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Afanasieva OI, Tyurina AV, Ezhov MV, Razova OA, Klesareva EA, Pokrovsky SN. Lipoprotein(a) and Low-Molecular-Weight Apo(a) Phenotype as Determinants of New Cardiovascular Events in Patients with Premature Coronary Heart Disease. Diseases 2023; 11:145. [PMID: 37873789 PMCID: PMC10594435 DOI: 10.3390/diseases11040145] [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: 07/01/2023] [Revised: 09/29/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Lipoprotein(a) (Lp(a)) is a genetic risk factor of atherosclerotic cardiovascular diseases (ASCVDs). Proprotein convertase subtilisin/kexin type 9 (PCSK9) is related to vascular inflammation and detected in atherosclerotic plaques. A temporary increase in the circulating concentration of PCSK9 and Lp(a) was shown in patients with myocardial infarction (MI). The aim of this study was to evaluate the role of the apo(a) phenotype and the Lp(a) concentration as well as its complex with PCSK9 in the development of cardiac events and MI in patients with a premature manifestation of coronary heart disease (CHD). METHODS In a prospective study with retrospective data collection, we included 116 patients with premature CHD who were followed for a median of 14 years. The medical history and information on cardiovascular events after an initial exam as well as data on the levels of lipids, Lp(a), PCSK9, PCSK9-Lp(a) complex, and apo(a) phenotype were obtained. RESULTS The patients were divided into two groups depending on the presence of a low- (LMW, n = 52) or high-molecular weight (HMW, n = 64) apo(a) phenotype. LMW apo(a) phenotype (odds ratio 2.3 (1.1 to 4.8), p = 0.03), but not elevated Lp(a) (1.9 (0.8-4.6), p = 0.13), was an independent predictor for the development of MI after adjustment for sex, age of CHD debut, initial lipids levels, and lipid-lowering treatment. The apo(a) phenotype also determined the relationship between Lp(a) and PCSK9 concentrations. The level of the PCSK9-Lp(a) complex was higher in LMW apo(a) patients. CONCLUSION The LMW apo(a) phenotype is a risk factor for non-fatal MI in a long-term prospective follow-up of patients with premature CHD, and this link could be mediated via PCSK9.
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Affiliation(s)
- Olga I. Afanasieva
- Institute of Experimental Cardiology, National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, Academician Chazov str., 15a, 121552 Moscow, Russia; (O.I.A.); (O.A.R.); (E.A.K.); (S.N.P.)
| | - Alexandra V. Tyurina
- A.L. Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, Academician Chazov str., 15a, 121552 Moscow, Russia;
| | - Marat V. Ezhov
- A.L. Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, Academician Chazov str., 15a, 121552 Moscow, Russia;
| | - Oxana A. Razova
- Institute of Experimental Cardiology, National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, Academician Chazov str., 15a, 121552 Moscow, Russia; (O.I.A.); (O.A.R.); (E.A.K.); (S.N.P.)
| | - Elena A. Klesareva
- Institute of Experimental Cardiology, National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, Academician Chazov str., 15a, 121552 Moscow, Russia; (O.I.A.); (O.A.R.); (E.A.K.); (S.N.P.)
| | - Sergei N. Pokrovsky
- Institute of Experimental Cardiology, National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, Academician Chazov str., 15a, 121552 Moscow, Russia; (O.I.A.); (O.A.R.); (E.A.K.); (S.N.P.)
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Agrawal A, Lamichhane P, Eghbali M, Xavier R, Cook DE, Elsherbiny RM, Jhajj LK, Khanal R. Risk factors, lab parameters, angiographic characteristics and outcomes of coronary artery disease in young South Asian patients: a systematic review. J Int Med Res 2023; 51:3000605231187806. [PMID: 37555333 PMCID: PMC10413899 DOI: 10.1177/03000605231187806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/27/2023] [Indexed: 08/10/2023] Open
Abstract
This systematic review provides a qualitative summary of the risk factors, angiographic characteristics, treatment, and complications of young South Asians with coronary artery disease (CAD). PubMed, Embase, and Google Scholar were searched to identify research articles published between 1 January 2010 and 13 November 2022. Studies in patients aged 18 to 45 years that were conducted in South Asian countries, were published in the English language, and included information on patients' clinical profiles and at least two risk factors for young CAD were included in the review. Smoking, dyslipidemia, high body mass index, increased high-sensitivity C-reactive protein, and hyperhomocysteinemia were observed in high proportions in young patients with CAD. Single-vessel disease was more common than multi-vessel disease in young CAD. The complications of CAD such as arrhythmias, cardiogenic shock, and heart failure were also commonly observed in young patients. Large-scale health promotion activities that curb modifiable risk factors such as smoking, obesity, and a sedentary lifestyle should be conducted in South Asian countries.
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Affiliation(s)
- Anushka Agrawal
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | | | - Mason Eghbali
- California University of Science and Medicine, School of Medicine, Colton, California, USA
| | | | | | | | | | - Rajaram Khanal
- Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal
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Samir A, Almahjori M, Zarif B, Elshinawi M, Yehia H, Elhafy M, Shehata A, Farrag A. Characterization of features and outcomes of young patients (< 45 years) presenting with ST-segment elevation myocardial infarction. Egypt Heart J 2023; 75:32. [PMID: 37097520 PMCID: PMC10127970 DOI: 10.1186/s43044-023-00357-2] [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: 12/05/2022] [Accepted: 04/14/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is the commonest cause of death worldwide. ST-segment elevation myocardial infarction (STEMI) and its consequences can be devastating particularly at younger age for a bigger impact on the patient's psychology and ability to work. Little is known about the differential features and outcomes of young STEMI patients in Egypt. This study characterized young STEMI patients (≤ 45 years) compared to patients > 45 years and evaluated 1-year outcomes. RESULTS A total of 492 eligible STEMI patients who presented to the National Heart Institute and Cairo University Hospitals were recruited. Young STEMI patients (< 45 years old) represented 20% of all STEMI comers. Male gender was predominant in both groups, yet with a significantly higher proportion in the younger compared to older patients (87% vs. 73%, p = 0.004). Compared to older patients, young STEMI patients had characteristically higher rates of smoking (72.4% vs. 49.7%, p < 0.001) and family history (13.3% vs. 4.8%, p = 0.002), while significantly lower rate of other conventional CAD risk factors as diabetes, hypertension, and dyslipidemia (20.4% vs. 44.7%, 20.4% vs. 44.9% and 12.7% vs. 21.8%, respectively, p < 0.05 for all). Follow-up was continued for at least 12 months after the index event. Younger STEMI patients had fewer major adverse cardiovascular events and fewer heart failure hospitalizations compared to the older controls (10.2 vs. 23.9% and 18.4% vs. 34.8%, respectively, p < 0.005 for both), however, 1-year mortality was similar (3.1% vs. 4.1%, p = 0.64). CONCLUSIONS Younger STEMI patients (≤ 45 years) show peculiar characteristics, with significantly higher rates of smoking and family history of premature CAD, while less prevalence of other conventional CAD risk factors. Overall MACE occurred less in younger STEMI patients; however, the mortality rate was similar to the older controls.
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Affiliation(s)
- Ahmad Samir
- Faculty of Medicine, Cairo University, Cairo, Egypt.
| | | | | | | | - Hesham Yehia
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Azza Farrag
- Faculty of Medicine, Cairo University, Cairo, Egypt
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Chrissini MK, Panagiotakos DB. Acute Myocardial Infarction in Young Patients and its Correlation with Obesity Status at Pre-adolescent Stage: A Narrative Review. Open Cardiovasc Med J 2022. [DOI: 10.2174/18741924-v16-e2206200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Cardiovascular diseases (CVD), especially acute myocardial infarction (AMI), remain a worldwide major cause of premature morbidity and mortality, with considerable health care costs. Metabolic, behavioural, environmental, and social risk factors are significant drivers of AMI, with obesity being a key determinant among them. Childhood obesity constitutes a major health threat that is considered a global epidemic of the 21st century.
Objective:
To assess whether excess weight from the first years of life acts as a predisposing factor in increasing the risk of AMI in young adults.
Methods:
This is a narrative review of the evidence concerning the epidemiology of early AMI and obesity, using PubMed and Google Scholar.
Results:
There is substantial evidence showing that excess weight during childhood multiplies the risk of AMI at an early age.
Conclusion:
Premature AMI seems to have significant drivers related to lifestyle factors, such as childhood obesity. In the era of a childhood obesity epidemic, the aforementioned relationship underlines the need for early prevention and management.
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Das S, Chander R, Garg T, Mendiratta V, Singh R, Sanke S. Cardiovascular risk markers in premature canities. Indian J Dermatol Venereol Leprol 2022; 89:221-225. [PMID: 35841351 DOI: 10.25259/ijdvl_501_2021] [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: 05/01/2021] [Accepted: 01/01/2022] [Indexed: 11/04/2022]
Abstract
Background An elevated cardiovascular risk has been demonstrated in middle-aged individuals with onset of hair greying before the age of 30 years. Increased serum levels of pro-inflammatory cytokines, interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α), indicate an ongoing state of chronic inflammation that is correlated with cardiovascular risk but have not been studied earlier in patients with early onset of hair greying. Aim/Objective To study various cardiovascular risk markers including pro-inflammatory cytokines interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) in patients with premature canities. Methods This was a hospital-based case-control study of 40 patients with premature canities (age between 19 and 25 years; >5 grey hair) and an equal number of age and gender-matched healthy controls. The blood pressure, pulse rate and body mass index were recorded, and investigations including fasting blood sugar, serum insulin, fasting lipid profile, high sensitivity c-reactive protein (hs-CRP), IL-6 and TNF-α were performed. The homeostatic model assessment of insulin resistance (HOMA-IR) was calculated for all the participants. Results The mean blood pressure, fasting blood sugar, serum insulin, hs-CRP and HOMA-IR were all significantly elevated in patients with premature canities and the serum HDL levels were significantly lower. A greater number of patients with premature canities had significantly elevated IL-6 as compared with the controls. Limitations The sample size was small. A subjective scale was used for grading the severity of premature canities. Trichoscopic evaluation of severity of greying or modified phototrichogram could not be used in this study. Conclusion Abnormalities in cardiovascular risk markers were found in patients with premature canities. Screening and counselling of patients with premature greying of hair is recommended in order to prevent future cardiovascular disease.
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Affiliation(s)
- Suparna Das
- Department of Dermatology and STD, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Ram Chander
- Department of Dermatology and STD, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Taru Garg
- Department of Dermatology and STD, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Vibhu Mendiratta
- Department of Dermatology and STD, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Ritu Singh
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Sarita Sanke
- Department of Dermatology and STD, Lady Hardinge Medical College, New Delhi, Delhi, India
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Yang L, Pu T, Zhang Y, Yan H, Yu H, Gao W. The R93C Variant of PCSK9 Reduces the Risk of Premature MI in a Chinese Han Population. Front Genet 2022; 13:875269. [PMID: 35480303 PMCID: PMC9035790 DOI: 10.3389/fgene.2022.875269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/11/2022] [Indexed: 12/27/2022] Open
Abstract
Background: Dyslipidemia is a common risk factor for premature myocardial infarction (PMI). Our previous work has shown that single-nucleotide polymorphisms (SNPs) of LDLR, APOB, and PCSK9 are associated with dyslipidemia, but how these SNPs correlate with risk for PMI is unknown. Objective: This study aims to evaluate the association between SNPs of LDLR, APOB, and PCSK9 and risk of PMI in Chinese Han population. Methods: Two cohorts were established. In Cohort 1 (413 in the PMI group and 1,239 in the control group), SNPs of APOB, LDLR, and PCSK9 with minor allele frequency (MAF) > 1%, which has been shown to impact the risk of PMI in a Chinese Han population, were thoroughly examined, and gene–environment interactions were analyzed. A model for PMI risk prediction was developed in Cohort 1 and externally validated in Cohort 2 (577 in the PMI group and 270 in the control group). Results: The distribution of the T allele at the PCSK9 R93C variant (rs151193009, C > T) was lower in the PMI group than that in the control group (PMI vs. Control in Cohort 1, 0.8% vs. 2.3%, Padjust < 0.05; in Cohort 2, 1.0% vs. 2.4%, Padjust < 0.05). The T allele at PCSK9 R93C variant (rs151193009, C > T) reduced the risk of PMI by ∼60% regardless of adjusting for confounding factors (in Cohort 1, adjusted odds ratio (OR) 0.354, 95% confidence interval (CI) 0.139–0.900, p = 0.029; in Cohort 2, adjusted OR 0.394, 95% CI 0.157–0.987, p = 0.047). No gene–environment interactions were observed between the R93C variant and diabetes/hypertension/smoking in PMI occurrence in this Chinese Han population. Our model showed good performance in predicting the risk of PMI in Cohort 1 (AUC 0.839, 95% CI 0.815–0.862, p < 0.001) and in an external cohort (AUC 0.840, 95% CI 0.810–0.871, p < 0.001). Conclusions: The PCSK9 R93C variant was associated with significantly reduced risk of PMI in the Chinese Han population, and the model we developed performed well in predicting PMI risk in this Chinese Han population.
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Affiliation(s)
- Lincheng Yang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
| | - Tian Pu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
| | - Yan Zhang
- Department of Cardiology and Institute of Cardiovascular Disease, Peking University First Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Hua Yan
- Department of Cardiology, Wuhan Asia Heart Hospital, Hubei, China
| | - Haiyi Yu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
- *Correspondence: Haiyi Yu, ; Wei Gao,
| | - Wei Gao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
- *Correspondence: Haiyi Yu, ; Wei Gao,
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Kar S. Elevated Lipoprotein A in South Asians and the Associated Risk of Cardiovascular Disease: A Systematic Review. Curr Probl Cardiol 2020; 46:100581. [PMID: 32295712 DOI: 10.1016/j.cpcardiol.2020.100581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND South Asians have a premature risk of cardiovascular disease and increased lipoprotein A which enhances their risk. METHODS This systematic review evaluates the role of elevated lipoprotein A in cardiovascular disease risk for South Asians. It discusses the pathophysiology, clinical studies, and treatment of elevated lipoprotein A using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. RESULTS A total of 72 articles was incorporated which consisted of clinical studies, case-control and cohort studies, meta-analysis, reviews, and editorials. Cardiovascular disease and myocardial infarction occurs prematurely in South Asians, which is further enhanced with an elevated lipoprotein A. CONCLUSIONS South Asians with an elevated lipoprotein A have an increased risk of coronary artery disease so they should have early enactment of lifestyle modification and aggressive medical management.
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Poorzand H, Tsarouhas K, Hozhabrossadati SA, Khorrampazhouh N, Bondarsahebi Y, Bacopoulou F, Rezaee R, Jafarzadeh Esfehani R, Morovatdar N. Risk factors of premature coronary artery disease in Iran: A systematic review and meta-analysis. Eur J Clin Invest 2019; 49:e13124. [PMID: 31038733 DOI: 10.1111/eci.13124] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/25/2019] [Accepted: 04/26/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of this study was to determine the mean age at which coronary artery disease (CAD) hase decreased in recent years in Iran. This systematic review and meta-analysis compares the prevalence of different risk factors of premature CAD (PCAD) in patients vs healthy individuals. METHODS Medline, Web of Science, Embase and Scientific Information Database were searched for studies about PCAD risk factors in Iran until 28 October 2017. Observational studies of Iranians, comparing risk factors between patients with PCAD and age- and sex-matched healthy subjects, were included. Fixed-effects and random-effects model were used for pooling data. Odds ratio (OR) with 95% CI and mean difference were used for effect size estimation among studies. RESULTS Twelve studies were eligible for meta-analysis. Diabetes mellitus (OR: 2.4, 95% CI: 1.9-3.03; P = 0.0001, I2 = 25.5%; P = 0.2), family history of CAD (OR: 2.09, 95% CI: 1.22-3.6; P = 0.007, I2 = 86%; P = 0.0001), dyslipidaemia (OR: 2.05, 95% CI: 1.15-3.64; P = 0.01, I2 = 54%; P = 0.08), smoking (OR: 1.65, 95% CI: 1.11-2.46; P = 0.01, I2 = 77.2%; P = 0.000) and hypertension (OR: 1.35, 95% CI: 1.21 to-1.50; P < 0.001, I2 = 31%, P = 0.1) associated with PCAD. Sensitivity analysis demonstrated that patients with PCAD had significantly lower levels of high-density lipoprotein (HDL) cholesterol and significantly higher levels of triglycerides compared to healthy subjects (MD: -2.56, 95% CI: -3.54 to -1.58, P < 0.001, I2 = 42%, P = 0.01 and MD: 21.17, 95% CI: 14.73-27.62, P < 0.001, I2 = 80.12%, P < 0.001, respectively). It should be noted that although high levels of heterogeneity in LDL and HDL values among the studies were observed, when dyslipidaemia was studied as a binary variable, no significant heterogeneity among studies was observed. CONCLUSION Diabetes mellitus, family history of CAD, dyslipidaemia, smoking, and hypertension were significantly and positively associated with CAD in young adults compared to healthy age- and sex-matched population in Iran.
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Affiliation(s)
- Hoorak Poorzand
- Atherosclerosis Prevention Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Konstantinos Tsarouhas
- Department of Cardiology, University Hospital of Larissa, Larissa, Greece.,Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Nastaran Khorrampazhouh
- Students Research Committee, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
| | - Yones Bondarsahebi
- Students Research Committee, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Ramin Rezaee
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Chemical Engineering, Aristotle University of Thessaloniki, Environmental Engineering Laboratory, University Campus, Thessaloniki, Greece.,HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Balkan Center, Thessaloniki, Greece
| | - Reza Jafarzadeh Esfehani
- Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Particularities of Acute Myocardial Infarction in Young Adults. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2019-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Coronary heart disease occurs more often in patients over the age of 45. However, recent data shows a growing incidence of coronary events in younger patients also. Young patients with acute myocardial infarction (AMI) represent a relatively small proportion of subjects suffering from an acute ischemic event. However, they represent a subset that is distinguished from elderly patients by a different profile of risk factors, often atypical clinical presentation, and different prognosis. The prevalence of risk factors such as smoking, dyslipidemia, and a family history of coronary events is higher in this group of patients compared to the general population with AMI. Because of an important negative impact on the patients’ psychology, impaired working abilities, and a high socioeconomical burden, myocardial infarction in young patients represents an important cardiovascular pathology. This manuscript aims to present the particularities of AMI occuring at a young age, in comparison with the rest of the population with AMI.
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Murali A, Mambatta AK, Ranganathan RRM, Shanmugasundaram R, Deepalakshmi K. Comparison of Carotid Intima Media Thickness in Children of Patients with and without Premature Coronary Artery Disease. J Clin Diagn Res 2017; 10:OC29-OC31. [PMID: 28208908 DOI: 10.7860/jcdr/2016/22625.9012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/21/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Increased Carotid Intima Medial Thickness (CIMT) is associated with cardiovascular risk factors and vascular events like Coronary Artery Disease (CAD) and stroke. AIM This study was designed to identify whether CIMT is increased in the children of parents with premature coronary artery disease and compare it with age and sex matched controls who are children of normal individuals. We also tried to compare and correlate the changes in CIMT if any, among the study group with relation to family history of diabetes and hypertension. MATERIALS AND METHODS It was an observational prospective case control study. Twenty five cases (children of parents with premature coronary artery disease) were recruited as per the inclusion and exclusion criteria. Age and sex matched controls were recruited from the paediatric Outpatient Department (OPD). The CIMT was measured using ultrasound Doppler as per the protocol by the Mannheim intima media thickness consensus statement. RESULTS Ten children out of 25 controls had CIMT of 0.05 cm and 5 out of 25 cases had CIMT of 0.07 cm. The association between cases and controls was not statistically significant. Even though the CIMT increases after 10 years, there is no statistically significant association between cases and controls in the different age groups. Out of the total 48% of the children among the case group had family history of hypertension whereas 28% in the control group. A 33% of children in the case group with family history of hypertension had CIMT of 0.07 cm; 46% of children in case group without family history of hypertension had CIMT of 0.05 cm. This difference was statistically significant (p=0.005). There was no significant association between family history of diabetes mellitus and CIMT in both groups. CONCLUSION There was significant association between CIMT in children with family history of premature CAD and family history of hypertension when compared with no family history of hypertension with premature CAD. There was no significant association between CIMT of children with and without family history of premature CAD.
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Affiliation(s)
- Alagesan Murali
- Professor, Department of General Medicine, PSG Institute of Medical Sciences and Research , Coimbatore, Tamilnadu, India
| | - Anith Kumar Mambatta
- Associate Professor, Department of General Medicine, PSG Institute of Medical Sciences and Research , Coimbatore, Tamilnadu, India
| | - R R M Ranganathan
- Senior Resident, Department of Cardiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamilnadu, India
| | - R Shanmugasundaram
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamilnadu, India
| | - K Deepalakshmi
- Associate Professor, Department of Physiology, PSG Institute of Medical Sciences and Research , Coimbatore, Tamilnadu, India
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Padur AA, Hamdan AB, Abdullah TTBIP, Gunalan C, Kumar N. Evaluation of cardiovascular disease in patients with systemic arterial hypertension in relation to age and sex: a retrospective study in a south Indian population. J Vasc Bras 2017; 16:11-15. [PMID: 29930617 PMCID: PMC5829686 DOI: 10.1590/1677-5449.010516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Systemic arterial hypertension manifests as constant elevation of blood pressure and is considered to be an important cardiovascular risk factor. Systemic evaluation of cardiovascular diseases in patients with systemic arterial hypertension is imperative for prevention. OBJECTIVES The objective of the present study was to investigate and inter-relate sex and age with systemic arterial hypertension and cardiovascular diseases. METHODS Medical records of patients with systemic arterial hypertension and cardiovascular disease were evaluated. Data from the medical records were recorded in a prescribed protocol and the data were analyzed and correlated to the patients' age and sex. RESULTS A total of 170 medical records for patients who visited the cardiology department were reviewed. Of these, 50 patients had systemic arterial hypertension and 19 of this subset had cardiovascular diseases. When we correlated systemic arterial hypertension with age, we observed that patients in the 51-60 years age group were more prone to systemic arterial hypertension (36%). Most of the patients with both systemic arterial hypertension and cardiovascular disease were female and in the 61-70 years age group, while among males the highest rate of occurrence was seen in the 51-60 years age group. The correlation coefficient (r) was 0.62, indicating a moderate, positive, linear relationship between systemic arterial hypertension and cardiovascular disease. CONCLUSIONS A majority of patients with systemic arterial hypertension may develop cardiovascular disease and, as age increases, the tendency to develop hypertension also increases.
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Affiliation(s)
- Ashwini Aithal Padur
- Manipal University, Melaka Manipal Medical College, Department of Anatomy, Manipal Campus, Manipal, Karnataka, India
| | - Aisyah Binti Hamdan
- Manipal University, Melaka Manipal Medical College, Manipal Campus, Manipal, Karnataka, India
| | | | - Chandrigga Gunalan
- Manipal University, Melaka Manipal Medical College, Manipal Campus, Manipal, Karnataka, India
| | - Naveen Kumar
- Manipal University, Melaka Manipal Medical College, Department of Anatomy, Manipal Campus, Manipal, Karnataka, India
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Aggarwal A, Srivastava S, Velmurugan M. Newer perspectives of coronary artery disease in young. World J Cardiol 2016; 8:728-734. [PMID: 28070240 PMCID: PMC5183972 DOI: 10.4330/wjc.v8.i12.728] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/03/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023] Open
Abstract
Coronary artery disease (CAD) occurring in less than 45 years of age is termed as young CAD. Recent studies show a prevalence of 1.2% of CAD cases in this age group. Ethnic wise south Asians especially Indians are more vulnerable to have CAD in young age group with a prevalence of 5% to 10%. Conventional risk factors such as smoking, diabetes, hypertension, obesity and family history seems to be as important as in older CAD subjects. But the prevalence of these risk factors seems to vary in younger subjects. By far the most commonly associated risk factor is smoking in young CAD. Several genes associated with lipoprotein metabolism are now found to be associated with young CAD like cholesterol ester transfer protein (CETP) gene, hepatic lipase gene, lipoprotein lipase gene, apo A1 gene, apo E gene and apo B. Biomarkers such as lipoprotein (a), fibrinogen, D-dimer, serum Wnt, gamma glutamyl transferase, vitamin D2 and osteocalcin are seems to be associated with premature CAD in some newer studies. In general CAD in young has better prognosis than older subjects. In terms of prognosis two risk factors obesity and current smoking are associated with poorer outcomes. Angiographic studies shows predominance of single vessel disease in young CAD patients. Like CAD in older person primary and secondary prevention plays an important role in prevention of new and further coronary events.
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Dalal J, Hiremath MS, Das MK, Desai DM, Chopra VK, Biswas AD. Vascular Disease in Young Indians (20-40 years): Role of Ischemic Heart Disease. J Clin Diagn Res 2016; 10:OE08-OE12. [PMID: 27790504 DOI: 10.7860/jcdr/2016/20206.8517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/16/2016] [Indexed: 12/23/2022]
Abstract
Coronary Artery Disease (CAD) occurs at a younger age in Indians with over 50% of Cardiovascular Disease (CVD) mortality occurring in individuals aged less than 50 years. Although several risk factors have been suggested; smoking, dyslipidemia and hypertension are major risk factors in the young. In this review, we have pooled the current evidence on Ischemic Heart Disease (IHD) in young (20-40 years) and provided an opinion for the effective management of IHD in young Indians.
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Affiliation(s)
- Jamshed Dalal
- Director, Centre for Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital , Mumbai, Maharashtra, India
| | | | - Mrinal Kanti Das
- Consultant Cardiologist, Birla Heart Research Centre , Kolkata, West Bengal, India
| | - Devangkumar M Desai
- Technical Director, Department of Cardiology, B. D. Mehta Mahavir Heart Institute , Surat, Gujarat, India
| | - Vijay Kumar Chopra
- Director, Heart Failure Program, Medanta - The Medicity , Gurgaon, Haryana, India
| | - Arup Das Biswas
- Ex-Professor and Head, Department of Cardiology, NRS Medical College , Kolkata, West Bengal, India
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George R, Sivadasanpillai H, Jayakumari N, Bhatt A, Thulaseedharan JV, Tharakan JA. Circulating Thrombotic Risk Factors in Young Patients with Coronary Artery Disease Who Are on Statins and Anti-platelet Drugs. Indian J Clin Biochem 2016; 31:302-9. [PMID: 27382201 PMCID: PMC4910856 DOI: 10.1007/s12291-015-0540-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/08/2015] [Indexed: 12/12/2022]
Abstract
Thrombotic risk factors may contribute to premature coronary artery disease (CAD), in addition to the conventional risk factors. There is paucity of data on studies evaluating the role of thrombotic factors in premature CAD in Indian patients. Thus a case-control study was performed to evaluate the role of thrombotic and atherogenic factors in young patients with angiographically proven CAD who are on treatment with statins and anti-platelet drugs. 152 patients (≤55 years) with angiographically proven CAD and 102 asymptomatic controls were recruited. Clinical and biochemical data were obtained in both groups. Blood levels of thrombotic factors-fibrinogen, antithrombin-III, tissue-plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), von-Willebrand factor (v-WF), lipoprotein(a) [Lp(a)] and homocysteine were analyzed. Patients had high levels of conventional CAD risk factors (diabetes mellitus, smoking, hypertension, dyslipidemia and positive family history) compared to controls. Logistic regression analysis revealed that low antithrombin-III (odds ratio/OR 11.2; 95 % confidence interval/CI 2.29-54.01), high fibrinogen (OR 6.04; 95 % CI 1.09-33.21) and high Lp(a) (OR 4.54; 95 % CI 0.92-22.56), as important, independent risk factors in patients. PAI-1(OR 0.15; 95 % CI 0.03-0.69) levels were significantly lower in patients. But other thrombotic risk factors studied (t-PA, v-WF and homocysteine) were comparable among patients and controls. The treatment using statins and anti-platelet drugs might be contributing to the control of some of the thrombotic risk factors. The strategies aiming at lowering the levels of thrombotic risk factors along with conventional risk factors may be useful in primary and secondary prevention of CAD.
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Affiliation(s)
- Reema George
- />Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011 Kerala India
| | - Harikrishnan Sivadasanpillai
- />Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011 Kerala India
| | - Narayani Jayakumari
- />Department of Biochemistry, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011 Kerala India
| | - Anugya Bhatt
- />Thrombosis Research Unit, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Poojapura, 695012 Kerala India
| | - Jissa V. Thulaseedharan
- />Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011 Kerala India
| | - Jaganmohan A. Tharakan
- />Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011 Kerala India
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Shah N, Kelly AM, Cox N, Wong C, Soon K. Myocardial Infarction in the "Young": Risk Factors, Presentation, Management and Prognosis. Heart Lung Circ 2016; 25:955-60. [PMID: 27265644 DOI: 10.1016/j.hlc.2016.04.015] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/31/2015] [Accepted: 04/10/2016] [Indexed: 12/15/2022]
Abstract
Myocardial infarction (MI) in the "young" is a significant problem, however there is scarcity of data on premature coronary heart disease (CHD) and MI in the "young". This may lead to under-appreciation of important differences that exist between "young" MI patients versus an older cohort. Traditional differences described in the risk factor profile of younger MI compared to older patients include a higher prevalence of smoking, family history of premature CHD and male gender. Recently, other potentially important differences have been described. Most "young" MI patients will present with non-ST elevation MI but the proportion presenting with ST-elevation MI is increasing. Coronary angiography usually reveals less extensive disease in "young" MI patients, which has implications for management. Short-term prognosis of "young" MI patients is better than for older patients, however contemporary data raises concerns regarding longer-term outcomes, particularly in those with reduced left ventricular systolic function. Here we review the differences in rate, risk factor profile, presentation, management and prognosis between "young" and older MI patients.
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Affiliation(s)
- Nadim Shah
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia.
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Vic, Australia
| | - Nicholas Cox
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia
| | - Chiew Wong
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia
| | - Kean Soon
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia
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Raina JK, Sharma M, Panjaliya RK, Bhagat M, Sharma R, Bakaya A, Kumar P. Methylenetetrahydrofolate reductase C677T and methionine synthase A2756G gene polymorphisms and associated risk of cardiovascular diseases: A study from Jammu region. Indian Heart J 2016; 68:421-30. [PMID: 27316508 PMCID: PMC4912384 DOI: 10.1016/j.ihj.2016.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 01/12/2016] [Accepted: 02/07/2016] [Indexed: 02/07/2023] Open
Abstract
Aim Potent risk factors at both genetic and non-genetic levels are accountable for susceptibility and instigation of different cardiovascular phenotypes. Recently, homocysteine is being identified as an important predictor for cardiovascular diseases. Homocysteine remethylation plays a key role in the synthesis of methionine and S-adenosine methionine. Methylenetetrahydrofolate reductase (MTHFR) and methionine synthase (MTR) genes are known to regulate the homocysteine remethylation reaction and higher homocysteine level is significantly associated with diverse cardiovascular phenotypes. In this context, we aimed to carry out a study on the association of MTHFR (C677T) and MTR (A2756G) gene polymorphism with CVD in population of Jammu region of J&K state. Materials and methods A total of 435 individuals were enrolled (195 CVD patients and 240 controls) for the case–control study. Genotyping of MTHFR C677T and MTR A2756G gene polymorphism was done by PCR-RFLP technique. Biochemical parameters were estimated by biochemical analyser. Results Metabolic variables such as serum LDL-C, TC and TG were significantly higher in patients (p < 0.0001), whereas serum HDL-C was higher in controls. Majority of the patients were having history of hypertension (57.44%; p < 0.0001) as a concomitant condition. The evaluation of genetic association showed that, MTHFR C6877T (OR: 8.89, 95% CI: 2.01–39.40) and MTR A2756G (OR: 1.48, 95% CI: 1.09–2.00) polymorphisms associated with higher risk of CVD. Conclusion The present study reveals significant differences in nongenetic variables among patients and control as well as association of gene polymorphisms with CVD risk.
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Affiliation(s)
- Jyotdeep K Raina
- Human Genetics Research cum Counselling Centre, University of Jammu, 180006, India
| | - Minakashee Sharma
- Human Genetics Research cum Counselling Centre, University of Jammu, 180006, India
| | - Rakesh K Panjaliya
- Human Genetics Research cum Counselling Centre, University of Jammu, 180006, India
| | | | - Ravi Sharma
- Human Genetics Research cum Counselling Centre, University of Jammu, 180006, India; Department of Zoology, University of Jammu, India
| | - Ashok Bakaya
- Department of Cardiology, Acharaya Shri Chander College of Medical Sciences and Hospital (ASCOMS), Sidhra, Jammu, India
| | - Parvinder Kumar
- Principal Investigator, Human Genetics Research cum Counselling Centre, University of Jammu, 180006, India; Assistant Professor, Department of Zoology, University of Jammu, India.
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Glushakova OY, Johnson D, Hayes RL. Delayed Increases in Microvascular Pathology after Experimental Traumatic Brain Injury Are Associated with Prolonged Inflammation, Blood–Brain Barrier Disruption, and Progressive White Matter Damage. J Neurotrauma 2014; 31:1180-93. [DOI: 10.1089/neu.2013.3080] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Association of angiotensin II type I and type II receptor genes polymorphisms with the presence of premature coronary disease and metabolic syndrome. Mol Biol Rep 2014; 41:1027-33. [PMID: 24385301 DOI: 10.1007/s11033-013-2947-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 12/20/2013] [Indexed: 12/13/2022]
Abstract
Premature coronary artery disease (PCAD) is known to have a particularly strong genetic component. We aimed to investigate the association between angiotensin II receptor type 1 (ATR1) or type II (ATR2) genes polymorphisms and PCAD with or without metabolic syndrome in males. 132 male patients with PCAD and 132 controls were included in the study. ATR1 and ATR2 genes polymorphisms were analyzed by polymerase chain reaction. The present study revealed that ATR1 CC genotype and ATR2 G allele increased the risk of PCAD by 2.9 and 1.3 respectively as well as they increased susceptibility to metabolic syndrome by 4.5 and 2.3 respectively. The present study proved that diabetes, smoking, obesity, total cholesterol, triglycerides, LDLc and HDLc were independent risk factors for the development of PCAD. We concluded that ATR1 CC genotype and ATR2 G allele increased the susceptibility of Egyptian males to have PCAD. The increased susceptibility to have metabolic syndrome could be one of the mechanisms leading to the development of PCAD in subjects carrying one or both of these polymorphisms.
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