Parâmetros bioquímicos, hemostáticos e moleculares em indivíduos submetidos à angiografia coronariana

Abstract

Coronary artery disease (CAD) has a multifactorial origin, including several biochemical processes involved in the formation and progression of the atheroma plaque. Alterations in lipid metabolism, vascular endothelium, blood clotting or fibrinolysis, and the inflammatory response resulting from atherosclerosis may be directly responsible or just beassociated with the disease. This study aimed to investigate the correlation between possible changes in the biochemical and hemostatic profiles and the presence of some genetic polymorphisms and the severity of CAD in subjects undergoing coronary angiography.Plasma levels of total cholesterol, HDLc, LDLc, triglycerides, lipoprotein(a), apolipoproteins AI, B and E, homocysteine, anti-oxidized LDL, high-sensitivity C-reactive protein (hs-CRP), phospholipase A2, plasminogen activator inhibitor type 1 (PAI-1), tissue factor (TF), andtissue factor pathway inhibitor (TFPI), as well as the identification of the alleles of the gene apolipoprotein E, the C677T mutation in the gene of the enzyme methylenetetrahydrofolate reductase (MTHFR) and (-675 4G/5G) polymorphism in the gene of PAI-1 were determinedin blood samples from 35 angiographycally normal subjects (AnN), 31 subjects presenting mild/moderate atheromatosis (ALM) and 57 showing severe atheromatosis (AG). A univariate analysis showed that plasma levels of the parameters lipoprotein(a), homocysteine, TF, anti-oxidized LDL, phospholipase A2, hs-CRP and PAI-1 were significantly higher in group AG than in the AnN group (p <0.05). No significant differenceswere observed for the other parameters. In the multivariate analysis, only the lipoprotein(a), phospholipase A2 and PAI-1 parameters were independently associated with the severity of the CAD, also considering the classic risk factors for the development of the disease. Therewere significant correlations between various parameters, including the presence of the 4G/4G genotype and increased plasma levels of PAI-1. The frequency of apolipoprotein E alleles and the C677T mutation in the MTHFR enzyme was similar to that observed in previous studies. The data obtained from this study reflected the multifactorial nature of CADin the subjects studied, with the involvement of biochemical parameters and inflammatory and hemostatic worsening of the atherosclerotic process. Among all parameters evaluated, lipoprotein(a), phospholipase A2 and PAI-1 may be important additional tools with a potential value to be inferred about the severity of the CAD, considering their independent associationwith the intensification of the disease, as demonstrated by the multiple logistic regression.