coronary heart disease

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LINE-1 Hypomethylation is Associated with the Risk of Coronary Heart Disease in Chinese Population

Li Wei et al. Shuchuan Liu Zhendong Su Rongchao Cheng … Xiuping Bai Xueqi Li

Background:

Global methylation level in blood leukocyte DNA has been associated with the risk of coronary heart disease (CHD), with inconsistent results in various populations. Similar data are lacking in Chinese population where different genetic, lifestyle and environmental factors may affect DNA methylation and its risk relationship with CHD.

Objectives:

To examine whether global methylation is associated with the risk of CHD in Chinese population.

Methods:

A total of 334 cases with CHD and 788 healthy controls were included. Global methylation in blood leukocyte DNA was estimated by analyzing LINE-1 repeats using bisulfite pyrosequencing.

Results:

In an initial analysis restricted to control subjects, LINE-1 level reduced significantly with aging, elevated total cholesterol, and diagnosis of diabetes. In the case-control analysis, reduced LINE-1 methylation was associated with increased risk of CHD; analysis by quartile revealed odds ratios (95%CI) of 0.9 (0.6-1.4), 1.9 (1.3-2.9) and 2.3 (1.6-3.5) for the third, second and first (lowest) quartile (P_trend< 0.001), respectively, compared to the fourth (highest) quartile. Lower (<median) LINE-1 methylation was associated with a 2.2-fold (95%CI = 1.7-3.0) increased risk of CHD. The lower LINE-1-related CHD risk estimates tended to be stronger among subjects with the highest tertile of homocysteine (P_interaction= 0.042) and those with diagnosis of hypertension (P_interaction= 0.012).

Conclusion:

LINE-1 hypomethylation is associated with the risk of CHD in Chinese population. Potential CHD risk factors such as older age, elevated total cholesterol, and diagnosis of diabetes may have impact on global DNA methylation, whereby exerting their effect on CHD risk.

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Life-habit intervention in a public institution

Carlos Scherr et al. Ademir Batista da Cunha Chyntia Karla Magalhães Rafael Aron Abitibol … Marcelo Barros Ivan Cordovil

BACKGROUND: Coronary disease is the major worldwide cause of death, according to the World Health Organization (WHO) and the second in Brazil. Sudden death occurs 4 to 6 times more frequently in those who have suffered an acute myocardial infarction (AMI); within 6 years, 18% of the men and 35% of the women will have a new AMI. The secondary prevention, of which effectiveness has been previously demonstrated, is of utmost importance. OBJECTIVE: To test the effectiveness of a multiprofessional program that aims at modifying risk factors for atherosclerosis in the public health system. METHODS: Of the 2,337 patients with coronary artery disease undergoing outpatient treatment, 513 with a coronary angiography study agreed to participate in the present study, which used lectures on how and why to control risk factors as therapeutic tool. Statistical analysis: significant variation pre and post-intervention; paired Student’s t test or Wilcoxon’s test ; existence of a significant difference between the two groups; Student’s t test for independent samples or Mann-Whitney test. Comparison among three groups: analysis of variance (ANOVA) or Kruskal-Wallis. RESULTS: Cholesterol, LDL, triglycerides, body mass index, Castelli indexes I and II and waist circumference showed a significant decrease, even in patients without hypolipemiant treatment. The assessment of the diet impact showed that 72% of the patients that did not follow a diet, started to do so. Physical activity: of the 55% sedentary patients, 71% started to exercise three or more times a week. Smoking: of the smokers, 60% (9% of the total) stopped smoking and 32% decreased the number of cigarettes. CONCLUSION: These results demonstrated the effectiveness of the programs to improve life habits when applied to the units of the public health system. (Arq Bras Cardiol. 2010; [online]. ahead print, PP.0-0)

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Framingham score for public transportation drivers in the dity of Teresina, Piauí

Maurício Batista Paes Landim et al. Edgar Guimarães Victor

OBJECTIVE: To estimate the absolute risk of the public transportation drivers in the city of Teresina, Piauí, to develop coronary heart disease over the course of ten years based on the Framingham risk score. METHODS: An observational, descriptive, cross-sectional study using the Framingham score was conducted with 107 public transportation drivers in the city of Teresina, Piauí, to assess level of risk and its association with the Framingham predictors that include: age, total cholesterol, HDL cholesterol, systolic blood pressure, diastolic blood pressure, diabetes mellitus and smoking. The significance test used was c². The prevalence rate was used as the association measurement. RESULTS: Mean risk was 5% and the greatest majority of the participants were situated in the low risk category (85.05%). Mean values for the variables were: 42 years of age, total cholesterol 200 mg%, HDL cholesterol 49 mg%, systolic blood pressure 130 mmHg and diastolic blood pressure 85 mmHg. The associations between diabetes mellitus, smoking and HDL cholesterol with level of risk were not statistically significant; however other variables had a great influence on the level of risk obtained. CONCLUSION: The mean absolute risk estimate for the public transportation drivers in the city of Teresina to develop coronary heart disease over the next ten years based on the Framingham score is low. The majority of the participants in the study (85.05%) were situated in the low risk category, that is, with a relative risk less than or equal to 10%.

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Nutritional status and lipid profile of postmenopausal women with coronary heart disease

Aparecida de Oliveira et al. Jorge Mancini Filho

OBJECTIVE: To assess the nutritional status and lipid profile of postmenopausal women with coronary heart disease. METHODS: A retrospective cross-sectional study was conducted with information obtained from the medical records of 217 women on the occasion of their first visit to the InCor Nutrition Outpatient Care Clinic. The data referred to the patients’ nutritional status, body mass index, use of lipid-lowering medication, and serum lipid levels (cholesterol and fractions). RESULTS: The mean age was 60.98 ± 9.23 years, and obesity prevailed in 56% of the patients. The use of lipid-lowering drugs was observed in 73% of the population. In regard to lipid profile, 56% had adequate serum levels of HDL-C. The nutritional status was inadequate due to the prevalence of obesity, which results in the appearance of other chronic diseases, such as dyslipidemias. Although the dosages of the lipid-lowering drugs used were not assessed, their use by the population studied did not seem to be favorable, because high levels of total cholesterol and LDL-C were observed, and those high levels in that condition are strongly related to the occurrence of cardiovascular diseases. CONCLUSION: Multidisciplinary action in the form of programs to promote women’s health is required, comprising preventive aspects related to coronary heart disease, to improve the quality of life in that population.

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Original Article

Coronary heart disease clinical manifestation and risk factors in Japanese immigrants and their descendents in the city of São Paulo

Reynaldo Vicente Amato et al. Luiz Antonio Machado César Antonio de Pádua Mansur Whady Armindo Hueb … José Renato Martines Martins Caio de Brito Vianna José Antonio Franchini Ramires

OBJECTIVE: To assess whether a difference exists in coronary heart disease clinical manifestations and the prevalence of risk factors between Japanese immigrants and their descendents in the city of São Paulo. METHODS: Retrospective analysis of coronary artery disease clinical manifestations and the prevalence of risk factors, comparing 128 Japanese immigrants (Japanese group) with 304 Japanese descendents (Nisei group). RESULTS: The initial manifestation of the disease was earlier in the Nisei group (mean = 53 years), a difference of 12 years when compared with that in the Japanese group (mean = 65 years) (P<0.001). Myocardial infarction was the first manifestation in both groups (P = 0.83). The following parameters were independently associated with early coronary events: smoking (OR = 2.25; 95% CI = 1.35-3.77; P<0.002); Nisei group (OR = 10.22; 95% CI = 5.64-18.5; P<0.001); and female sex (OR = 5.04; 95% CI = 2.66-9.52; P<0.001). CONCLUSION: The clinical presentation of coronary heart disease in the Japanese and their descendents in the city of São Paulo was similar, but coronary heart disease onset occurred approximately 12 years earlier in the Nisei group than in the Japanese group.

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Original Article

Trends in Productive Years of Life Lost to Premature Mortality Due to Coronary Heart Disease

Ines Lessa

OBJECTIVE: To estimate the number of productive years of life lost to premature death due to coronary heart disease in Brazil and to report their trends over a 20-year period. METHODS: The Brazilian Ministry of Health raw database on death due to coronary heart disease from 1979-1998 was used. The productive years of life lost to premature death were estimated using 20 and 59 years of age as the cut points for the productive years, replacing the potential years of 1 and 70 of the original formula. A descriptive analysis was provided with adjustments, means, proportions, ratios, percentages of increase or reduction, and mobile means. RESULTS: A 35.8% increase in death for males and 51.3% for females was observed, +43.3% being the relative difference for females. The annual means of the productive years of life prematurely lost were analyzed in 140,865 males and 58,559 females, with the differential ratio between the age groups ranging from 2.3 to 2.5. The annual means were less favorable for males. Within each group (intragroup), the ratios decreased with the increase in age, and the age means at the time of death remained constant. The raw tendencies decreased in the 20- to 29-year age group and increased in the 40- to 59-year age group for females and the 40- to 49-year age group for males. When adjusted, the raw tendencies decreased. CONCLUSION: The 43.3% increase in the number of female deaths as compared with that of males and the ascending tendency in the productive years of life lost in the 40- to 59-year age group point to the influence of unfavorable changes in female lifestyles and suggest a deficiency in programs for prevention and control of risk factors and in their treatment in both sexes.

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Original Article

Are apolipoproteins A and B better than lipoproteins for assessing risk of obstructive coronary heart disease?

Waldomiro Carlos Manfroi et al. Alcides José Zago Marcelo Campos Alexandre Alves … Maria Lúcia Brisolara Josiane de Souza Rafael Henriques Candiago Luciana Kirschnick Letícia Ribeiro Kárem Ordovás Cristiane Leitão Rosana Cruz

OBJECTIVE: To evaluate whether apolipoproteins A-I (Apo A-I) and B (Apo B) have, higher ensitivity (SN), specificity (SP) and positive predictive value (PPV) than lipoproteins (LP), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), and triglycerides (TGL) in assessing the risk of coronary heart disease (CHD). METHODS: This is a transversal case-control study of 241 patients, who were divided into two groups: 1) 145 patients with CHD, and 2) 96 patients without coronary disease. A model of logistic regression to evaluate the relation between the LPs and CHD was developed in which variables with a p-alpha <0.1 were included. RESULTS: Apo A-I levels were higher in the patients without CHD, (OR 2.08, CI 1.20-3.57). There were no statistical differences between the values of Apo A-I and the remaining lipid fractions (Apo A-I: 67%; Apo B: 100%; PPV: TC= 71%; TGC=71%; HDL=71%; LDL=71%). The costs of the tests in Reais were as follows: Apo A-I: R$ 56.60; Apo B-100: R$ 56.60; TC: R$ 9.94; HDL: R$ 21.30; LDL: R$ 28.40; TGL: R$ 14.20. CONCLUSION: Levels of Apo A-I and Apo B have no advantage over conventional lipoproteins in predicting the risk of CHD, despite the statistical association between Apo A-I and CHD; in addition, their costs are higher than those of the conventional lipoproteins.

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Changes in the profile of lipoprotein subfractions associated with hormone replacement therapy

José Luiz da Costa Vieira et al. Marcos Emanuel W. Gomes Áurea Beltrão de Almeida Emílio H. Moriguchi

OBJECTIVE: To report the effects of 2 regimens of hormone replacement therapy during the postmenopausal period on the profile of the major lipoprotein subfractions (HDL, LDL, and VLDL). METHODS: We carried out a cohort study in 38 postmenopausal patients who were starting their hormone replacement therapy due to gynecological indications, for a period of 12 weeks. Analysis of lipoprotein subclasses was performed through nuclear magnetic resonance spectroscopy. RESULTS: Hormone replacement therapy cause an increase in the proportion of larger subfractions of VLDL and HDL (p=0.008 and 0.03, respectively) and in the proportion of larger particles of VLDL due to a 36% increase in the levels of larger particles (p=0.004), concomitantly with a 15% reduction in the levels of smaller particles (p=0.04). In regard to HDL, the increase occurred only a 17% increase in the levels of larger particles (p=0.002). No significant change occurred in the distribution pattern of LDL subfractions. CONCLUSION: The proportion of larger subfractions of VLDL and HDL increases after hormone replacement therapy. The increase in the proportion of larger particles of VLDL occurs due to an increase in the levels of the larger subclasses concomitantly with a reduction in the smaller particles. However, an increase in the proportion of larger particles of HDL occurs only due to an increase in the levels of the larger subfractions.

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