronary artery disease

BACKGROUND

Thrombogenesis, angiogenesis, and endothelial damage/dysfunction are components in the pathogenesis of atherosclerosis.

OBJECTIVE

To investigate the relation of these variables to atherosclerotic disease severity and the possible interrelations between the three.

METHODS

111 patients attending for coronary angiography were studied (85 male, 26 female; mean (SD) age, 61.6 (10.0) years). Plasma concentrations of von Willebrand factor (vWf, a marker of endothelial damage/dysfunction), vascular endothelial growth factor (VEGF, associated with angiogenesis), soluble VEGF receptor Flt-1 (sFlt-1), and tissue factor (TF, a key component of coagulation) were measured by an enzyme linked immunosorbent assay. Following angiography, disease severity was assessed by the number of coronary vessels diseased (> 50% stenosis) and by a coronary atheroma score.

RESULTS

All indices were raised in the patients compared with 34 healthy controls except sFlt-1, which was lower in the patients. No significant correlations were found between the coronary atheroma score and values of vWf (Spearman correlations: r = 0.21, p = 0.83), VEGF (r = 0.11, p = 0.27), or TF (r = -0.04, p = 0.68). However, there was an inverse correlation between plasma sFlt-1 and coronary atheroma score (r = -0.19, p = 0.049). The number of vessels diseased had no relation to any marker. Correlations were found between TF and VEGF (r = 0.25, p = 0.008) and between TF and sFlt-1 (r = 0.42, p < 0.001) in the patients.

CONCLUSIONS

Despite evidence of abnormal angiogenesis (VEGF and sFlt-1), thrombogenesis (TF), and endothelial damage/dysfunction (vWf) in the patients with coronary artery disease, there was no correlation between VEGF, sFlt-1, vWf, or TF and angiographically defined disease severity.

Circulating ICAM‐1, VCAM‐1, E‐Selectin, P‐Selectin, and TNFαRII in Patients with Coronary Artery Disease

OBJECTIVE

To evaluate the relationship between the serum concentration of TNFalphaRII and some adhesion molecules (including ICAM-1, VCAM-1, P-selectin and E-selectin) and coronary artery stenosis.

DESIGN AND SETTING

Observational (cross-sectional) study in a university heart hospital in Tehran, Iran.

PATIENTS

81 patients with angiographically proven coronary artery disease were compared with 75 individuals who had undergone coronary angiography with no significant evidence of stenosis (control subjects).

METHODS

Soluble adhesion molecules and TNFalphaRII were determined by enzyme-linked immunosorbent assay technique. sICAM-1 and sP-selectin values were significantly higher in patients with coronary artery disease than in control subjects (146 +/- 38 vs. 132 +/- 48 p < 0.04 and 275 +/- 107 vs. 241 +/- 104 ng/ml p < 0.04 respectively). Multiple logistic regression analysis showed sICAM-1 as an independent discriminating risk factor for coronary artery disease (p < 0.03). Prediction models that incorporated sICAM-1 in addition to other established coronary risk factors were significantly better at predicting risk than the models based on the other risk factors alone. Multiple regression analysis indicated that sP-selectin levels were greater in patients with single-vessel disease than in the respective normal (p < 0.01).

CONCLUSIONS

Our findings suggest that sICAM-1 has an association with stable coronary artery disease and the evaluation of this marker may improve the coronary risk assessment in Iranian patients.