George Reema, Sivadasanpillai Harikrishnan, Jayakumari Narayani, Bhatt Anugya, Thulaseedharan Jissa V, Tharakan Jaganmohan A
Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011 Kerala India.
Department of Biochemistry, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011 Kerala India.
Indian J Clin Biochem. 2016 Jul;31(3):302-9. doi: 10.1007/s12291-015-0540-y. Epub 2015 Dec 22.
Thrombotic risk factors may contribute to premature coronary artery disease (CAD), in addition to the conventional risk factors. There is paucity of data on studies evaluating the role of thrombotic factors in premature CAD in Indian patients. Thus a case-control study was performed to evaluate the role of thrombotic and atherogenic factors in young patients with angiographically proven CAD who are on treatment with statins and anti-platelet drugs. 152 patients (≤55 years) with angiographically proven CAD and 102 asymptomatic controls were recruited. Clinical and biochemical data were obtained in both groups. Blood levels of thrombotic factors-fibrinogen, antithrombin-III, tissue-plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), von-Willebrand factor (v-WF), lipoprotein(a) [Lp(a)] and homocysteine were analyzed. Patients had high levels of conventional CAD risk factors (diabetes mellitus, smoking, hypertension, dyslipidemia and positive family history) compared to controls. Logistic regression analysis revealed that low antithrombin-III (odds ratio/OR 11.2; 95 % confidence interval/CI 2.29-54.01), high fibrinogen (OR 6.04; 95 % CI 1.09-33.21) and high Lp(a) (OR 4.54; 95 % CI 0.92-22.56), as important, independent risk factors in patients. PAI-1(OR 0.15; 95 % CI 0.03-0.69) levels were significantly lower in patients. But other thrombotic risk factors studied (t-PA, v-WF and homocysteine) were comparable among patients and controls. The treatment using statins and anti-platelet drugs might be contributing to the control of some of the thrombotic risk factors. The strategies aiming at lowering the levels of thrombotic risk factors along with conventional risk factors may be useful in primary and secondary prevention of CAD.
除了传统的危险因素外，血栓形成风险因素可能会导致早发性冠状动脉疾病（CAD）。关于评估血栓形成因素在印度患者早发性CAD中作用的研究数据很少。因此，进行了一项病例对照研究，以评估血栓形成和致动脉粥样硬化因素在接受他汀类药物和抗血小板药物治疗的经血管造影证实患有CAD的年轻患者中的作用。招募了152例年龄≤55岁、经血管造影证实患有CAD的患者和102例无症状对照者。两组均获得了临床和生化数据。分析了血栓形成因素的血液水平——纤维蛋白原、抗凝血酶III、组织纤溶酶原激活物（t-PA）、纤溶酶原激活物抑制剂-1（PAI-1）、血管性血友病因子（v-WF）、脂蛋白(a) [Lp(a)]和同型半胱氨酸。与对照组相比，患者具有较高水平的传统CAD危险因素（糖尿病、吸烟、高血压、血脂异常和家族史阳性）。逻辑回归分析显示，低抗凝血酶III（比值比/OR 11.2；95%置信区间/CI 2.29-54.01）、高纤维蛋白原（OR 6.04；95% CI 1.09-33.21）和高Lp(a)（OR 4.54；95% CI 0.92-22.56）是患者重要的独立危险因素。患者的PAI-1水平（OR 0.15；95% CI 0.03-0.69）显著较低。但研究的其他血栓形成危险因素（t-PA、v-WF和同型半胱氨酸）在患者和对照者之间具有可比性。使用他汀类药物和抗血小板药物的治疗可能有助于控制一些血栓形成危险因素。旨在降低血栓形成危险因素水平以及传统危险因素水平的策略可能对CAD的一级和二级预防有用。
