Acute versus Chronic Myocardial Ischemia: A Differential Biological Profile Study

Abstract

Objective: To determine the possible differences in lipid, thrombogenic and inflammatory marker concentrations and the presence of chronic and acute coronary artery disease (stable and unstable angina, respectively), comparing them with a group of control patients with normal coronary arteries. Material and Methods: This prospective cohort study included 125 patients with unstable angina, 189 with stable angina and a control group of 83 patients with normal coronary arteries. Marker concentrations were measured in all 3 groups. Logistic regression analysis was performed to determine whether such factors could predict unstable or stable angina. Results: Lipid parameter concentrations were similar in the 2 coronary disease groups and significantly lower than in controls. Haemostatic and inflammatory marker concentrations were higher in patients with coronary disease, but were statistically significant only when comparing unstable angina patients with normal controls. Unstable angina patients had significantly higher levels of lipoprotein (a) [Lp(a)], fibrinogen, C-reactive protein (CRP) and leucocytes. Multiple logistic regression analysis showed that CRP (OR 2.635, 95% CI 1.417–4.898), smoking (OR 3.416, 95% CI 1.773–6.584), leucocytes (OR 2.034, 95% CI 1.079–3.836) and Lp(a) (OR 2.269, 95% CI 1.188–4.334) were independent risk factors of unstable versus stable angina. Conclusions: Patients with unstable angina present a more atherogenic profile than patients with stable angina. Together with smoking, elevated Lp(a), CRP and leucocyte concentrations proved to be associated with the presence of unstable angina.

Heterogeneous associations between smoking and a wide range of initial presentations of cardiovascular disease in 1 937 360 people in England: lifetime risks and implications for risk prediction

“…This is because previous studies have not collected data on this range of clinical phenotypes, or have lacked statistical power. Nonetheless, our findings are consistent with previously reported associations with a limited number of diseases, 25–28 with stronger associations found for MI than for stable or unstable angina, 29 , 30 for unstable than for stable angina 31 and for SAH than for other types of stroke. 32 , 33 Stronger associations were also seen in younger than in older individuals.…”

Smoking, alcohol consumption, physical activity, and family history and the risks of acute myocardial infarction and unstable angina pectoris: a prospective cohort study

“…To our knowledge, two studies investigated the effect of smoking status on UAP risk [2,3]. In a case-control study by Sagastagoitia et al [2], smoking was found to be independently associated with the presence of UAP (OR 3.42, 95% CI 1.77-6.58).…”

“…In a case-control study by Sagastagoitia et al [2], smoking was found to be independently associated with the presence of UAP (OR 3.42, 95% CI 1.77-6.58). This OR is considerably higher than the RR of 1.64 found in the present prospective study which may be due to differences in study design.…”

“…Although these factors are well-known risk factors for CHD, only few studies investigated the associations between the risk of (unstable) angina pectoris and smoking status [2,3], alcohol consumption [4-8], or physical inactivity [9-11]. In contrast, the influence of these lifestyle factors on the risk of total CHD or acute myocardial infarction (AMI) is thoroughly investigated e.g.…”