RESUMEN
Aims Recent studies have reported an association between the platelet glycoprotein (GP) Ia C807T polymorphism and myocardial infarction, whereas other studies have reported contradictory results concerning the platelet GPIIIa PlA1/A2 polymorphism. In most of these studies the patients were older than 45 years. Thus we decided to examine both genotypes in 287 men who had their first myocardial infarction before age 45, and a group of 138 healthy controls. Methods and Results The frequency of T807 allele carriers was similar among myocardial infarction patients and among controls (54.6% vs 62.3%; odds ratio (OR) 0.73; 95% confidence interval (CI), 0.47-1.12). The frequency of PlA2 carriers was higher in cases than in controls (26.5% vs 15.2%; OR 1.65; CI, 1.09-2.54). After performing a logistic regression analysis, taking into account other cardiovascular risk factors, this difference did not remain significant. The combination of the risk alleles of both genotypes had no major effect on the myocardial infarction risk. Conclusions The GPIIIa PlA2 allele is not independently associated with the risk of premature myocardial infarction. The T807 allele of the GPIa gene alone or in combination with the PlA2 allele had no major effect on premature myocardial infarction risk.
Asunto(s)
Integrinas/genética , Infarto del Miocardio/genética , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/genética , Polimorfismo Genético , Adulto , Estudios de Casos y Controles , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Receptores de Colágeno , Factores de RiesgoRESUMEN
Low serum levels of high-density lipoprotein (HDL) cholesterol or apolipoprotein A-I and high serum levels of insulin increase the risk of coronary heart disease (CHD) and can indicate insulin resistance. We tested the strength, independence, and interactions of associations between HDL cholesterol (or apolipoprotein A-I), insulin (or C-peptide), glucose, and CHD in 95 male nondiabetic patients with CHD who were <60 years old, in 92 probands from the PROCAM study, and in 61 non-cardiologic patients; all subjects were matched by age, body mass index, and smoking habits. Systemic hypertension (odds radio [OR] 2.8, 95% confidence intervals [CI] 1.6 to 4.8), high serum levels of glucose (OR 2.3, 95% CI 1.6 to 4.8), insulin (OR 2.1, 95% CI 1.3 to 3.6), and C-peptide (OR 4.1, 95% CI 2.2 to 7.5) as well as low serum levels of HDL cholesterol (OR 2.0, 95% CI 1.1 to 3.5) or apolipoprotein A-I (OR 3.9, 95% CI 2.1 to 7.1) had significant associations with CHD. At multivariate analysis, systolic blood pressure, glucose, apolipoprotein A-I, and C-peptide, but not HDL cholesterol and insulin, had consistent independent associations with CHD. Thus, the combined measurement of apolipoprotein A-I and C-peptide may improve the identification of nondiabetic patients at increased risk for CHD.
Asunto(s)
Apolipoproteína A-I/sangre , Péptido C/sangre , HDL-Colesterol/sangre , Enfermedad Coronaria/sangre , Insulina/sangre , Adulto , Estudios de Casos y Controles , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/sangre , Análisis de Regresión , Factores de RiesgoRESUMEN
BACKGROUND: Authors both of retrospective and of prospective studies have demonstrated that there is a relationship between concentration of fibrinogen in plasma and the angiographically determined severity of coronary heart disease (CHD). OBJECTIVE: To determine the relevance of the plasma fibrinogen concentration for the severity of CHD, particularly in cases with additional arteriosclerotic changes in the extracranial arteries supplying the brain [cerebrovascular disease (CVD)], in the pelvic/leg arteries [peripheral occlusive arterial disease (POAD)], or in both. PATIENTS AND METHODS: In a retrospective cross-sectional survey the cardiological and angiographical status of a total of 1112 male and 299 female patients with stable angina pectoris after sustained myocardial infarction and an age-matched control group of 326 male and 138 female subjects with no clinical symptoms of CHD was determined, together with measurements of plasma fibrinogen, dynamic plasma viscosity and D-dimers. RESULTS: More than two-thirds of the patients with arteriosclerosis had plasma fibrinogen concentrations in the uppermost tertile of the control range (men > 2.75; women > 2.83 g/l). Plasma fibrinogen concentration was correlated to the severity of CHD (for men r = 0.173, P < 0.001; for women r= 0.144, P < 0.013). Patients with generalized arteriosclerosis had higher plasma fibrinogen concentrations than did those suffering from CHD only (for men, control 2.65 +/- 0.51, CHD 3.07 +/- 0.73, CHD plus POAD 3.17 +/- 0.77 and CHD plus POAD plus CVD 3.45 +/- 0.78 g/l; for women, control 2.69 +/- 0.44, CHD 3.25 +/- 0.67, CHD plus POAD 3.19 +/- 0.77, CHD plus POAD plus CVD 3.60 +/- 0.84 g/l). Multivariate analysis showed that C-reactive protein, D-dimers and dynamic plasma viscosity accounted for 48.2% (for men) and 49.4% (for women) of the variance in plasma fibrinogen concentration. CONCLUSIONS: Our findings demonstrate that there is not only a correlation between plasma fibrinogen concentration and the severity of CHD, but also a correlation to the incidence of additional POAD or CVD.
Asunto(s)
Angina de Pecho/sangre , Arteriopatías Oclusivas/sangre , Arteriosclerosis/sangre , Trastornos Cerebrovasculares/sangre , Fibrinógeno/análisis , Infarto del Miocardio/sangre , Enfermedades Vasculares Periféricas/sangre , Adulto , Anciano , Angina de Pecho/etiología , Angina de Pecho/fisiopatología , Arteriopatías Oclusivas/fisiopatología , Arteriosclerosis/fisiopatología , Trastornos Cerebrovasculares/fisiopatología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/fisiopatología , Enfermedades Vasculares Periféricas/fisiopatología , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Recent findings provide evidence for the importance of inflammatory processes in the pathogenesis of atherosclerosis. C-reactive protein was elevated in patients with peripheral artery disease, coronary heart disease and myocardial infarction compared to normal subjects. METHODS: In 1112 male and 299 female survivors of myocardial infarction (mean age +/- SD, men, 50.4 +/- 9.5, women, 56.1 +/- 9.3), we investigated whether plasma C-reactive protein concentration is associated with the severity of coronary heart disease and generalized pre-clinical or clinically manifest arteriopathy. The control group consisted of 326 male and 138 female individuals matched for age without clinical symptoms of coronary disease. The severity of arteriosclerotic changes was determined for the extra-cranial brain-supplying arteries, abdominal aorta, pelvis and leg arteries. In myocardial infarction patients coronary angiography was performed. Laboratory analyses included determination of C-reactive protein, fibrinogen, D-dimer, HDL-cholesterol, LDL-cholesterol and triglycerides. RESULTS: The following ranking of C-reactive protein concentrations was found: controls < or = patients after myocardial infarction without atherosclerosis < or = patients with myocardial infarction and pre-clinical atherosclerosis < or = patients with myocardial infarction and clinically manifest atherosclerosis. Additionally, our data showed a significant association between C-reactive protein concentrations and the angiographically detected degree of coronary heart disease. CONCLUSIONS: As C-reactive protein is a marker of inflammatory processes, our results in patients with clinically manifest and early pre-clinical atherosclerosis support the hypothesis that inflammatory processes in the vessel wall participate in atherogenesis. Moreover, they support the hypothesis of a causal relationship between an acute phase reaction and the pathogenesis of atherosclerosis in coronary arteries and other parts of the arterial vessel system.
Asunto(s)
Angina de Pecho/complicaciones , Arteriosclerosis/sangre , Arteriosclerosis/diagnóstico por imagen , Proteína C-Reactiva/análisis , Infarto del Miocardio/complicaciones , Adulto , Arteriosclerosis/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Concentración Osmolar , Factores de Riesgo , UltrasonografíaRESUMEN
BACKGROUND: Plasma concentrations of D-dimers show the extent of intravascular fibrinolysis of cross-linked fibrin. Higher concentrations of D-dimers are found in the plasma of arteriosclerosis patients with increased fibrin metabolism. The present study was performed in order to investigate whether there is a relationship between the severity of arteriosclerosis and fibrinolytic activity indicated by plasma levels of D-dimer. METHODS: The study populations consisted of 1112 men and 299 women with stable angina pectoris, on average 36+/-5.6 days after a myocardial infarction, as well as 326 men and 138 women with no clinical signs of cardiovascular disease. In addition to cardiological and angiological examinations, the lipid status and levels of fibrinogen, plasma viscosity, F 1+2, plasminogen, plasminogen activator inhibitor-1, D-dimer, and C-reactive protein of the participants were determined. RESULTS: The plasma concentration of D-dimers increases with age, both in the group with coronary artery disease and in the control group, with the female gender showing consistently higher concentrations in both groups. D-dimers correlate with other parameters of the lipid and coagulation systems, which explains 32.0% and 39.2% of the variance in D-dimer values in men and women, respectively. A significant increase in the level of D-dimers can be found in participants with generalized arteriosclerosis, with a left ventricular ejection fraction
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Angina de Pecho/etiología , Arteriosclerosis/sangre , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Infarto del Miocardio/complicaciones , Índice de Severidad de la Enfermedad , Adulto , Angina de Pecho/sangre , Angina de Pecho/fisiopatología , Aorta Abdominal/diagnóstico por imagen , Arteriosclerosis/complicaciones , Arteriosclerosis/diagnóstico por imagen , Biomarcadores/sangre , Viscosidad Sanguínea , Proteína C-Reactiva/metabolismo , Arterias Carótidas/diagnóstico por imagen , Arterias Cerebrales/diagnóstico por imagen , Ensayo de Inmunoadsorción Enzimática , Femenino , Fibrinógeno/metabolismo , Fibrinólisis/fisiología , Humanos , Masculino , Infarto del Miocardio/sangre , Infarto del Miocardio/fisiopatología , Plasminógeno/metabolismo , Inhibidor 1 de Activador Plasminogénico/sangre , Pronóstico , Volumen Sistólico , Ultrasonografía Doppler Dúplex , Ultrasonografía Doppler Transcraneal , Función Ventricular IzquierdaRESUMEN
Several recent studies have reported contradicting results concerning the relevance of the plasminogen activator inhibitor-1 (PAI-1) 4G/5G-polymorphism for myocardial infarction. In addition, the common factor V Q506 (FV:Q506) mutation is frequently discussed as a risk factor for arterial thrombosis, but evidence is rare. In order to further highlight the role of both polymorphisms in myocardial infarction, we investigated 241 young male myocardial infarction patients (< or = 45 years-of-age) aged 38.6+/-4.4 years (mean+/-SD) for the presence of both genotypes. The control group consisted of 179 healthy men aged 47.1+/-6.4 years (mean+/-SD) of the same ethnic background as the patients. Neither the distribution of the PAI-1 4G/5G-polymorphism nor the prevalence of the FV: Q506 mutation was significantly different between young patients and controls (4G/4G-genotype: chi2=2.08, NS; odds ratio 1.36, 95% confidence interval 0.89-2.06; FV:Q506 mutation: chi2=0.33, NS; odds ratio 1.33, 95% confidence interval 0.64-2.78). Moreover, the PAI-1 4G/5G-distribution did not differ significantly between patients and controls in subgroups by tertiles of triglyceride levels. In conclusion, in the present study neither homozygosity for the 4G allele of the PAI-1 4G/5G-polymorphism nor the FV:Q506 mutation led to an increased risk of myocardial infarction in young men.
Asunto(s)
Factor V/genética , Mutación , Infarto del Miocardio/genética , Inhibidor 1 de Activador Plasminogénico/genética , Adulto , Humanos , Masculino , Persona de Mediana Edad , Polimorfismo Genético , Factores de RiesgoRESUMEN
The present investigation was performed to determine the dependence of the length of stay in community hospitals and rehabilitation clinics from patient characteristics and physical activity at the end of treatment. Comparing age, end-diastolic volume index, left ventricular ejection fraction, number of stenosed coronary arteries, number of bypass grafts, levels of physical exercise, body mass index and the ratio total cholesterol/HDL-cholesterol, no significant differences were found in patients, who reached the rehabilitation clinic in the early postoperative period (7.4 +/- 2.0 days, n = 98), after 15-28 days (n = 74) or later than 28 days (n = 156) after bypass-surgery. Similar results were observed in 103 patients after heart-valve replacement, who arrived at the rehabilitation clinic after a corresponding length of hospital care like the bypass patients. Also, no significant differences in the clinical characteristics and physical activity appeared in patients who were admitted in the early phase (9.2 +/- 4.5 days) after transmural myocardial infarction (n = 37) and those entering the rehabilitation clinic after 26.7 +/- 9.4 days of hospital stay (n = 32). The absence of any relationship between the length of stay in hospitals on the one hand and severity of the heart disease on the other hand points out that the whole duration of stay in community hospitals and rehabilitation clinics after surgical intervention and also after transmural myocardial infarction could be drastically shortened by an optimal cooperation of both, hospitals and rehabilitation clinics, without any impairment of clinical results.
Asunto(s)
Actividades Cotidianas/clasificación , Puente de Arteria Coronaria , Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas , Tiempo de Internación , Infarto del Miocardio/cirugía , Adulto , Anciano , Puente de Arteria Coronaria/rehabilitación , Prueba de Esfuerzo , Femenino , Estudios de Seguimiento , Prótesis Valvulares Cardíacas/rehabilitación , Humanos , Masculino , Persona de Mediana Edad , Centros de Rehabilitación , Resultado del TratamientoRESUMEN
In 3715 survivors (pts) of an acute myocardial infarction (3343 males and 372 females), of ages between 20 and 80 years (mean 52.9 +/- 7.7 years), lipid-metabolism, amount of cigarette-smoking, severity of coronary artery disease (CHD) by selective coronary arteriography, and age at first manifestation of CHD documented by myocardial infarction were investigated. In contrast to normals, there is a significant reduction of disorders of lipid-metabolism with increasing age. The rate of cigarette-smoking is lower in the elderly. Females are affected by MI 3.6 to 5.3 years later than are males. There was a strong correlation between the degree of lipid-disorders and the severity of CHD, whereas the lipid-disturbances were mostly marked in the younger pts. Dependent on the degree of the underlying lipid-disorder, CHD strikes pts at a younger age, whereby the Chol/HDL-Chol-ratio is most sensitive. In a similar manner, cigarette-smoking transfers the manifestation-date of CHD "dose-dependent" to a younger age. Smokers with a daily consumption of more than 40 cigarettes are 9.2 years younger at the time of first myocardial infarction than are non-smokers. In older pts the influence of lipid-disorders and smoking becomes smaller, compared with the risk-factor "age", but it is also significant. The proven correlation between the risk-profile and the age at first myocardial event stresses the need for preventive and educative strategies.