Risk Factors, biochemical markers, and genetic polymorphisms in early coronary artery disease.

OBJECTIVE: To assess the risk factors, lipid and apolipoprotein profile, hemostasis variables, and polymorphisms of the apolipoprotein AI-CIII gene in early coronary artery disease (CAD). METHODS: Case-control study with 112 patients in each group controlled by sex and age. After clinical evaluation and nutritional instruction, blood samples were collected for biochemical assays and genetic study. RESULTS: Familial history of early CAD (64 vs 39%), arterial hypertension (69 vs 36%), diabetes mellitus (25 vs 3%), and previous smoking (71 vs 46%) were more prevalent in the case group (p<0.001). Hypertension and diabetes were independent risk factors. Early CAD was characterized by higher serum levels of total cholesterol (235 +/-6 vs 209 +/- 4 mg/dL), of LDL-c (154 +/- 5 vs 135 +/- 4 mg/dL), triglycerides (205 +/- 12 vs 143 +/- 9 mg/dL), and apolipoprotein B (129 +/- 3 vs 105 +/- 3 mg/dL), and lower serum levels of HDL-c (40 +/- 1 vs 46 +/- 1 mg/dL) and apolipoprotein AI (134 +/- 2 vs 146 +/- 2mg/dL) [p<0.01], in addition to an elevation in fibrinogen and D-dimer (p<0.02). The simultaneous presence of the rare alleles of the APO AI-CIII genes in early CAD are associated with hypertriglyceridemia (p=0.03). CONCLUSION: Of the classical risk factors, hypertension and diabetes mellitus were independently associated with early CAD. In addition to an unfavorable lipid profile, an increase in the thrombotic risk was identified in this population. An additive effect of the APO AI-CIII genes was observed in triglyceride levels.

Terapia combinada de colestiramina e inibidores da HMAG-CoA redutase na prevençäo secundária da doença coronária / Combinedtherapy with cholestyramine and HMG-CoA reductase inihibtors in secondary prevention of coronary disease

OBJETIVO: Avaliar as alteraçöes obridas no perfil lipídico de coronariopatas dislipidêmicos, após a adiçäo de colestiramina, em pacientes tratados com inibidores da HMG-Co redutase, e que näo atingiram os valores ideais de LDL-colesterol. MÉTODOS: Vinte coronariopatas (12 submetidos à revascularizaçäo do miocárdio, 3 à angioplastia coronária e 5 mantidos sob tratamento clínico), com média de idade de 60,78 anos, que já realizavam dieta hipolipemiante e eram medicados com lovastatina 20 mg/dia ou sinvastatina 10 mg/dia, receberam também colestiramina na dose de 8 a 16 g/dia durante 8 semanas, com o objetivo de reduzir LDL-colesterol para valores inferiores a 100 mg/dl. RESULTADOS: Houve significante reduçäo do colesterol total (valor médio inicial 239,52 mg/dL e ao final 199,00mg/dL), obtendo-se um decréscimo percentual médio de 16,92 "por cento". O valor médio de LDL-colesterol também se reduziu, significantemente, de 172,73 mg/dL para 118,26 mg/dL, com decréscimo percentual médio de 31,53 "por cento". A trigliceridemia média aumentou, ainda dentro da faixa de refência normal, de 145,05 mg/dL para 162,00 mg/dL, (diferença percentual média de 11,69 "por cento". Houve significante aumento da fraçäo HDL-colesterol de um valor médio inicial de 38,00 mg/dL para um valor médio final de 48,21 mg/dL (diferença média percentual 26,87 "por cento"). Näo houve efeitos adversos que impedissem a continuidade do tratamento. CONCLUSÄO: A associaçäo de colestiramina a doses baixas de vastatinas em pacientes com hipercolesterolemia primária e de alto risco coronária é uma boa opçäo terapêutica, podendo atingir benefícios sobre o perfil lipídico semelhantes àqueles obtidos quando esses fármacos säo utilizados,isoladamente, ou em associaçäo, e em doses mais elevadas.

Fatores de risco, marcadores bioquímicos e polimorfismos genéticos na doença arterial coronariana prematura / Risk Factors, biochemical markers, and genetic polymorphisms in early coronary artery disease

OBJECTIVE: To assess the risk factors, lipid and apolipoprotein profile, hemostasis variables, and polymorphisms of the apolipoprotein AI-CIII gene in early coronary artery disease (CAD). METHODS: Case-control study with 112 patients in each group controlled by sex and age. After clinical evaluation and nutritional instruction, blood samples were collected for biochemical assays and genetic study. RESULTS: Familial history of early CAD (64 vs 39 percent), arterial hypertension (69 vs 36 percent), diabetes mellitus (25 vs 3 percent), and previous smoking (71 vs 46 percent) were more prevalent in the case group (p<0.001). Hypertension and diabetes were independent risk factors. Early CAD was characterized by higher serum levels of total cholesterol (235 ± 6 vs 209 ± 4 mg/dL), of LDL-c (154 ± 5 vs 135 ± 4 mg/dL), triglycerides (205 ± 12 vs 143 ± 9 mg/dL), and apolipoprotein B (129 ± 3 vs 105 ± 3 mg/dL), and lower serum levels of HDL-c (40 ± 1 vs 46 ± 1 mg/dL) and apolipoprotein AI (134 ± 2 vs 146 ± 2mg/dL) [p<0.01], in addition to an elevation in fibrinogen and D-dimer (p<0.02). The simultaneous presence of the rare alleles of the APO AI-CIII genes in early CAD are associated with hypertriglyceridemia (p=0.03). CONCLUSION: Of the classical risk factors, hypertension and diabetes mellitus were independently associated with early CAD. In addition to an unfavorable lipid profile, an increase in the thrombotic risk was identified in this population. An additive effect of the APO AI-CIII genes was observed in triglyceride levels

Fibrogênio como fator de risco independente de doença vascular cerebral / Fibrinogen as independent risk factor for ischemic stroke

No protocolo de avaliaçäo clínico-laboratorial de pacientes com acidente vascular cerebral (AVC) aterotrombótico dosamos e analisamos níveis de fibrinogênio plasmático (técnica de Clauss automatizada), para determinar seu possível papel como fator de risco trombogênico em 29 pacientes (20 homens e 9 mulheres) com idades entre 25 a 79 anos (mediana=55); todos tinham tido AVC aterotrombótico. Eles foram classificados em 2 grupos segundo alteraçöes de fluxo nas carótidas: g1 - sem alteraçäo de fluxo (n=19) e g2 - com alteraçöes de fluxo (n=10). Resultados- A média das dosagens de fibrinogênio no g1 foi de 269 e no g2 de 353 mg/dl. Quarenta e sete por cento dos pacientes do g1 e 80 por cento do g2, apresentaram medidas >300 mg/dl. As diferenças obtidas entre os grupos neste estudo foram significante. Conclusäo- Considerando o nível de risco epidemiológico de 300 mg/dl, nossos resultados sugerem que o fibrinogênio é um fator de risco independente para AVC aterotrombótico, especialmente naqueles com alteraçäo de fluxo carotídeo.