Impact of obesity in intima media thickness of carotid arteries

Objective: To explore differences in intima media thickness (IMT) of the carotid arteries induced by differences in BMI. Research Methods and Procedures: Data from 3173 consecutive subjects, who were referred to our Hypertension Center from 1998 to 2004, were reviewed. Criteria for patients to be considered for further analysis included no past or concurrent antihypertensive medication, no concurrent medication with the potential to raise blood pressure (BP) (e.g., prednisone), and no clinical signs or laboratory evidence of secondary causes of hypertension. Our population was divided into four groups according to NIH criteria for obesity: underweight, normal weight, overweight, and obese. BMI, mean IMT of internal carotid arteries, and 24‐hour BP values were available for all subjects. Five hundred thirty six subjects of the four groups, matched for age, gender, and mean 24‐hour BP values, were included in the analysis. Results: Mean IMT of internal carotid arteries was increased with increasing BMI. Mean IMT was significantly higher in obese subjects compared with normal‐weight (p < 0.01) and underweight (p < 0.001) subjects. Mean IMT was significantly higher in overweight subjects compared with normal‐weight ones (p < 0.05). Furthermore, multivariate regression analysis in obese subjects revealed that fasting serum glucose was independently associated with IMT. Discussion: Obesity may be an important factor for carotid atherosclerosis, and at least some of the effects of obesity are independent of the BP levels. Fasting serum glucose levels in obese subjects may play an important role in carotid atherosclerosis.     

Differential value of intima thickness in ischaemic stroke due to large-artery atherosclerosis and small-vessel occlusion

No study has examined the differential value of arterial intima thickness in the subtypes of acute ischaemic stroke. This study aimed to assess whether intima thickness of carotid artery (CIT), radial artery (RIT) and dorsalis pedis artery (PIT) have an independent and additive value in differentiating ischaemic stroke subtypes due to large-artery atherosclerosis (LAA) or small-vessel occlusion (SVO). One hundred and sixty-one patients with LAA and 79 patients with SVO were recruited. CIT, RIT and PIT were measured with a 24-MHz ultrasound transducer. Binary logistic regression analysis was used to evaluate the differential values of the different parameters in the two subtypes. ROC curve analyses were plotted to compare the differential performance of different parameters and the combination model. Both RIT and PIT were substantially thicker in LAA than in SVO stroke patients. RIT and carotid intima-media thickness had similar performances in differentiating stroke subtypes. Introduction of RIT to traditional atherosclerotic associated risk factors had a marginal satisfactory differential performance for LAA and SVO stroke patients (AUC 0.775). RIT is a promising parameter for LAA and SVO subgroup classification. The combination of RIT and traditional risk factors might be a promising tool for differentiating ischaemic stroke subgroups.     

Circulating oxidized low-density lipoprotein and common carotid artery intima-media thickness in a random sample of middle-aged men

Circulating oxidized low-density lipoprotein (oxLDL) has been suggested to play an important role in atherosclerosis development. According to previous observations, oxLDL correlates with clinically manifest coronary and carotid artery disease. We investigated the association between the oxLDL concentration measured directly in plasma and common carotid artery intima-media thickness (IMT) in a population-based, case-control study in middle-aged men from Southern Finland. oxLDL was determined in 214 men by a commercially available sandwich ELISA test (Mercodia). Carotid artery IMT was measured at 12 standardized segments by B-mode ultrasonography (at the near and far wall of the left and right common carotid arteries, bifurcations and internal carotid arteries), and the overall mean maximum IMT (MMaxIMT) was calculated. The MMaxIMT of the carotid arteries was significantly associated with circulating oxLDL (r_s=0.16, p=0.018). In a stepwise multiple regression model with MMaxIMT as dependent variable and systolic blood pressure, smoking, oxLDL, HDL cholesterol and apolipoprotein B as covariates, systolic blood pressure (=0.22, p<0.001), oxLDL (=0.15, p=0.022) and smoking (=0.17, p=0.014) showed an independent association with IMT (R²=0.10, p<0.001). Our results show that oxLDL measured directly from plasma is independently associated with subclinical carotid artery atherosclerosis in middle-aged men.     

High accumulation of calcium and phosphorus in the coronary artery of the Thai in comparison with the Japanese

To examine whether there were differences between races in regard to age-related changes of mineral contents and the relationships among element contents in the arteries, the authors investigated the coronary arteries of Thai and Japanese. The Thai subjects consisted of 13 men and 3 women, ranging in age from 39 to 84 yr, whereas the Japanese subjects consisted of 17 men and 9 women, ranging in age from 55 to 92 yr. After the ordinary dissections at Chiang Mai University and Nara Medical University were finished, the coronary arteries were resected and the element contents were determined by inductively coupled plasma-atomic emission spectrometry. In the Thai, an accumulation of calcium and phosphorus began to occur in the forties and increased markedly in the fifties, whereas in the Japanese, an accumulation of calcium and phosphorus began to occur in the seventies and increased markedly in the nineties. The result revealed that an accumulation of calcium and phosphorus occurred earlier in the Thai than in the Japanese. Regarding the relationships among element contents, extremely significant correlations were found between calcium and phosphorus contents, between calcium and magnesium contents, and between phosphorus and magnesium contents in both the coronary arteries of the Thai and the Japanese. As far as the coronary arteries with a very high accumulation of calcium and phosphorus, the mass ratios of magnesium to calcium and phosphorus were lower in the coronary arteries of the Thai in comparison with the Japanese.     

Finite element modelling of the common carotid artery in the elderly with physiological intimal thickening using layer-specific stress-released geometries and nonlinear elastic properties

To investigate the mechanical effects of tissue responses, such as remodelling, in the arteries of the elderly, it is important to evaluate stress in the intimal layer. In this study, we investigated a novel technique to evaluate the effect of layer-specific characteristics on stress in the arterial wall in an elderly subject. We used finite element analysis of a segment of carotid artery with intimal thickening, incorporating stress-released geometries and the stress–strain relationships for three separate wall layers. We correlated the stress–strain relationships and local curvatures of the layers with the stress on the arterial wall under physiological loading. The simulation results show that both the stress–strain relationship and the local curvature of the innermost stress-released layer influence the circumferential stress and its radial gradient. This indicates that intimal stress is influenced significantly by location-dependent intimal remodelling. However, further investigation is needed before conclusive inferences can be drawn.     

Association between OLR1 K167N SNP and intima media thickness of the common carotid artery in the general population

Background and Purpose

The lectin-like oxidised LDL receptor-1 (OLR1) gene encodes a scavenger receptor implicated in the pathogenesis of atherosclerosis. Although functional roles have been suggested for two variants, epidemiological studies on OLR1 have been inconsistent. Methods - We tested the association between the non-synonymous substitution K167N (rs11053646) and intima media thickness of the common carotid artery (CCA-IMT) in 2,141 samples from the Progression of Lesions in the Intima of the Carotid (PLIC) study (a prospective population-based study).

Results

Significantly increased IMT was observed in male carriers of the minor C (N) allele compared to GC and GG (KN and KK) genotype. Functional analysis on macrophages suggested a decreased association to Ox-LDL in NN carriers compared to KN and KK carriers which is also associated with a reduced OLR1 mRNA expression. Macrophages from NN carriers present also a specific inflammatory gene expression pattern compared to cells from KN and KK carriers.

Conclusions

These data suggest that the 167N variant of LOX-1 receptor affects the atherogenic process in the carotid artery prior to evidence of disease through an inflammatory process.     

幽门螺杆菌感染对冠心病患者血清生化水平及颈动脉硬化的影响

目的 探讨幽门螺杆菌感染对冠心病患者血清生化水平及颈动脉硬化的影响。方法 选取150例冠心病患者,所有患者均接受14C呼气试验检查,将呼气试验阳性患者分为观察组,阴性患者分为对照组。两组患者均检测甘油三酯（TG）、胆固醇（TC）、低密度脂蛋白（LDL-C）、血清同型半胱氨酸（HCY）和血清超敏C反应蛋白（hs-CRP）水平,并接受彩色多普勒超声检查颈动脉。观察并比较两组患者血清生化水平及颈动脉情况。结果 观察组患者血清TC、LDL-C、HCY和hs-CRP水平显著高于对照组（P0.05）。观察组患者内膜厚度显著大于对照组（P0.05）。结论 冠心病患者感染幽门螺杆菌会影响脂蛋白代谢,激活炎症反应,增加冠心病患者动脉硬化发生的风险,应早期积极干预治疗。     

Earlier accumulation of calcium, phosphorus, and magnesium in the coronary artery in comparison with the ascending aorta, aortic valve, and mitral valve

To explore reasons for a high accumulation of Ca and P occurring in the coronary artery of Thai with aging, the authors investigated age-related changes of elements in the coronary artery, ascending aorta near the heart, and cardiac valves in single individuals, and the relationships in the elements between the coronary artery and either the ascending aorta or cardiac valves. After an ordinary dissection by medical students at Chiang Mai University was finished, the anterior descending arteries of the left coronary artery, ascending aortas, mitral valves, and aortic valves were resected from the subjects. The subjects consisted of 17 men and 9 women, ranging in age from 46 to 76 yr. The element content was analyzed by inductively coupled plasma-atomic emission spectrometry. The average content of Ca and P was the highest in the coronary artery and decreased in the order aortic valve, ascending aorta, and mitral valve. The Ca, P, and Mg content increased in the coronary artery in the fifties and in the ascending aorta, aortic valve, and mitral valve in the sixties. It should be noted that the accumulation of Ca, P, and Mg occurred earlier in the coronary artery than in the ascending aorta, aortic valve, and mitral valve. It was found that with respect to the Ca, P, Mg, and Na contents, the coronary artery correlated well with both the aortic valve and ascending aorta, especially with the aortic valve, but it did not correlate with the mitral valves. This finding suggests that the accumulation of Ca, P, Mg, and Na occurs in the coronary artery together with the aortic valve and ascending aorta, but not together with the mitral valve. Because regarding the accumulation of Ca, P, and Mg, the ascending aorta and aortic valve are preceded by the coronary artery, it is unlikely that the accumulation of Ca, P, and Mg spreads from the ascending aorta or aortic valve to the coronary artery.     

Diagnostic and prognostic value of absence of coronary artery calcification in patients with stable chest symptoms

The aim of this study was to determine the prognostic value of a coronary artery calcium score (CACS) of 0 in patients with stable chest symptoms and to compare it as a first-line test with bicycle exercise testing (X-ECG). Altogether, 315 consecutive patients over 44 years of age, with stable chest symptoms and no previous diagnosis of coronary artery disease (CAD) visited the outpatient clinic of our community hospital and underwent both CACS and X-ECG. The mean age was 60.54 years (SD 9.7; range 45–88 years). Of these patients, 141 had no detectable coronary calcium (44.8%) We excluded patients who did not sign informed consent (n = 4). Three patients were lost to follow-up. The follow-up group therefore consisted of 134 patients. The mean follow-up period was 44.6 months (25th–75th percentile: 35.5–54.3 months), during which no major adverse cardiac events (MACE) occurred. The negative predictive value (NPV) was 100%. X-ECG was negative in only 89 patients, equivocal in 39 patients and false-positive in 6 patients requiring additional stress myocardial imaging in 45 patients. NPV as a first-line test was therefore 66.4%. In conclusion: patients over 44 years with stable chest symptoms and no detectable coronary calcium have an excellent prognosis. CACS performs better compared with X-ECG as an initial test in patients with stable chest symptoms.     

幽门螺杆菌感染对冠心病患者血清炎症因子及颈动脉硬化的影响

目的 探讨幽门螺杆菌感染对冠心病患者血清炎症因子及颈动脉硬化的影响。方法 选取2015年6月至2017年2月在安康市中心医院治疗的幽门螺杆菌感染冠心病患者（感染组）50例,以及同时期未被幽门螺杆菌感染的冠心病患者（非感染组）50例。对两组患者血清炎症因子及颈动脉硬化程度进行评估。结果 幽门螺杆菌感染组患者TC、TG及LDL水平均显著高于非感染组,HDL水平显著低于非感染组,差异均有统计学意义（P0.05）,感染组患者不稳定斑块的检出率为48.00%,显著高于非感染组的24.00%,差异有统计学意义（P<0.05）。结论 幽门螺杆菌感染能显著升高冠心病患者血脂水平,加重机体炎症反应,并增加患者颈动脉中膜厚度及斑块的不稳定性。     

Serum palmitic acid-oleic acid ratio and the risk of coronary artery disease: a case-control study

Serum free fatty acids are risk factors for future coronary artery disease (CAD). We investigated the association between serum palmitic acid (PA)-oleic acid (OA) ratio and CAD risk in a case-control (n=108/129) study. The PA-OA ratio was associated with future CAD events independently of standard lipid values. The PA-OA ratio was significantly associated with the risk of fatal CAD [odds ratio (OR): 60.4; 95% confidence interval (CI): 11.5-316.9; P<.001] while inversely associated in nonfatal CAD group (OR: 0.11; 95% CI: 0.02-0.53; P<.01), and no distinct modification by sex was found. Receiver-operating characteristic (ROC) analysis found that PA-OA ratio did as well as triglyceride (TG) and apolipoprotein B (apo B)-high-density lipoprotein cholesterol (HDLC) ratio at discriminating fatal CAD (area under ROC, TG, 0.692; apo B-HDLC, 0.683; PA-OA, 0.768, P<.001), and had similar effect with HDLC at discriminating nonfatal CADs (area under ROC, HDLC, 0.649; PA-OA, 0.659, P<.01).These findings suggested that PA-OA ratio did as well as and even better than traditional risk factors and arteriography examination in discriminating fatal and nonfatal CAD events. Serum PA-OA ratio could be a new factor for CAD risk assessment and prediction.     

Gender-related differences in octogenarians with congenital coronary artery fistula: a report of two cases and a review

Aim

To highlight gender-related differences in octogenarians with a congenital coronary artery fistula (CAF).

Materials and methods

We present two elderly female patients with a congenital fistula, a septuagenarian and a nonagenarian, and review the world literature between 1954–2010.

Results

The septuagenarian patient presented with easy fatigability and the nonagenarian patient with acute myocardial infarction contralaterally to the fistula. Coronary angiography (CAG) demonstrated a coronary-pulmonary artery fistula (CPF). The nonagenarian patient underwent percutaneous coronary intervention of the right coronary artery. CAG revealed a CPF associated with a huge multiple aneurysmal formation. Data from 57 mainly symptomatic patients with a mean age of 75.3 years (range 70–87 years) were collected. The cohort was subdivided into female (mean age 84.3 years) and male (mean age 75.2 years) subgroups and compared with each other. Multi-origin (bilateral and multilateral) was prevalent in females, 40% versus 12% in males. Aneurysmal formation was found in females and males in 40% and 18%, respectively. Ethnicity was 65% Caucasian and 35% Asian. Multi-origin fistulas were prevalent in the Asian (45%) compared with the Caucasian (11%) subset.

Conclusions

A septuagenarian and a nonagenarian female patient with congenital CAF are presented. On reviewing the literature, important differences were found between elderly females and males with congenital CAF.     

Mass ratios of magnesium to calcium and phosphorus in the arteries of Japanese and Thai

To elucidate quantitative changes of Ca, P, and Mg in the arteries with aging, the authors investigated changes of the mass ratios of Mg to Ca and P in the arteries of Japanese and Thai by inductively coupled plasma-atomic emission spectrometry. The arteries of Japanese that were used were the thoracic and abdominal aortas, coronary, common iliac, internal iliac, external iliac, and femoral arteries, in which very high accumulations of Ca and P occurred in old age. The arteries of Thai that were used were the abdominal aorta, ramifying site of the abdominal aorta, coronary, common iliac, internal iliac, and external iliac arteries. It was found that there were extremely significant correlations both between Ca and Mg contents and between P and Mg contents in all of the arteries of the Japanese and the Thai. With regard to the mass ratio, the mass ratios of Mg to Ca ranged from 1.5% to 2.1% in the six arteries of the Japanese, except for the thoracic aorta at 3.1%, at an advanced stage of atherosclerosis, being similar to each other. In the arteries of the Thai, the mass ratios of Mg to Ca ranged from 1.9% to 3.0%, except for the coronary artery at 0.5%, at an advanced stage of atherosclerosis. The mass ratios of Mg to P ranged from 2.5% to 2.7% in the six arteries of the Japanese, except for the coronary artery at 1.8%, at an advanced stage of atherosclerosis. With regard to the arteries of the Thai, the mass ratios of Mg to P ranged from 1.9% to 3.3%, except for the coronary artery at 0.7%, at an advanced stage of atherosclerosis. These results revealed that both the mass ratios of Mg to Ca and Mg to P were almost similar among the arteries of Japanese and Thai, except for the coronary arteries. Therefore, these results suggested that the inorganic deposits in the coronary arteries of Japanese and Thai were similar to those in the intimal tunica of the thoracic aorta, whereas in the other arteries, they were similar to those in the middle tunica of the thoracic aorta.     

七味白术散合补阳还五汤对2型糖尿病患者颈动脉内中膜厚度和胰岛素抵抗的影响

摘要 目的：评价七味白术散合补阳还五汤对2型糖尿病（T2DM）患者颈动脉内中膜厚度（IMTc）和胰岛素抵抗（IR）的影响。方法：选入我院2020年9月~2022年9月收治的T2DM患者80例,根据治疗方法不同分为常规组（常规基础治疗）和联合组（常规基础治疗+七味白术散合补阳还五汤）,各40例。检测两组的血糖、血脂指标,计算IR指数（HOMA-IR）,并通过超声测定IMTc。结果：两组治疗后各血糖（FPG和HbA1c）、血脂（TC、TG、LDL-C和HDL-C）指标均较治疗前有不同程度的改善,而联合组改善幅度明显大于常规组（P<0.05）;相较于治疗前,两组治疗后HOMA-IR明显下降、HOMA-?茁显著升高（P<0.05）,而联合组下降/升高幅度更大,与常规组差异显著（P<0.05）;治疗前,两组IMTc值无明显差异（P＞0.05）,而治疗后,联合组IMTc值显著低于常规组（P<0.05）;联合组治疗总有效率较常规组高（92.50% vs. 72.50%,P<0.05）,不良反应发生率较常规组低（2.50% vs. 15.00%,P＜0.05）。结论：七味白术散合补阳还五汤可有效提升T2DM的治疗效果,改善糖脂代谢及?茁细胞功能,减少IR及IMTc值,且不良反应少。     

Association between HindIII (rs320) variant in the lipoprotein lipase gene and the presence of coronary artery disease and stroke among the Saudi population

Lipoprotein Lipase (LPL) is known to be a key enzyme for lipid metabolism specifically in an enzymatic glycoprotein which provide tissues without fatty-acids and eliminates triglycerides (TG) by the circulation. Mutations in LPL were proven to cause alteration in fractions within lipoprotein, causing the development of atherosclerosis which predispose to weakening coronary artery disease (CAD) and stroke. We examined the linkage between genetic variant HindIII in LPL on lipoprotein fractions, stroke occurrences and CAD. In this case-control study, we have recruited 315 CAD cases and 205 age-matched controls. A total of 520 genomic DNA was digested with the purified PCR products for restriction fragment length polymorphism with HindIII restriction enzyme. The distribution of genotypes in a decreasing order were TT, 148 (47%), GT 135 (42.9%) and GG 32 (10.2%) in CAD groups of the study while the pattern in controls were GT 91 (44.4%), TT 86 (42%) and GG 28 (13.7%). None of all the allele or genotype frequencies were found to be significant in our study (p greater than 0.05), while the biochemical levels for both TG and LDL-c were shown to be prone in CAD patients when compare with the controls. Furthermore, the occurence of strokes were more in CAD groups vs. controls: 72 (22.9%) vs. 7 (3.4%) [p 0.000]. This could indicate the influence of HindIII variant on plasma lipid levels, and the possibility of considering it a risk factor for atherosclerosis leading to CAD and stroke occurrence.     

Comparison of mineral contents between the arteries in upper and lower limbs of japanese monkeys

To examine whether the calcium accumulation in aged arteries is related to the way of walking, the mineral contents were determined in the arteries of Japanese monkeys of quadrupedal walk by inductively coupled plasma-atomic emission spectrometry. Sixteen Japanese monkeys consisting of 7 males and 9 females ranging in age from 2 to 33 yr were studied. The accumulation of calcium, phosphorus, and magnesium occurred progressively in most, but not all, of the arteries with aging. It was found that independent of the upper and lower limbs, a higher accumulation of calcium, phosphorus, and magnesium occurred in the arteries of the proximal regions with aging, compared with the arteries of the distal regions. In a comparison between the arteries of anatomically corresponding regions of the upper and lower limbs, the accumulation of calcium and magnesium was 20–60% higher in the external iliac and femoral arteries of the lower limb than in the axillary and brachial arteries of the upper limb. Regarding phosphorus, the accumulation was 20–120% higher in the external iliac and femoral arteries than in the axillary and brachial arteries. It was known that in humans, the accumulation of calcium, phosphorus, and magnesium was three to seven times higher in the arteries of the lower limb than in the arteries of the upper limb. It is clear that there is a very significant difference in the accumulation of calcium and magnesium in the arteries of the lower limbs between Japanese monkeys and humans. The present study suggests that the accumulation of calcium and magnesium in the arteries of the lower limb with aging is affected by the way of walking.     

血清同型半胱氨酸及超敏C反应蛋白水平与老年原发性高血压患者颈动脉粥样硬化程度的关系研究

目的:探讨血清同型半胱氨酸(Hcy)及超敏C反应蛋白(hs-CRP)水平与老年原发性高血压患者颈动脉粥样硬化程度的关系。方法:选择我院于2015年5月至2017年10月收治的141例老年原发性高血压患者作为研究对象。检测所有患者颈动脉内膜-中层厚度(IMT),并根据IMT将其分为正常组(IMT≤1.0 mm,n=28)、增厚组(1.0 mmIMT1.5 mm,n=53)和斑块组(IMT≥1.5 mm,n=60)。比较三组患者血清Hcy、hs-CRP、总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)水平,采用Pearson相关分析四项指标与IMT的相关性,采用多元线性逐步回归分析IMT增厚的影响因素。结果:增厚组与斑块组血清Hcy、hs-CRP、TC、LDL-C水平均明显高于正常组,且斑块组血清Hcy、hs-CRP、TC、LDL-C水平明显高于增厚组,差异具有统计学意义(均P0.05)。Pearson相关分析结果表明,血清Hcy、hs-CRP、TC、LDL-C水平均与IMT呈正相关关系(r=0.775、0.836、0.492、0.415,均P0.05)。多元线性逐步回归分析结果显示,血清Hcy、hs-CRP均为IMT增厚的独立危险因素(OR=5.689、7.381,均P0.05)。结论:老年原发性高血压患者颈动脉粥样硬化程度与血清Hcy、hs-CRP关系密切,临床上检测其Hcy、hs-CRP水平可在一定程度上评估颈动脉粥样硬化程度。     

Cys-C、FT3及Apo-A与冠心病严重程度的相关性

目的:探讨胱抑素C(Cys-C)、游离三碘甲状腺原氨酸(FT3)和载脂蛋白A(Apo-A)与冠心病严重程度的相关性。方法:选取2017年10月至2018年3月于西安交通大学第一附属医院心血管内科行冠脉造影的患者353例,根据临床症状及冠脉造影结果将其分为急性心肌梗死组(AMI,n=119)、心绞痛组(AP,n=100)和冠脉造影正常组(NT,n=133)。采用免疫比浊法检测胱抑素(Cys-C)、载脂蛋白A(Apo-A)水平,电化学发光法检测游离三碘甲状腺原氨酸(FT3)水平。通过Logistic回归分析Cys-C、FT3及Apo-A与心绞痛和急性心肌梗死的相关性。ROC曲线分析Cys-C、FT3及Apo-A对心绞痛和急性心肌梗死的诊断价值。结果:AMI组、AP组血清Apo-A水平较NT组显著减低(0.97±0.36、0.92±0.45 vs. 1.05±0.32,P0.05);AMI组的FT3水平显著低于NT组和AP组(0.80±0.45 vs. 1.16±0.30、1.06±0.26,P0.001);AP组Cys-C水平高于NT组及AMI组(1.13±0.38 vs. 0.84±0.22、0.94±0.30,P0.001)。多因素Logistic回归分析结果显示Cys-C水平与心绞痛的发生呈正相关(B=4.071),Apo-A和FT3水平与急性心肌梗死发生呈负相关(B=-2.795,-2.844)。ROC曲线分析结果显示Cys-C对心绞痛的诊断价值最大(曲线下面积=0.794),FT3对急性心肌梗死的诊断价值最大(曲线下面积=0.156),其次为Apo-A(曲线下面积=0.299)。结论:Cys-C水平升高与冠心病的发生具有显著相关性,而FT3和Apo-A减低与冠心病严重程度有明显相关性。     

Association of polymorphism in the thermolabile 5, 10-methylene tetrahydrofolate reductase gene and hyperhomocysteinemia with coronary artery disease

Objective To determine the incidence of methylene tetrahydrofolate reductase (MTHFR) gene 677C→T polymorphism and plasma homocysteine (Hcy) levels in a group of subjects who underwent coronary angiography, in an attempt to establish a correlation between these parameters and the severity of coronary artery disease (CAD) and to investigate the correlation between hyperhomocysteinemia (HHcy) and the presence of 677C→T polymorphism. Background Elevated plasma Hcy level is an independent risk factor for CAD. A common mutation (677C→T) in the gene coding for MTHFR has been reported to reduce the enzymatic activity and is associated with elevated levels of Hcy, especially in subjects with low folate intake. Methods The study group comprised of 84 patients with CAD and 100 age-and-sex matched controls who had no history or clinical evidence of CAD and/or MI. DNA was extracted from peripheral blood and genotypes were determined by polymerase chain reaction, restriction mapping with Hinf1, and gel electrophoresis. Conventional risk factors for CAD were prospectively documented. Results Allele and genotype frequencies in cases and control subjects were compatible with Hardy–Weinberg equilibrium. The frequencies of TT, CT, and CC genotypes among CAD patients were 4.8, 27.4, and 67.8% and in controls were 1.0, 19.0, and 80%. Hcy levels were higher in patients with triple-vessel disease compared to single and double vessel disease (P = 0.002). Multivariate analyses identified HHcy, diabetes mellitus, and hypertension as the independent predictors of CAD. Conclusions HHcy appears to have a graded effect on the risk of CAD as well as the severity and extent of coronary atherosclerosis. Our findings support that homozygous genotype of MTHFR is a genetic risk factor for CAD. A further study with larger sample size including assessment of vitamin status is needed to better clarify the relationship between MTHFR genotypes and CAD.