[Elevated levels of homocysteine in plasma as a risk factor for coronary artery disease]. / Podwyzszone stezenie homocysteiny w osoczu jako czynnik ryzyka choroby niedokrwiennej serca.

This study was performed to assess the significance of association between coronary artery disease (CAD) and circulating homocysteine concentrations. 100 consecutive CAD patients (78 men and 22 women, aged 31 to 79 years) qualified for PTCA were investigated. At the time of PTCA, the risk factors for CAD and plasma for homocysteine and vitamins were obtained. The controls were without clinical evidence of coronary artery disease and hypertension (90 men and 30 women aged 32 to 81 years). Homocysteine was assayed using ELISA test. Red cell folate and plasma vitamin B12 were assayed by immunofluoroscency (Delphia test). Homocysteine concentrations were higher in patients than in controls (13.61 +/- 4.5 vs 10.99 +/- 4.49 mumol/L, p < 0.001, adjusted for age). Male patients had nonsignificantly higher homocysteine levels than females (13.94 +/- 5.21 vs 11.46 +/- 5.16 mumol/L, p = 0.05, adjusted for age). Elevated homocysteine level--defined as one in the top fifth of the control distribution > or = 12.83 mumol/L--was seen in 46% of the patients compared with 20% of the control group (p = 0.001). The odds ratio (OR) for CAD in persons with elevated homocysteine level was 3.1 (95% Cl 1.6-5.8, p < 0.001, adjusted for age). The OR for CAD of 5 mumol/L increment in homocysteine level was 2.1 (95% Cl 1.4-3.1 p < 0.001, adjusted for age). After adjustment for conventional risk factors (age, smoking, hypertension, family history of CAD, hyperlipidemia), elevated homocysteine level remained independent risk factor for CAD (OR 2.88, 95% Cl 1.1-7.8, p < 0.05). We observed inverse correlation between homocysteine and folate level (r = -0.32, p = 0.005) and between homocysteine and vitamin B12 concentrations (r = -0.24, p = 0.03), especially in men. Patients with elevated homocysteine level had lower levels of folate (629.6 +/- 241.2 nmol/L vs 735.1 +/- 252.4 nmol/L, p < 0.05), and vitamin B12 (213.6 +/- 64.4 pmol/L vs 246.6 +/- 62.3 pmol/L, p < 0.05) than patients with normal level of homocysteine. Elevated plasma homocysteine level is a strong risk factor for coronary artery disease. A 5 mumol/L increment in total homocysteine level may be associated with twofold increase of risk for the disease.

[Influence of Chlamydia pneumoniae and cytomegalovirus infections on prevalence and the course of coronary artery disease]. / Wplyw zakazenia Chlamydia pneumoniae i wirusem cytomegalii na wystepowanie oraz przebieg choroby wiencowej.

Chlamydia pneumoniae (C. pneumoniae) as well as cytomegalovirus (CMV) are common pathogens found in about 50% of healthy western population. Many studies suggest a role of C. pneumoniae in development of coronary artery disease (CAD). CMV infection is also considered to increase risk of developing of CAD as well as restenosis after percutaneous coronary revascularization (PCI). The aim of our study was to evaluate a possible role of C. pneumoniae and CMV infections in both CAD development and course in patients (pts) undergoing PTCA. We enrolled 105 pts (mean age 56.4 years, 83 males) with angiographically documented CAD. Control group consisted of 63 healthy controls (mean age 47.25 years; 31 males). The study subjects were evaluated for presence of C. pneumoniae specific IgG antibodies (MIF test--MRL Diagnostic, USA; seroprevalence assumed when titre > or = 1/8). In 58 random PCI pts CMV specific IgG antibodies (ELISA Eti-Cytok-G PLUS--Dia Sorin) were evaluated. Pts were sampled at the time of PTCA. All PCI pts were assessed by angina questionnaire 5.9 +/- 2.6 months (mo) after the procedure with respect to clinical restenosis. C. pneumoniae IgG antibodies were detected in 37.1% of pts and in 22% of healthy controls (p < 0.05). After logistic regression was applied trend towards more frequent occurrence of C. pneumoniae specific IgG in CAD pts was shown (p = 0.10 OR = 2.4; 95% CI: 0.8-6.8). No significant correlation was found between anti-C. pneumoniae IgG presence or anti-CMV IgG titre and coronary atherosclerosis advancement. There was no significant difference in anti-CMV IgG titre between 9 pts who developed clinical restenosis 5.9 +/- 2.6 mo after PCI and the remaining pts. Our study results suggest a possible significant correlation between C. pneumoniae with CAD prevalence. We did not find a positive association of either infection markers with coronary atherosclerosis advancement. We did not find correlation of clinical restenosis after PCI with markers of CMV infection.