The role of atherogenic index of plasma in coronary artery patients with high SYNTAXII score

Yıl 2023, , 729 - 735, 30.12.2023

Serdar Gökhan Nurkoç

https://doi.org/10.18663/tjcl.1328053

Öz

Aim: We tried to evaluate the best diagnostic threshold value of the atherogenic index of plasma (AIP) with respect to coronary artery disease (CAD) and its relationship with SYNTAX II (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score (SSII).
Material and Methods: The research encompassed 280 consecutive patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing coronary angiography, through which SSII was calculated based on initial coronary angiography by at least two independent cardiologists. The patients were separated into two groups low SSII (<23, n=116) and high SSII (≥23, n=164), while AIP was calculated by logarithmic conversion of triglyceride to high-density lipoprotein-to-cholesterol ratio.
Results: We determined some differences between the study groups in point of age, gender, smoking, hypertension, family history, diabetes mellitus, serum urea, C-reactive protein, hemoglobin level, left ventricular ejection fraction, and AIP (P <.05), which indicates a positive connection found between high SSII and AIP (r=0.343; p<0.001; statistically significant p<.05). As a result of multivariate logistic regression analysis, AIP was determined to be an independent risk factor for CAD and high SSII. In addition, we found that AIP values of 0.54 ng/ml and above could estimate the severity of coronary artery disease with 62.8% sensitivity and 60.5% specificity (area under the curve:0.676, %95 confidence interval, 0.613 – 0.739%; p<0.001).
Conclusion: AIP ratios were detected to be increased in patients with high SSII in comparison to those with low SSII. In addition, AIP was significantly independently connected with CAD and high SSII in the group with high SSII. In light of these findings, AIP, as a biomarker, may help prevent CAD.

Anahtar Kelimeler

Atherogenic index of plasma, SYNTAX score II, acute coronary syndrome.

Yüksek SYNTAXII skoru olan koroner arter hastalarında plazma aterojenik indeksinin rolü

Öz

Amaç: Koroner arter hastalığına (KAH) göre aterojenik plazma indeksinin (AIP) en iyi tanısal eşik değerini ve bunun SYNTAX II (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) skoru (SSII) ile ilişkisini değerlendirmeye çalıştık.
Gereç ve Yöntemler: Araştırma, koroner anjiyografi uygulanan, ST segment yükselmesiz miyokard enfarktüsü (NSTEMI) olan ve en az iki bağımsız kardiyolog tarafından ilk koroner anjiyografiye dayalı olarak SSII'nin hesaplandığı ardışık 280 hastayı kapsamıştır. Hastalar düşük SSII (<23, n=116) ve yüksek SSII (≥23, n=164) olarak iki gruba ayrıldı. AIP, trigliseritin yüksek yoğunluklu lipoprotein-kolesterol oranına logaritmik dönüştürülmesiyle hesaplandı.
Bulgular: Çalışma grupları arasında yaş, cinsiyet, sigara kullanımı, hipertansiyon, aile öyküsü, diyabet, serum üre, C-reaktif protein, hemoglobin düzeyi, sol ventriküler ejeksiyon fraksiyonu ve AIP açısından bazı farklılıklar belirledik (P<.05), bu da yüksek SSII ile AIP arasında pozitif bir bağlantı bulunduğunu göstermektedir (r=0,343; p<0,001; istatistiksel olarak anlamlı p<0,05). Çok değişkenli lojistik regresyon analizi sonucunda AIP'nin KAH ve yüksek SSII için bağımsız bir risk faktörü olduğu belirlendi. Ayrıca 0,54 ng/ml ve üzerindeki AIP değerlerinin koroner arter hastalığının ciddiyetini %62,8 duyarlılık ve %60,5 özgüllükle tahmin edebildiğini bulduk (eğri altında kalan alan:0,676, %95 güven aralığı, %0,613 – 0,739; p <0,001).
Sonuç: Yüksek SSII'li hastalarda AIP oranlarının düşük SSII'li hastalara göre arttığı tespit edildi. Ayrıca yüksek SSII'li grupta AIP'nin KAH ve yüksek SSII ile anlamlı derecede bağımsız olarak ilişkili olduğu görüldü. Bu bulgular ışığında, bir biyobelirteç olarak AIP, KAH'ın önlenmesine yardımcı olabilir.

Anahtar Kelimeler

Plazmanın aterojenik indeksi, SYNTAX II skoru, akut koroner sendrom.

Destekleyen Kurum

no

Kaynakça

• Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. "Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data." The Lancet 367.9524;2006: 1747-1757.
• Ertas F, Can Ö, Acet H, Ozbakkaloglu M. The clinical significance of anticardiolipin antibody levels in patients with acute myocardial infarction: a regional study. Postepy Kardiol Interwencyjnej. 2013;9;4:328-331.
• Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105;9:1135-1143.
• Pearson TA, Mensah GA, Alexander RW, et al. Centers for Disease Control and Prevention; American Heart Association. Markers of inflammation and cardiovascular disease application to clinical and public health practice: a statement for healthcare professionals from the centers for disease control and prevention and the American Heart Association. Circulation. 2003;107;3: 499-511.
• Montero-Vega MT. The inflammatory process underlying atherosclerosis. Crit Rev Immunol 2012;32;5:373-462.
• Manduteanu I, Simionescu M. Inflammation in atherosclerosis: a cause or a result of vascular disorders? J Cell Mol Med 2012;16;9:1978-1990.
• Catapano AL, Pirillo A, Norata GD. Vascular inflammation and low-density lipoproteins: is cholesterol the link? A lesson from the clinical trials. Br J Pharmacol. 2017;174:3973-3985.
• Cochain C, Zernecke A. Macrophages in vascular inflammation and atherosclerosis. Pflugers Arch. 2017;469:485-499.
• Sun HJ, Wu ZY, Nie XW, Bian JS. Role of endothelial dysfunction in cardiovascular diseases: the link between inflammation and hydrogen sulfide. Front Pharm. 2019;10:1568.
• Wilson PWF, Polonsky TS, Miedema MD, Khera A, Kosinski AS, Kuvin JT. Systematic review for the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73:3210-3227.
• Fulcher J, O’Connell R, Voysey M, et al. Efficacy and safety of LDL-lowering therapy among men and women: a meta-analysis of individual data from 174,000 participants in 27 randomized trials.Lancet. 2015;385:1397-1405.
• Baigent C, Blackwell L, Emberson J, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomized trials. Lancet. 2010;376:1670-1681 Krumholz HM. Treatment of cholesterol in 2017. JAMA. 2017;318;5:417-418.
• Ioannidis JPA. Inconsistent guideline recommendations for cardiovascular prevention and the debate about zeroing in on and zeroing LDL-C levels with PCSK9 inhibitors. JAMA. 2017;318;5:419-420.
• Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002;347:1557-1565.
• Hoogeveen RC, Gaubatz JW, Sun W, et al. Small dense low-density lipoprotein-cholesterol concentrations predict risk for coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) study. Arterioscler Thromb Vasc Biol. 2014;34:1069-1077.
• Ivanova EA, Myasoedova VA, Melnichenko AA, Grechko AV, Orekhov AN. Small dense low-density lipoprotein as a biomarker for atherosclerotic diseases. Oxid Med Cell Long. 2017;2017:1273042.
• Vavlukis M, Kedev S. Effects of high-intensity statin therapy in the treatment of diabetic dyslipidemia in patients with coronary artery disease. Curr Pharm Des. 2018;24:427-441.
• Dobiásová M, Frohlich J. The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER(HDL)). Clin Biochem. 2001;34;7:583-588.
• Niroumand S, Khajedaluee M, Khadem-Rezaiyan M, et al. Atherogenic index of plasma (AIP): a marker of cardiovascular disease. Med J Islam Repub Iran. 2015;29:240.
• Dobiasova M. AIP–atherogenic index of plasma as a significant predictor of cardiovascular risk: from research to practice. Vnitr Lek. 2006;52;1:64-71.
• Akgun T, Oduncu V, Bitigen A, et al." Baseline SYNTAX score and long-term outcome in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention." Clinical and Applied Thrombosis/Hemostasis 2015;21.8: 712-719.
• Collet JP, Thiele H, Barbato E, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021 Apr 7;42;14:1289-1367.
• Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Dec 23;64;24:139-228.
• Tan MH, Johns D, Glazer NB. Pioglitazone reduces the atherogenic index of plasma in patients with type 2 diabetes. Clin Chem. 2004;50:1184-8.
• Nishikura T, Koba S, Yokota Y, et al. Elevated small dense low-density lipoprotein cholesterol as a predictor for future cardiovascular events in patients with stable coronary artery disease. J Atheroscler Thromb. 2014;21:755-67.
• Song P, Xu L, Xu J, et al. Atherogenic index of plasma is associated with body fat level in type 2 diabetes mellitus patients. Curr Vasc Pharmacol. 2018;16:589-595.
• Shen SW, Lu Y, Li F, et al. Atherogenic index of plasma is an effective index for estimating abdominal obesity. Lipids Health Dis. 2018;17:11.
• Guelker JE, Bufe A, Blockhaus C, et al. The atherogenic index of plasma and its impact on recanalization of chronic total occlusion. Cardiol J. 2020;27;6:756-761.
• Çerik İB, Dindaş F, Ömür S, Yenerçağ M. "The Relationship of Inflammation Parameters with Obstruction in Coronary Artery Ectasia." Harran Üniversitesi Tıp Fakültesi Dergisi. 2021:18;1:1-7.