Compare and correlate the levels of lipoprotein (a) and high-sensitive C-reactive protein in coronary heart disease with control

Authors

  • Kamal Lochan Behera Department of General Medicine, Maharajahs Institute of Medical Sciences, Nellimarla, Andhra Pradesh, India
  • Ashok Vankayala Department of General Medicine, Maharajahs Institute of Medical Sciences, Nellimarla, Andhra Pradesh, India
  • Suresh Babu Sayana Department of Pharmacology, Maharajahs Institute of Medical Sciences, Nellimarla, Andhra Pradesh, India
  • D. S. S. K. Raju Department of Biochemistry, Maharajahs Institute of Medical Sciences, Nellimarla, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20191517

Keywords:

Coronary heart disease, High-sensitive C-reactive protein, Lipoprotein (a), Myocardial Infarction

Abstract

Background: The incidence of ischemic heart disease/ myocardial infarction is rapidly increasing in India. However, the traditional risk factors alone could not explain this excess of Coronary Heart Disease (CHD). So, we are in need of a tool to assess the severity and prognosis of these acute coronary syndromes. Lipoprotein (a) [Lp(a)] and High Sensitive C-Reactive Protein (hs-CRP) have been recognised as independent risk factors for CHD in many retrospective case control studies. As the data shows inconsistency in the prediction of risk by Lp(a) and hs-CRP, the study is carried out to compare and correlate the levels of Lp(a) and hs-CRP in coronary heart disease patients with controls.

Methods: An observational case control study was conducted at Maharaja’s Institute of Medical Sciences, Nellimarla, with 120 participants. 80 admitted with CHD were categorised as type 2 diabetic and non-diabetic. Remaining 40 participants were age matched controls, who have attended the OP for general health check-up. Samples collected from the participants were analysed for Lp(a), hs-CRP and HbA1c.

Results: Lp(a) levels were significantly elevated in CHD patients with diabetes (69.2±27.5) and non-significant in CHD patients without diabetes (50.4±24.3) as compared to their controls (36.6±22.5). There was significant correlation and elevation of hs-CRP in CHD patients with diabetes (6.0±2.6) and without diabetes (3.7±2.0) as compared to their controls (0.7±0.4).

Conclusions: The present study shows a lack of association of Lp(a) levels in CHD patients with and without diabetes. A strong correlation of the inflammatory marker, hs-CRP was observed between the CHD patients with and without diabetes and even as compared to their controls. It may be concluded that hs-CRP is a better and independent marker than Lp(a) in patients with CHD.

References

Moran AE, Oliver JT, Masaud M, Mohammed HF, Marina C, Laurie A, et al. Assessing the global burden of ischemic heart disease. Glob Heart. 2012;7(4):315-29.

Shrihari MB. Changing trends in the prevalence of coronary heart disease. Indian Heart J. 2016;68(4):445-6.

Gupta R, Mohan I, Narula J. Trends in coronary heart disease epidemiology in India. Ann Glob Health. 2016;82(2):307-15.

Eagle KA, Geoffrey SG, Kiran M, William CA, Robert SB, Susan KB, et al. Identifying patients at high risk of a cardiovascular event in the near future. Circulations. 2010;121(12):1447-54.

Arsenault BJ, Perrot N, Coutrure P. Does lifestyle contribute to disease severity in patients with inherited lipid disorders? Curr Opin Lipidol. 2017;28(2):177-85.

Canto JG, Kiefe CI, Rogers WJ, Peterson ED, Frederick PD, French WJ, et al. Number of coronary heart disease risk factors and mortality in patients with first myocardial infarction. JAMA. 2011 Nov 16;306(19):2120-7.

Jialal I. Evolving lipoprotein risk factors: lipoprotein (a) and oxidized low-density lipoprotein. Clin Chem. 1998 Aug 1;44(8):1827-32.

Paultre F, Pearson TA, Weil HF, Tuck CH, Myerson M, Rubin J, et al. High levels of Lp (a) with a small apo (a) isoform are associated with coronary artery disease in African American and white men. Arterioscl Thrombos Vasc Biol. 2000 Dec;20(12):2619-24.

Willerson JT, Ridker PM. Inflammation as a cardiovascular risk factor. Circulation. 2004;109(21_suppl_1):II-2.

Yousuf O, Mohanty BD, Martin SS, Joshi PH, Blaha MJ, Nasir K, et al. High-sensitivity C-reactive protein and cardiovascular disease: a resolute belief or an elusive link?. J Am Coll Cardiol. 2013 Jul 30;62(5):397-408.

Musumuru K, Brian GK, Roger SB, Valentin F, Catherine YC, J Gluckman. The use of high sensitive C-Reactive protein in clinical practice. Nat Clin Pract Cardiovasc Med. 2008;5(10):621-35.

Santica MM, John JA, Lipoprotien (a) measurement for clinical application. J Lipid Res. 2015;57(4):526-37.

Hamvi A, Vukovich T, Oswald W, Helnut R, Roswitha S et al. Evaluation of turbidiometric hs-CRP assays for cardiovascular risk estimation. Clin Chem. 2001;47(11):2044-6.

Tayal D, Goswami B, Koner BC, Mallika V. Role of Homocysteine and Lipoprotein (A) in atherosclerosis: An update. Biomed Res. 2011;22(4):391-405.

Ye Z, Haycock PC, Gurdasani D, Pomilla C, Boekholdt SM, Tsimikas S, et al. The association between circulating lipoprotein (a) and type 2 diabetes: is it causal?. Diabetes. 2014;63(1):332-42.

Jauhiainen M, Koskinen P, Ehnholm C, Frick MH, Mänttäri M, Manninen V, Huttunen JK. Lipoprotein (a) and coronary heart disease risk: a nested case-control study of the Helsinki Heart Study participants. Atheroscler. 1991;89(1):59-67.

Raggi P, Genest J, Giles JT, Rayner KJ, Dwivedi G, Beanlands RS, et al. Role of inflammation in the pathogenesis of atherosclerosis and therapeutic interventions. Atheroscler. 2018 Sep 1;276:98-108.

Sara JD, Prasad M, Zhang M, Lennon RJ, Herrmann J, Lerman LO, et al. High-sensitivity C-reactive protein is an independent marker of abnormal coronary vasoreactivity in patients with non-obstructive coronary artery disease. Am Heart J. 2017 Aug 1;190:1-1.

Osman R, L'Allier PL, Elgharib N, Tardif JC. Critical appraisal of C-reactive protein throughout the spectrum of cardiovascular disease. Vasc Health Risk Managem. 2006 Sep;2(3):221.

Jager A, van Hinsbergh VW, Kostense PJ, Emeis JJ, Yudkin JS, Nijpels G, et al. von Willebrand factor, C-reactive protein, and 5-year mortality in diabetic and nondiabetic subjects: the Hoorn Study. Arterioscler Thrombo Vasc Biol. 1999;19(12):3071-8.

King DE, Mainous AG, Buchanan TA, Pearson WS. C-reactive protein and glycemic control in adults with diabetes. Diab Care. 2003 May 1;26(5):1535-9.

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Published

2019-05-24

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Original Research Articles