scholarly journals Hyperhomocysteinemia as an Independent Risk Factor for Coronary Heart Disease. Comparison with Conventional Risk Factors

2023 ◽  
Vol 83 ◽  
R. Muzaffar ◽  
M. A. Khan ◽  
M. H. Mushtaq ◽  
M. Nasir ◽  
A. Khan ◽  

Abstract The present study was designed to evaluate the strength of association of raised plasma homocysteine concentration as a risk factor for coronary heart disease independent of conventional risk factor. It was a case control study conducted at Punjab Institute of Cardiology Lahore. A total of 210 subjects aged 25 to 60 years comprising of 105 newly admitted patients of CHD as cases and 105 age and sex matched healthy individuals with no history of CHD as control were recruited for the study. Fasting blood samples were obtained from cases and controls. Plasma homocysteine was analyzed by fluorescence polarization immunoassay (FPIA) method on automated immunoassay analyzer (Abbott IMX). Total cholesterol, triglyceride and HDL cholesterol were analyzed using calorimetric kit methods. The concentration of LDL cholesterol was calculated using Friedewald formula. The patients were also assessed for traditional risk factors such as age, sex, family history of CVD, hypertension, smoking and physical activity, and were compared with control subjects. The collected data was entered in SPSS version 24 for analysis and interpretation.The mean age in controls and experimental groups were 43.00± 8.42 years and 44.72± 8.59 years with statistically same distribution (p- value= 0.144). The mean plasma homocysteine for cases was 22.33± 9.22 µmol/L where as it was 12.59±3.73 µmol/L in control group. Highly significant difference was seen between the mean plasma level of homocysteine in cases and controls (p˂0.001).Simple logistic regression indicates a strong association of coronary heart disease with hyperhomocysteinemia (OR 7.45), which remained significantly associated with coronary heart disease by multivariate logistic regression (OR 7.10, 95%C1 3.12-12.83, p=0.000). The present study concludes that elevated levels of Plasma homocysteine is an independent risk factor for coronary heart disease independent of conventional risk factors and can be used as an indicator for predicting the future possibility for the onset of CVD.

2021 ◽  
Vol 9 (B) ◽  
pp. 451-456
Eka Fithra Elfi ◽  
Eva Decroli ◽  
Ellyza Nasrul ◽  
Yanwirasti Yanwirasti ◽  
Eryati Darwin

BACKGROUND: Coronary heart disease (CHD) is the leading cause of death and start with injury to the endothelium of a coronary artery. The common feature of endothelial dysfunction is a decrease of nitric oxide (NO) bioavailability that regulated by endothelial NO synthase (eNOS) activity. AIM: The aim of our study was to study the relationship between risk factors of CHD patients with the level of eNOS. METHODS: Thirty-seven outpatients in cardiology department of the regional public hospital diagnosed as CHD were included in our study. Thirty healthy individuals were included as the control group. Risk factors of CHD were identified according to anamnesis and laboratory finding. eNOS was measured by ELISA methods. RESULTS: Endothelial NOS levels were significantly higher in the CHD when compared to the controls (p < 0.05). The most dominant risk factor for CHD is overweight, and followed by dyslipidemia, smoking, hypertension, history of CHD, and diabetes mellitus. eNOS in CHD patients who had one risk factor was 37.598 ± 0.1541 ng/ml, two risk factors 42.154 ± 22.329 ng/ml, three risk factors 25.329 ± 6.083 ng/ml, four risk factors 22.483 ± 4.022 ng/ml, and five risk factors 15.994 ± 4.774 ng/ml. There were significant differences in the average eNOS levels based on the number of risk factors (p < 0.05), and a tendency that more risk factors in CHD patients, the lower the average level of eNOS. CONCLUSION: In our study, eNOS levels showed highly significant relation with CHD and related to the number of risk factors those the CHD patients had.

2019 ◽  
Vol 40 (Supplement_1) ◽  
M R Poudel ◽  
S Kirana ◽  
K P Mellwig ◽  
D Horstkotte ◽  
C Knabbe ◽  

Abstract Background Elevated lipoprotein (a) [LP (a)] levels are an independent risk factor for coronary heart disease (CHD) and associated with myocardial infarction (MI). CHD took a devastating toll in Europe and in the United States in the 20th century, killing more people than any other disease. It remains the leading cause of death in most countries worldwide. CHD shares risk factors with atherosclerosis. It has been shown that elevated LP (a) levels are associated with an increased risk for CHD across various ethnic groups. LP (a) is genetically determined, stable throughout life and yet refractory to drug therapy. While 30 mg/dl is considered the upper normal value for LP (a) in central Europe, extremely high LP (a) levels (>150mg/dl) are rare in the general population. The aim of our study was to analyse the correlation between lipoprotein (a) [LP (a)] levels and an incidence of coronary heart disease (CHD) in high-risk patients. Patients and methods We reviewed the LP (a) concentrations of 52.898 consecutive patients admitted to our cardiovascular center between January 2004 and December 2014. Of these, 579 patients had LP (a) levels above 150 mg/dl (mean 181.45±33.1mg/dl). In the control collective LP (a) was <30mg/dl (n=350). Other atherogenic risk factors in this group were HbA1c 6.58±1.65%, low density lipoprotein (LDL) 141.99±43.76 mg/dl, and body mass index 27.81±5.61. 54.40% were male, 26.07% were smokers, 93.2% had hypertension, and 24% had a family history of cardiovascular diseases. More than 82.6% were under statins. The mean glomerular filtration rate (GFR) was 69.13±24.8 ml/min [MDRD (Modification of Diet in Renal Disease)]. Results 64.98% (n=373) of the patients with LP (a) >150mg/dl had CHD. The prevalence of CHD in patients with LP (a) <30mg/dl in our control collective was 37.14%. (P- Value 0.0001). Patients with LP (a) >150mg/dl had a significantly increased risk for CHD (Odds ratio 5.98). 12.72% (n=73) of these patients suffered from CHD with single-vessel disease (VD), 14.63% (n=84) from CHD with 2VD and 37.63% (n=216) from CHD with 3VD. 47.92% of patients were re-vascularized by percutaneous coronary angioplasty (PTCA) and 37.06% of patients had to undergo coronary artery bypass grafting (CABG). 19.13% of patients had both, PTCA and CABG. Mean LP (a) level in patients with 1-vessel CHD was 181.5±29.98, in patients with 2-vessel CHD 178.94±34.26 and in patients with 3-vessel CHD 180.97±32.38 mg/dl. Conclusion Elevated LP (a) levels above 150 mg/dl are associated with a significantly increased risk of CHD in our collective and it confirms our hypothesis. Most of these patients had severe CHD with 3-vessel disease (VD) requiring coronary revascularization therapy. We need more prospective studies to confirm our findings.

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Nina P Paynter ◽  
Raji Balasubramanian ◽  
Shuba Gopal ◽  
Franco Giulianini ◽  
Leslie Tinker ◽  

Background: Prior studies of metabolomic profiles and coronary heart disease (CHD) have been limited by relatively small case numbers and scant data in women. Methods: The discovery set examined 371 metabolites in 400 confirmed, incident CHD cases and 400 controls (frequency matched on age, race/ethnicity, hysterectomy status and time of enrollment) in the Women’s Health Initiative Observational Study (WHI-OS). All selected metabolites were validated in a separate set of 394 cases and 397 matched controls drawn from the placebo arms of the WHI Hormone Therapy trials and the WHI-OS. Discovery used 4 methods: false-discovery rate (FDR) adjusted logistic regression for individual metabolites, permutation corrected least absolute shrinkage and selection operator (LASSO) algorithms, sparse partial least squares discriminant analysis (PLS-DA) algorithms, and random forest algorithms. Each method was performed with matching factors only and with matching plus both medication use (aspirin, statins, anti-diabetics and anti-hypertensives) and traditional CHD risk factors (smoking, systolic blood pressure, diabetes, total and HDL cholesterol). Replication in the validation set was defined as a logistic regression coefficient of p<0.05 for the metabolites selected by 3 or 4 methods (tier 1), or a FDR adjusted p<0.05 for metabolites selected by only 1 or 2 methods (tier 2). Results: Sixty-seven metabolites were selected in the discovery data set (30 tier 1 and 37 tier 2). Twenty-six successfully replicated in the validation data set (21 tier 1 and 5 tier 2), with 25 significant with adjusting for matching factors only and 11 significant after additionally adjusting for medications and CHD risk factors. Validated metabolites included amino acids, sugars, nucleosides, eicosanoids, plasmologens, polyunsaturated phospholipids and highly saturated triglycerides. These include novel metabolites as well as metabolites such as glutamate/glutamine, which have been shown in other populations. Conclusions: Multiple metabolites in important physiological pathways with robust associations for risk of CHD in women were identified and replicated. These results may offer insights into biological mechanisms of CHD as well as identify potential markers of risk.

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Piotr Bandosz ◽  
Maria Guzman-Castillo ◽  
Simon Capewell ◽  
Tomasz Zdrojewski ◽  
Julia Critchley ◽  

Background: Poland has experienced one of the most dramatic declines in coronary heart disease (CHD) mortality rates in recent decades. This decline reflects the use of evidence based treatments and, crucially, population wide changes in diet. Our aim is to explore the potential for further gains in Poland by achieving population wide reductions in smoking, dietary salt and saturated fat intake and physical inactivity levels. Methods: A validated and updated policy model was used to forecast potential decreases in CHD deaths by 2020 as consequence of lifestyle and dietary changes in the population. Data from the most recent Polish risk factor survey was used for the baseline (2011). We modeled two different policy scenarios regarding possible future changes in risk factors: A) conservative scenario: reduction of smoking prevalence and physically inactivity rates by 5% between 2011 and 2020, and reduction of dietary consumption of energy from saturated fats by 1% and of salt by 10%. B) ideal scenario: reduction of smoking and physically inactivity prevalence by 15%, and dietary reduction of energy from saturated fats by 3% and of salt by 30%. We also conducted extensive sensitivity analysis using different counterfactual scenarios of future mortality trends. Results: Baseline scenarios. By assuming continuing declines in mortality and no future improvements in risk factors the predicted number of CHD deaths in 2020 would be approximately 13,600 (9,838-18,184) while if mortality rates remain stable, the predicted number of deaths would approximate 22,200 (17,792-26,688). Conservative scenario. Assuming continuing declines in mortality, small changes in risk factors could result in approximately 1,500 (688-2,940) fewer deaths. This corresponds to a 11% mortality reduction. Under the ideal scenario, our model predicted some 4,600 (2,048-8,701) fewer deaths (a 34% mortality reduction). Reduction in smoking prevalence by 5% (conservative scenario) or 15% (ideal scenario) could result in mortality reductions of 4.5% and 13.8% respectively. Decreases in salt intake by 10% or 30% might reduce CHD deaths by 3.0% and 8.6% respectively. Replacing 1% or 3% of dietary saturated fats by poly-unsaturates could reduce CHD deaths by 2.6% or 7.7% Lowering the prevalence of physically inactive people by 5%-15% could decrease CHD deaths by 1.2%-3.7%. Conclusion: Small and eminently feasible population reductions in lifestyle related risk factors could substantially decrease future number of CHD deaths in Poland, thus consolidating the earlier gains.

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