PPG - Medicina (Cardiologia)

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Navegando PPG - Medicina (Cardiologia) por Palavras-chave "Acute Coronary Syndrome"

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    Associação de múltiplas variantes genéticas com a extensão e gravidade da doença coronária
    (Universidade Federal de São Paulo (UNIFESP), 2017-02-24) Fischer, Simone Cristina Pinto Matheus [UNIFESP]; Izar, Maria Cristina de Oliveira [UNIFESP]; http://lattes.cnpq.br/3734118596685936; http://lattes.cnpq.br/6991742643826788; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVES: Cardiovascular diseases, mainly ischemic heart disease and stroke, respond for the majority of deaths worldwide. Sedentary lifestyle and industrialized foods have determined na increase in metabolic diseases and cardiovascular risk. The concept of metabolic syndrome (MS) has emerged, and patients after an acute coronary syndrome (ACS) are associated with greater anatomic obstruction in the coronary tree. Despite the strong environmental influence, MS can be influenced in each componente by genetic variants. Polymorphisms related to lipid metabolism, lipid peroxidation, increase in blood pressure levels, and vascular reactivity can interact with environment to determine greater severity of coronary atherosclerosis in individuals with MS, acting sinergistically, even though the individual contribution of each genetic variant is small. Thus. The aim of this study was to examine the contribution of genetic polymorphisms on the extension and severity of coronary disease in subjects with MS and recente ACS. METHODS: One-hundred and sixteen patients of both genders, with three ormore criteria for MS (NCEP III) were prospectively evaluated, in the hospitalization period after na ACS. In this cross sectional study we performed clinical evaluation, laboratory parameters, assessment of inflammation and hemostasia markers, TBARS (thiobarbituric acid reactive substances), adiponectin, endotelial function (FMD). The extension and severity of coronary disease was assessed by measuring the Gensini score. Polymorphisms of the genes encoding paraoxonase-1 (PON-1), methylenotetrahydrofolato reductase (MTHFR), endothelial nitirc oxide sintase (ENOS), angiotensin-converting enzyme (ECA), angiotensin II type 1 receptor (AT1R), apolipoprotein C3 (APOC3), lipoprotein lipase (LPL) were analysed using PCR-RFLP, with data presented according to genotype distribution. Statistical analyses used Chisquare, or Fisher’s exact test, for categorical variables and to test for deviation of the Hardy-Weinberg equilibrium. Numerical variables were compared by Student’s t testo r Mann-Whitney test, when appropriate. Pearson’s correlation test was also used. Significance was set at a P-value < 0.05. RESULTS: One-hundred and sixteen patients with MS in the hospital phase after na ACS, aging 56 + 9 years, 68% males, were evaluated. Polymorphisms of PON-1, MTHFR and ENOS were not in Hardy-Weinberg equilibrium. Many genotypes were associated with clinical variables, such as heart rate, diastolic blood pressure, or laboratory parameters like C-reactive protein, glycated hemoglobin, adiponectin, coagulation and fibrinolysis, in addition to associations with hormones or hepatic and muscle enzymes. Only the DD genotype of the D9N polymorphism of LPL was associated with greater severity and extension of coronary lesions. Genetic score was greater in patients with Gensini score < P50 (13.7 + 1.5 vs. 13.0 + 1.6, P=0.066). There was a weak inverse correlation between genetic score and Gensini score (R=-0.194, P=0.078). CONCLUSION: The polymorphisms studied had small contribution to the extension and severity of coronary disease. Only the D9N polymorphism of LPL has contributed to the severity of coronary disease in patients with MS after na ACS. Combined analyses of these polymorphismspresented weak association with severity of coronary disease, being the disease more severe with lower genetic score.