Assessment of Diagnostic Efficiency of Lipoprotein (a), Homocysteine, High Sensitive C-Reactive Protein and Fibrinogen in Patients with Coronary Artery Disease

Year 2013, Volume: 38 Issue: 4, 559 - 566, 01.12.2013

Ebru Dundar Yenilmez , Hale Toyaksi Abdi Bozkurt Abdullah Tuli Esmeray Acartürk

Abstract

Backround: To evaluate the diagnostic value of major and other risk factors as lipoprotein (Lp) (a), homocysteine (Hcy), high sensitive C-reactive protein (hs-CRP) and fibrinogen in CAD patients. Methods: A total of 223 subjects (118 patients and 105 controls) were included in the study according to their coronary angiographic results. Lipoprotein (a), Hcy, hs-CRP and fibrinogen levels were measured using immunoturbidometric, florescent polarization immunoassay and nefelometric methods, respectively. Fasting glucose and lipid parameters, except low density lipoprotein cholesterol (LDL-C), are determined by enzymatic colorimetric methods and the LDL-C levels were calculated by the Fridewald formula. Results: Logistic regression analysis showed that when the biochemical variables in placed in a model, the most important variables were Lp (a), Hcy, hs-CRP and fibrinogen. We showed that each unit of Lp (a), Hcy, hs-CRP and fibrinogen increases the risk of CAD 1.029, 1.177, 1.027 and 1.013 fold, respectively. Among these, fibrinogen level was the most sensitive and efficient parameter in prediction of CAD. Conclusion: Although Lp (a), Hcy, hs-CRP and fibrinogen are independent risk factors for CAD, fibrinogen was the most important one. Fibrinogen can be used as a reliable risk factor for CAD in clinical practice.

Keywords

Coronary artery disease, risk factors, Lipoprotein (a), Homocysteine, hs-CRP, fibrinogen.

Koroner Arter Hastalarında Lipoprotein (a), Homosistein, Yüksek Duyarlı CReaktif Protein ve Fibrinojen Etkinliğinin Tanısal Değerlendirilmesi

Abstract

Amaç: Koroner arter hastalığında (KAH) Lipoprotein (Lp) (a), homosistein (Hcy), yüksek duyarlıklı C-reaktif protein (hs-CRP) ve fibrinojen gibi majör ve diğer risk faktörlerinin tanısal değerini araştırmak amaçlanmıştır. Metotlar: Çalışmaya koroner anjiyografi sonucuna gore 118"i KAH ve 105"i KAH olmadığı belirlenen toplam 223 kişi dahil edildi. Lipoprotein (a), Hcy, hs-CRP ve fibrinojen düzeyleri sırasıyla, immünoturbidometrik, flöresan polarizasyon immünoassay ve nefelometrik yöntemlerle ölçüm yapıldı. Açlık glukoz ve düşük dansiteli lipoprotein kolesterol (LDL-K) dışındaki lipid parametrelerine enzimatik kolorimetrik yöntemlerle bakılmış olup, LDL-K düzeyleri Fridewald formülüne göre hesaplanmıştır. Bulgular: Lojistik regresyon modelinde biyokimyasal değişkenlerden en önemlileri göre Lp (a), Hcy, hs-CRP ve fibrinojen olarak belirlenmiştir. Lipoprotein (a), Hcy, hs-CRP ve fibrinojenin herbir ünitesinin sırasıyla, 1.029, 1.177, 1.027 ve 1.013 kat KAH riskini artırdığı gösterilmiştir. Bu parametrelerden KAH için öngörüsü en hassas ve etkili olanın fibrinojen olduğu gösterilmiştir. Sonuç: Lipoprotein (a), Hcy, hs-CRP ve fibrinojen KAH için bağımsız risk faktörleri olması yanında bunların arasında en önemlisinin fibrinojen olduğu belirlenmiştir. Fibrinojen, klinik uygulamada KAH için güvenilir bir risk factör olarak kullanılabilir.

Keywords

Koroner arter hastalığı, risk faktörleri, Lipoprotein (a), Homosistein, hs-CRP, fibrinojen.

References

• Robinson K, Mayer EL, Miller D, Green R, van Lente F, Gupta A et al. Hyperhomocysteinemia and low pyridoxal phosphate: common and independent reversible risk factors for coronary artery disease. Circulation. 1995; 92: 2825-30.
• Ridker PM. Novel risk factors and markers for coronary disease. Adv in Intern Med. 2000; 45: 3914
• McCully KS. Homocystein and vascular disease. Nat Med. 1996; 2: 386-9.
• Thambyrajah J, Townend JN, Homocysteine and atherotrhrombosis mechanisms for injury. Eur Heart J. 2000; 21: 967-73.
• Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men published erratum appears in N Engl J Med. 1997; 337: 356.
• Ridker PM, Hennekens CH, Buring JE, Rifai N. Creactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000; 342: 836-43.
• Isordia-Salas I, Mendoza-Valez L, Almeida-Gutierrez E, Borrayo-Sanchez G. Genetic factors of hemostatic system in young patients with myocardial infarction. Cir Ciruj. 2010; 78:87-91. 1999 World Health Organization-International Society of Hypertension Guidelines for the management of
• Hypertension. J Hypertens. 1999; 17: 151-183.
• Executive summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Cholesterol in Adults (Adult Treatment Panel III). JAMA.2001; 285, 2486-97.
• American Diabetes Association, The Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 1999; 22: 5-19.
• Friedewald WT, Levy RI, Fredrickson DS. Estimation of the Concentration of Low-Density Lipoprotein Cholesterol in Plasma, Without Use of the Preparative Centrifuge. Clin Chem. 1972; 18: 499500.
• Ridker PM, Genest J, Libby P. Risk factors for atherosclerotic disease. In: Heart Disease: A Textbook of Cardiovascular Medicine W.B. Saunders, Philadelphia, PA. 2001: 1010–39.
• Vahdat K, Jafari SM, Pazoki R, Nabipour I. Current increased high sensitivity C-reactive protein and chorionic infections are associated with coronary artery disease: A population-based study. Indian J Med Sci. 2007; 61: 135-43.
• Koschinsky M L, Marcovina S M. Structure-function relationships in apolipoprotein(a): insights into lipoprotein(a) assembly and pathogenicity. Curr Opin Lipidol. 2004; 15: 167–74.
• Bozbaş H, Yıldırır A, Pirat B, Eroğlu S, Korkmaz ME, Atar İ. et al. Increased lipoprotein (a) in metabolic syndrome: Is it a contributing factor to premature atherosclerosis? Anat Cardiol J. 2008; 8: 111-5.
• Nordestgaard BG, Chapman MJ, Ray K, Bore´n J, Andreotti F, Watts GF. et al. Lipoprotein(a) as a cardiovascular risk factor. Eur Heart J. 2010; 31: 2844Nikfardjam M, Graf S, Hornykewycz S et al. Homocysteine plasma levels in young patients with coronary artery disease. Relation to history of acute myocardial infarction and anatomical extent of disease. Thromb Res. 2001; 103:35-9.
• Cleopas TJ, Hornstra N, van Hoogstraten B, Van der Meulen J. Homocysteine, a risk factor for coronary artery disease or not? A Meta analysis. Am J Cardiol. 2000; 86: 1005-9.
• Yan J, Liao JK, Wang D. Elevated homocysteine and C-reactive protein levels independently predict worsening prognosis after stroke in Chinese patients. Journal of Huazhong University of Science and Technology Med Sci. 2010; 30:643-7.
• Kazemi MBS, Eshraghian K , Omrani GR, Lankarani KB, Hosseini E. Homocysteine Level and Coronary Artery Disease. Angiology. 2006; 57: 9-14.
• Senaratne MP, MacDonald K, DeSilva D. Possible ethnic differences in plasma homocysteine levels associated with coronary artery disease between South Asian and East Asian immigrants. Clin Cardiol. 2001; 24: 730-4.
• Lin T, Liu JC, Chang LY, Shen CW. Association of C-reactive protein and homocysteine with subclinical coronary plaque subtype and stenosis using lowdose MDCT coronary angiography. Atherosclerosis 2010; 212: 501-6.
• Yun KH, Jeong MH, Oh SK, Rhee SJ, Park EM, Lee EM. et al. Response of high-sensitivity C-reactive protein to percutaneous coronary intervention in patients with acute coronary syndrome. Heart Vessels. 2009; 24:175–80.
• Guran O, Akalin F, Ayabakan C, Dereli FY, Haklar G. High-sensitivity C-reactive protein in children at risk for coronary artery disease. Acta Pædiatrica. 2007; 96: 1214–9.
• Kim PY, Stewart RJ, Lipson SM, Nesheim ME. The relative kinetics of clotting and lysis provide a biochemical rationale for the correlation between elevated fibrinogen and cardiovascular disease. J Thromb Haemost. 2007; 5:1250–6.
• Luca GD, Verdoia M, Casetti E, Schaffer A, Cavallino C, Bolzani V. et al. Novara Atherosclerosis Study Group (NAS). High fibrinogen level is an independent predictor of presence and extent of coronary artery disease among Italian population. J Thromb Thrombol. 2010; DOI 10.1007.
• Ernst E, Resch KL. Fibrinogen as a cardiovascular risk factor: a meta-analysis and review of the literature. Ann Intern Med. 1993; 118: 956–63.
• Green D, Foiles N, Chan C, Schreiner PJ, Liu K Elevated fibrinogen levels and subsequent subclinical atherosclerosis: the CARDIA Study. Atherosclerosis. 2009; 202: 623–31.
• Rodrigues TC, Snell-Bergeon JK, Maahs DM, Kinney GL, Rewers M. Higher fibrinogen levels predict progression of coronary artery calcification in adults with type 1 diabetes. Atherosclerosis. 2010; 210: 671–3.
• Taylor AJ, Bindeman J, Le TP et al Progression of calcified coronary atherosclerosis: relationship to coronary risk factors and carotid intima–media thickness. Atherosclerosis. 2008; 197: 339–45.
• Yazışma Adresi / Address for Correspondence: Dr. Ebru Dundar Yenilmez Çukurova University, School of Medicine, Department of Medical Biochemistry, 01330, Adana, Turkey. Tel: [phone] (Dahili: 3466) e-mail: [e-mail] & geliş tarihi/received :13.02.2013 kabul tarihi/accepted:29.03.2013