Русский
Myocardial infarction type 1 at young age: Contribution of proatherogenic factors and genetic thrombophilies
DOI: https://dx.doi.org/10.18565/therapy.2023.4.30-37
Shushanova A.S., Gladkikh N.N., Yagoda A.V.
1) Stavropol Regional Clinical Hospital; 2) Stavropol State Medical University of the Ministry of Healthcare of Russia
The aim: to study proatherogenic factors and genetic thrombophilias in young patients with type 1 MI.
Material and methods. 100 male patients with type 1 MI aged 25–44 years were examined. Inclusion criteria: informed consent to participate in the study; MI type 1; age 25–44 years. Exclusion criteria: absence of coronary angiography; MI types 2–5; acquired thrombophilia; hypothyroidism; relationship with the patient included in the current study. The comparison group consisted of 100 male patients aged 42–44 years without MI. Risk factors for atherosclerosis and lipid profile were analyzed. 8 genes (1 polymorphism) of the hemostasis system were studied: blood coagulation factors I (FGB: -455G>A), II (F2: 20210G>A), V (F5: 1691G>A), VII (F7: 10976G>A), XIII (F13A1: 103G>T), inhibitor of plasminogen activator type 1 (PAI-1: -675 5G>4G), platelet receptors for collagen (ITGA2: 807C>T) and fibrinogen (ITGB3: 1565T>C).
Results. Young male patients with type 1 MI are characterized by smoking (53%; p <0,0001), arterial hypertension (72%; p <0,0001), type 2 diabetes mellitus (8%; p=0,041), heredity for early CAD (11%; p=0,022), abdominal obesity (45%; p <0,0001), obesity (45%; p <0,0001), carrier of heterozygous G1691A genotypes of the F5 gene (8%; p=0,041), T1565C of the ITGB3 gene (37%; p=0,012) and 5G(-675)4G of the PAI-1 gene (57%; p=0,007). There took place an increase in total cholesterol, LDL, triglycerides and a decrease in HDL. In 5% of patients, heterozygous familial hypercholesterolemia was verified. Based on multivariate analysis, the most significant factors associated with type 1 MI in young male patients were identified: smoking (p=0,010), hypertension (p <0,0001), LDL (p <0,0001), triglycerides (p=0,013), genotype -675 5G/4G of the PAI-1 gene (p=0,002).
Conclusion. Identification of genetic thrombophilias complements the identification of «traditional» proatherogenic factors and allows timely identificate a risk group for type 1 MI at a young age.
Literature
1. Андреенко Е.Ю., Явелов И.С., Лукьянов М. М. с соавт. Ишемическая болезнь сердца у лиц молодого возраста: распространенность и сердечно-сосудистые факторы риска. Кардиология. 2018; 58(10): 53–58. [Andreenko E.Yu., Yavelov I.S., Loukianov М.М., et al. Ischemic heart disease in subjects of young age: current state of the problem: prevalence and cardiovascular risk factors. Kardiologiya = Cardiology. 2018; 58(10): 53–58 (In Russ.)]. https://dx.doi.org/10.18087/cardio.2018.10.10184. EDN: YLGHJJ. 2. Подзолков В., Наткина Д., Драгомирецкая Н. Инфаркт миокарда у молодых пациентов: новый взгляд на «старые» факторы риска. Врач. 2015; (8): 7–10. [Podzolkov V., Natkina D., Dragomiretskaya N. Myocardial infarction in young patients: a new view of «old» risk factors. Vrach = The Doctor. 2015; (8): 7–10. (In Russ.)]. EDN: UIBPUZ. 3. Киселева М.А., Болгова М.Ю. Тромбофилии как причина неатерогенных инфарктов миокарда. Евразийский кардиологический журнал. 2019; (S2): 210. [Kiseleva M.A., Bolgova M.Yu. Thrombophilia as a cause of non-atherogenic myocardial infarctions. Evraziyskiy kardiologicheskiy zhurnal = Eurasian Journal of Cardiology. 2019; (S2): 210 (In Russ.)]. EDN: SZAWAI. 4. Рукавицин О.А. Гематология: национальное руководство. М.: ГЭОТАР-Медиа. 2019; 784 с. [Rukavitsyn O.A. Hematology: National guidelines. Moscow: GEOTAR-Media. 2019; 784 pp. (In Russ.)]. ISBN: 978-5-9704-3327-0. 5. Данковцева Е.Н., Затейщиков Д.А., Сидоренко Б.А. Полиморфизм генов факторов гемостаза у пациентов с ранним развитием ишемической болезни сердца. Кардиология. 2006; 46(2): 56–65. [Dankovtseva E.N., Zateyshcikov D.A., Sidorenko B.A. Polymorphism of genes of hemostasis factors in patients with early development of coronary heart disease. Kardiologiya = Cardiology. 2006; 46(2): 56–65 (In Russ.)]. EDN: MOTDMT. 6. Rosendaal F.R., Siscovick D.S., Schwartz S.M. et al. Factor V Leiden (resistance to activated protein C) increases the risk of myocardial infarction in young women. Blood. 1997; 89(8): 2817–21. 7. Tanis B.C., Bloemenkamp D.G., van den Bosch M.A. et al. Prothrombotic coagulation defects and cardiovascular risk factors in young women with acute myocardial infarction. Br J Haematol. 2003; 122(3): 471–78. https://dx.doi.org/10.1046/j.1365-2141.2003.04454. 8. Данковцева Е.Н., Затейщиков Д.А., Чудакова Д.А. с соавт. Ассоциация генов факторов гемостаза с ранним развитием ишемической болезни сердца и манифестацией инфаркта миокарда в молодом возрасте. Кардиология. 2005; 45(12): 17–24. [Dankovtseva E.N., Zateyshikov D.A., Chudakova D.A. et al. Association of hemostasis factors genes with early development of ischemic heart disease and manifestation of myocardial infarction in young age. Kardiologiya = Cardiology. 2005; 45(12): 17–24 (In Russ.)]. EDN: HSBYCH. 9. Пономаренко И.В., Сукманова И.А. Традиционные факторы риска и генные мутации тромбоза, ассоциированные с острым коронарным синдромом у пациентов молодого возраста. Кардиология. 2019; 59(1S): 19–24. [Ponomarenko I.V., Sukmanova I.A. Thrombosis risk factors and gene mutations in young age patients with acute coronary syndrome. Kardiologiya = Cardiology. 2019; 59(1S): 19–24 (In Russ.)]. https://dx.doi.org/10.18087/cardio.2602. EDN: YUJHZZ. 10. Dogra R.K., Das R., Ahluwalia J. et al. Prothrombotic gene polymorphisms and plasma factors in young North Indian survivors of acute myocardial infarction. J Thromb Thrombolysis. 2012; 34(2): 276–82. https://dx.doi.org/10.1007/s11239-012-0734-6. 11. Mohammad A.M., Othman G.O., Saeed C. et al. Genetic polymorphisms in early-onset myocardial infarction in a sample of Iraqi patients: A pilot study. BMC Res Notes. 2020; 13(1): 541. https://dx.doi.org/10.1186/s13104-020-05367-w. 12. Кухарчук В.В., Ежов М.В., Сергиенко И.В. с соавт. Диагностика и коррекция нарушений липидного обмена с целью профилактики и лечения атеросклероза. Российские рекомендации, VII пересмотр. Атеросклероз и дислипидемии. 2020; (1): 7–40. [Kukharchuk V.V., Ezhov M.V., Sergienko I.V. et al. Diagnositcs and correction of lipid metabolism disorders in order to prevent and treat of atherosclerosis. Russian recommendations VII revision. Ateroskleroz i dislipidemii = Atherosclerosis and dyslipidemia. 2020; (1): 7–40 (In Russ.)]. https://dx.doi.org/10.34687/2219-8202.JAD.2020.01.0002. EDN: ZFAWEI. 13. Shah N., Kelly A-M., Cox N. et al. Myocardial infarction in the «young»: Risk factors, presentation, management and prognosis. Heart Lung Circ. 2016; 25(10): 955–60. https://dx.doi.org/10.1016/j.hlc.2016.04.015. 14. Якушин С.С. Многоликий инфаркт миокарда: руководство. М.: ГЭОТАР-Медиа. 2022; 232 с. [Yakushin S.S. Multiple myocardial infarction: a guide. Moscow: GEOTAR-Media. 2022; 232 pp. (In Russ.)]. ISBN: 978-5-9704-6421-2.https://dx.doi.org/10.33029/9704-6421-2-INF-2022-1-232. 15. Аверкова А.О., Бражник В.А., Рогожина А.А. с соавт. Отягощенная наследственность у больных с «ранним» развитием острого коронарного синдрома. Кардиология. 2018; 58(8): 12–17. [Averkova A.O., Brazhnik V.A., Rogozhina A.A., et al. Family history of cardiovascular disease in patients with early development of acute coronary syndrome. Kardiologiya = Cardiology. 2018; 58(8): 12–17 (In Russ.)]. https://dx.doi.org/10.18087/cardio.2018.8.10158. EDN: XUZIAP. 16. Braenne I., Kleinecke M., Reiz B. et al. Systematic analysis of variants related to familial hypercholesterolemia in families with premature myocardial infarction. Eur J Human Genetics. 2016; 24(2): 191–97. https://dx.doi.org/10.1038/ejhg.2015.100. 17. Ellis K.L., Pang J., Schultz C.J., Watts G.F. New data on familial hypercholesterolaemia and acute coronary syndromes: The promise of PCSK9 monoclonal antibodies in the light of recent clinical trials. Eur J Prev Cardiol. 2017; 24(11): 1200–5.https://dx.doi.org/10.1177/2047487317708890. 18. Кожанова Т.В., Неудахин Е.В., Жилина С.С. с соавт. Генетическая предрасположенность к развитию атеросклероза. Архивъ внутренней медицины. 2018; 8(6): 407–17. [Kozhanova T.V., Neudakhin E.V., Zhilina S.S., et al. The genetic susceptibility to atherosclerosis. Arkhiv vnutrenney meditsiny = The Russian Archives of Internal Medicine. 2018; 8(6): 407–17 (In Russ.)].https://dx.doi.org/10.20514/2226-6704-2018-8-6-407-17. EDN: YOTCEP. 19. Boroumand M., Pourgholi L., Ziaee S. et al. The association between Factor V Leiden with the presence and severity of coronary artery disease. Clin Biochem. 2014; 47(6): 356–60. https://dx.doi.org/10.1016/j.clinbiochem.2013.12.006. 20. Song C., Burgess S., Eicher J. D. et al. Causal effect of plasminogen activator inhibitor type 1 on coronary heart disease. J Am Heart Assoc. 2017; 6(6): e004918. https://dx.doi.org/10.1161/JAHA.116.004918. 21. Оганов Р.Г. Дислипидемии и атеросклероз. Биомаркеры, диагностика и лечение: руководство для врачей. М.: ГЭОТАР-Медиа. 2009; 160 с. [Oganov R.G. Dyslipidemia and atherosclerosis. Biomarkers, diagnostics and treatment: a guide for doctors. Moscow: GEOTAR-Media. 2009; 160 pp. (In Russ.)]. ISBN: 978-5-9704-1370-8. 22. Шестерня П.А., Никулина С.Ю., Щульман В.А. с соавт. Генетические предикторы инфаркта миокарда у лиц молодого возраста. Кардиология. 2013; 53(7): 4–8. [Shesternya P.A., Nikulina S.Yu., Shulman V.A., et al. Genetic predictors of myocardial infarction in subjects of young age. Kardiologiya = Cardiology. 2013; 53(7): 4–8 (In Russ.)]. EDN: RGRNPV. 23. Roy H., Bhardwaj S., Yla-Herttuala S. Molecular genetics of atherosclerosis. Hum Genet. 2009; 125(5–6): 467–91.https://dx.doi.org/10.1007/s00439-009-0654-5.
About the Autors
Alena S. Shushanova, cardiologist at Stavropol Regional Clinical Hospital. Address: 355029, Stavropol, 1 Semashko Str. E-mail: safronovna89@gmail.com. ORCID: https://orcid.org/0000-0002-1337-818X
Natalya N. Gladkikh, MD, professor, professor of the Department of hospital therapy, Stavropol State Medical University of the Ministry of Healthcare of Russia. Address: 355029, Stavropol, 1 Semashko Str. E-mail: ngladkih@mail.ru. ORCID: https://orcid.org/0000-0003-4510-3604
Alexander V. Yagoda, MD, professor, head of the Department of hospital therapy, Stavropol State Medical University of the Ministry of Healthcare of Russia, Honored Scientist of the Russian Federation. Address: 355029, Stavropol, 1 Semashko Str. E-mail: alexander.yagoda@gmail.com. ORCID: https://orcid.org/0000-0002-5727-1640
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