أمراض القلب التاجية ونقص بروتينات الدم

أ.د. خالد فاروق عبد الغفور
جامعة الانبار / كلية العلوم / قسم الكيمياء
الصفحة الرئيسية للمؤلف

Coronary heart disease (CHD) is one of the leading causes of death worldwide. CHD is characterized by the formation of arterial plaques, which are mainly composed of lipids, calcium, and inflammatory cells. These plaques narrow the lumen of coronary arteries, causing episodic or recurrent angina. The rupture of these plaques contributes to the formation of thrombus. Blood flow is interrupted, resulting in myocardial infarction and death. Obesity, diabetes, and high blood pressure are also risk factors for heart disease (CHD). A diagnosis is made based on the amount of cholesterol, triglycerides, and lipoproteins in the blood. Hypoalphalipoproteinemia, or low levels of high density lipoprotein cholesterol (HDL-C), is related to an increased risk of coronary heart disease (CHD). A better understanding of the mechanisms that lead to low HDL-C and CHD is one of the treatment choices. Clinical studies have shown that cytokines affect both the concentration and structure of plasma lipoproteins. Since inflammation is thought to play a role in the pathogenesis of CHD, inflammatory biomarkers such as interleukin-6 and C-reactive protein are used to assess the severity and prognosis of the disease (CRP).

CHD is more common in men than in women, and it is marked by angina, heart failure, and irregular heartbeats. Myocardial infarction, the leading cause of death in developing countries, may be caused by CHD^(1–4). In 2013, CHD was the underlying cause of more than 8.14 million deaths, a substantial rise from the 5.2 million CHD-related deaths recorded in 1990^(5,6). CHD can strike anyone at any age, but it becomes increasingly more frequent as people get older, with the incidence tripling per decade. Coronary artery atherosclerosis is the root cause of CHD. High blood pressure, obesity, diabetes mellitus, elevated blood cholesterol, smoking, lack of exercise, poor diet, excessive alcohol intake, and depression are all risk factors for CHD^(7,8). The levels of blood cholesterol, triglycerides, and lipoproteins are used to make a diagnosis^(9,10). Plaques form as a result of the accumulation of fatty deposits, inflammatory cells, and calcification, resulting in artery stiffening^(11,12). Ischemia, which may cause ventricular arrhythmia, occurs when the lumen narrows, and when the lumen closes, ventricular fibrillation and infarction occur^(13,14).

Hypoalphalipoproteinemia (HA) is a dyslipidemia in which HDL-C levels are less than 1.04 mmol/L (40 mg/dL)⁽¹⁵⁾. HDL (High Density Lipoprotein) is a multi-functional lipoprotein particle that plays an important role in lipid metabolism and disease prevention^(16,17) by I) transporting excess cholesterol from tissues to the liver for elimination; II) protecting endothelial cell function; III) inhibiting LDL oxidation and platelet aggregation; and IV) engaging in lipid metabolism by passing the lipase cofactor and receptor. Cardiovascular disease (CVD), type 2 diabetes mellitus, dementia, lung cancer, and lymphoma have all been linked to HA^(18,19). It may be caused by environmental and behavioral factors (such as smoking, drugs, being overweight, and being physically inactive), as well as genetic defects⁽²⁰⁾. The most common lipoprotein abnormality in patients with premature coronary artery disease is a decreased HDL-C level⁽²¹⁾. Low HDL-C is a strongly atherogenic condition, and high HDL-C protects against CHD(^22,23), and when LDL-C levels are average to medium, low levels of HDL-C have a greater prognostic significance than high levels of LDL-C. They are more important in women and the elderly than in middle-aged men, and they may be linked to overall rates of impairment and death following angioplasty or myocardial infarction(²⁴). A low serum HDL level (0.9 mmol/L) is particularly significant when combined with high triglycerides (> 2.3 mmol/L) and a high LDL-to-HDL ratio (> 5): patients with these features were by far the most likely to experience myocardial infarction in the PROCAM(²⁵⁾ and Helsinki⁽²⁶⁾ trials. Smoking, obesity (especially core, or "androgenic"), drugs such as thiazides and some,3 blockers, use of androgens or anabolic steroids, a low-fat diet, acute illness or injury, and hypertriglyceridemia must all be considered when making a differential diagnosis of HA.

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