LITHUANIAN UNIVERSITY OF HEALTH SCIENCES LUHS LIBRARY REPOSITORY

Moterų vainikinių arterijų aterosklerozės sąsajos su kraujo serumo lipidais, apolipoproteinais a-i ir b bei ab0 sistemos kraujo grupėmis

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dc.contributor.author Maksvytis, Arūnas
dc.date.accessioned 2017-08-21T08:06:38Z
dc.date.available 2017-08-21T08:06:38Z
dc.date.issued 2006
dc.identifier.uri http://repository.lsmuni.lt/handle/1/60055
dc.description.abstract At present, cardiovascular diseases cause ca. 30 of deaths worldwide, and are the most common cause of death and disability (The World Health Report 2002; Pearson 1999). Coronary artery disease (CAD) accounts for nearly 50 of all deaths caused by cardiovascular diseases. In 2002, 7.2 million people died of CAD worldwide, and 5.8 million new cases were diagnosed. In 2000, the number of people with CAD around the world amounted to ca. 40 millions (Mackay 2004). The modern understanding of the pathophysiology of atherosclerosis and the concept of “cardiovascular risk factors” started forming in 1950s, when the first findings of the Framingham study were published (Wilson et al. 1998, D’Agostino et al. 2000). Information accumulated during scientific research on atherosclerosis allowed for a significant reduction of CAD-related mortality in the developed countries during the last 20 years, but a more profound analysis showed that the mortality mostly decreased in males, whereas in females it continues to grow. Nearly two-thirds of suddenly deceased women previously showed no clinical symptoms of CAD (AHA 2002). This most probably was influenced by a still predominant erroneous opinion that women, especially of younger age, very rarely have CAD and atherosclerosis of peripheral arteries. Epidemiological studies showed that cardiovascular diseases induced by atherosclerosis are equally frequent cause of death in both males and females. Of all patients who in 2000 in the U.S. died of cardiovascular diseases, 53.5 were females (AHA 2003). Cardiovascular death in young (pre-menopausal) women undoubtedly occurs less frequently, but morbidity with cardiovascular diseases is a significant and clearly related with CAD risk factors. As the Framingham study showed, with age, the incidence of cardiovascular diseases equally increases in both sexes; however, in women, clearly increasing morbidity with CAD begins 10-15 years later than in men (Castelli 1988). It is universally accepted that older age, family history, smoking, arterial hypertension (AH), obesity, increased total and low density lipoprotein (LDL) cholesterol, decreased blood serum high density lipoprotein (HDL) cholesterol, and Type 2 diabetes mellitus (DM) are risk factors for CAD (Grundy et al. 1999), but their significance in males and females may differ (Mosca et al. 1999). This especially applies to Type 2 DM – there is a 3- to 7-fold increase in the risk for developing CAD in women, whereas in men – 2- to 3-fold increase (Barrett-Connor et al. 1991), and the causes of this phenomenon are still unclear. In addition to that, dyslipidemia as a risk factor for CAD in females is more significant than in males: increased levels of triglycerides (TG) and decreased levels of HDL cholesterol are more characteristic of females with CAD (Mosca et al. 1999). In women, there is another sex-related risk factor for CAD – the menopause; post-menopausal women more frequently develop CAD, compared to pre-menopausal women of the same age (LaRosa 1997). The influence of lipids on the progression of atherogenesis in women is not fully investigated. There are a number of studies that in cases of CAD detected significantly increased levels of apolipoprotein (apo) B, whereas the levels of LDL cholesterol did not differ from those in healthy subjects (Genest et al. 1992; Kwiterovich et al. 1992; Caslake et al. 2000). Studies in men showed that the level of apoB is significant in determining the risk for CAD (Kwiterovich et al. 1992, Stakishaitis et al. 1991). It is thought that in determining the risk for CAD, the concentration of apoA-I may be more informative than HDL cholesterol (Garfagnini et al. 1995, Luc et al. 2002). Much new information on the importance of apolipoproteins in prognosticating the risk for CAD was obtained from the AMORIS clinical trial (175 553 patients studied) (Walldius et al. 2001). However, it is noteworthy that the majority of studies on apolipoproteins are performed in men. Only in a few apolipoprotein studies in women, CAD diagnosis was confirmed angiographically (Westerveld et al. 1998, Bahl et al. 1994). Studies on atherosclerosis in women became more active after 1990, when the World Health Organization for the first time announced that women die of CAD as frequently as men, and the course of CAD in women is more severe (WHO 1990). Since then a lot of information has been accumulated, proving that the development and course of atherosclerosis in women differ from those in men. It is becoming obvious that the influence of Type 2 DM, obesity, dyslipidemia, and their combination is highly significant in the development of atherosclerosis in women (Mosca et al. 1999; Barrett-Connor et al. 1991), but so far this has not been sufficiently studied. 1.2. The aim of the study To determine blood serum concentrations of total cholesterol, HDL cholesterol, triglycerides, and apoA-I and apoB in women referred for scheduled coronary angiography, to determine the associations of these concentrations with changes in coronary arteries and coronary risk factors (obesity and Type 2 DM), and to determine the distribution of AB0 system blood groups among females with established CAD. 1.3. The objectives of the study 1. To investigate the blood serum concentrations of total cholesterol, HDL cholesterol, triglycerides, apoA-I and apoB TG, as well as apoB/apoA-I ratio in women with angiographically determined CAD or with clear coronary arteries, and to compare the obtained findings with those of healthy female controls with normal weight. 2. To determine the differences in the blood serum concentrations of total cholesterol, HDL cholesterol, triglycerides, apoA-I and apoB TG, as well as apoB/apoA-I ratio in women diagnosed with CAD with different degrees of the outspread of the disease (in one sub-group, sporadic plaque was found in 1 or 2 coronary arteries, while in the other subgroup a diffuse disease involving 3 coronary arteries was detected). 3. To determine blood serum concentrations of total cholesterol, HDL cholesterol, triglycerides, apoA-I and apoB, as well as apoB/apoA-I ratio in women with CAD and Type 2 DM, and to compare the obtained findings with those of female subjects with CAD but without DM. 4. To determine blood serum concentrations of total cholesterol, HDL cholesterol, triglycerides, apoA-I and apoB, as well as apoB/apoA-I ratio in obese female subjects without CAD (clear coronary arteries group), and to compare the obtained findings with those of healthy normal weight female controls. 5. To determine the distribution of the AB0 system blood groups among women with angiographically confirmed CAD, and to compare the obtained findings with those of healthy female blood donors and healthy long-lived women. 1.4. Scientific novelty and practical significance of the study So far in Lithuania there have been no studies on atherosclerosis in women. The novelty of our study is not limited to its object. • The spreading of CAD in women was evaluated angiographically. In the majority of studies performed worldwide, CAD was evaluated only according to the anamnestic data – clinical manifestations of angina pectoris, previous myocardial infarction, etc. The survey of original scientific articles published in the Medline database during 1976-2005 yielded only 12 studies on atherosclerosis in women where angiographic control was applied. • When studying CAD in women, we strived to determine the significance of lipids (total cholesterol, HDL cholesterol, and TG), apoA-I and B, and apoB/apoA-I ratio. • We strived to determine the influence of overweight/obesity and Type 2 DM on the blood serum levels of apoA-I and B. • For the first time in Lithuania, a possible association between the blood types of the AB0 system and CAD in women was established. The information obtained during the study complements theoretical knowledge on the development of CAD in women, and the significance of apoA-I and B in the prognostication of CAD. The study showed that obesity and Type 2 DM in women is also associated with atherogenic changes in the concentration of lipids and apolipoproteins. The performed investigations of the blood types of the AB0 system in women with CAD revealed complex relationships between genetic determinants and atherogenesis: B blood group may have influence on the development of CAD, while blood group 0 in women may have athero-protective properties. 2. MATERIALS AND METHODS 2.1. The contingent of the study The study was performed in Klaipėda Seamen’s Hospital in 2002-2005. The study protocol was confirmed by The Bioethical Committee of Lithuania (permission to perform a biomedical study No. 01-64/2001-11-28). All participants of the study were familiarized with the study protocol, and signed an informed consent (2 copies) to participate in the study; each participant received one copy of the signed informed consent. The groups of subjects were formed according to the set objectives of the study (part 1); the scheme of group formation is presented in Fig. 1. The studied women were selected according to the following criteria: 2.1.1. Inclusion criteria • Age over 40 years (this age margin was chosen after the analysis of the findings of coronary angiographies performed during the last 5 years at Klaipėda Seamen’s Hospital, which showed that women under 40 years of age relatively rarely undergo coronary angiography, and the majority of cases when this examination was performed were acute coronary syndromes); • Written consent to participate in the study; • Performed scheduled coronary angiography, when non-invasive methods showed the presence of stable angina pectoris (this study was aimed at determining the treatment tactics). 2.1.2. Exclusion criteria: • No conformity with the inclusion criteria; • Usage of lipid-lowering medications, preparations with sex hormones, or estrogen receptor modulators; • Pregnancy or lactation dur
dc.language.iso lit
dc.subject Atherosclerosis of coronary arteries
dc.subject Vainikinių arterijų aterosklerozė
dc.subject Apolipoproteins A-I and B
dc.subject AB0 sistemos kraujo grupės
dc.subject Lipidai
dc.subject Women
dc.subject AB0 blood groups
dc.subject Apolipoproteinai A-I irB
dc.subject Moterys
dc.subject Lipids
dc.title Moterų vainikinių arterijų aterosklerozės sąsajos su kraujo serumo lipidais, apolipoproteinais a-i ir b bei ab0 sistemos kraujo grupėmis
dc.title.alternative Associations of coronary artery atherosclerosis in women with blood serum lipids, apolipoproteins a-i and b, and ab0 blood groups
dc.type Daktaro disertacija


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