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Indian Pediatr 2011;48: 156-157 |
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Homocysteine, Fibrinogen and Lipid Profile in
Children of Young Adults with Coronary Artery Disease |
Anita Khalil, Kausik Mandal, Sumaira Khalil and V Mallika*
Department of Pediatrics and Biochemistry, Maulana Azad
Medical College and
GB Pant Hospital, New Delhi, India.
email: [email protected]
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Plasma homocysteine (9.05 ± 4.78 vs 5.93 ± 1.46µmol/L, P<0.01),
plasma fibrinogen (313.76 ± 80.02 vs 275.47 ± 53.77 mg/dL, P<0.01),
serum total cholesterol (171.64 ± 35.48 vs 152.62 ± 25.40 mg/dL,
P<0.01), serum LDL cholesterol (109.51 ± 36.93 vs 87.6 ±
21.6 mg/dL, P<0.01) and fasting blood sugar (99.89 ± 17.46 vs
90.29 ± 9.85 mg/dL, P<0.01) were significantly higher in children
(n=45) of young adults (£45
y) with coronary artery disease as compared to control group (n=45).
No significant correlation was found for plasma homocysteine level of
children with that of their parents in either group, whereas significant
correlation was found for plasma fibrinogen of children with their
parents in both the groups.
Key words: Children, Coronary artery disease, Fibrinogen,
Homocysteine, India, Parents.
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We conducted this study to determine plasma total homocysteine,
fibrionogen, fasting blood sugar and lipid profile in 45 children (5-18y)
of young adults ( £
45y) with coronary artery disease (CAD) and compare their values with age
and sex matched controls (n=45). 20 parents of the study group and
19 parents of the control group were also analyzed for similar parameters
as their children.
A detailed history of the parents regarding diabetes,
hypertension, alcohol intake, smoking, drug intake and family history of
CAD was taken. Weight, height and abdominal girth were recorded and body
mass index (BMI) was calculated for both parents and children in each
group. Blood pressure was measured for all the parents and their children.
Quantitative determination of fibrinogen in plasma was done using clotting
method of Clauss [1]. Enzyme immunoassay [2] was used for quantitative
estimation of total homocysteine in plasma. Serum lipid profile was
estimated by enzymatic colorimetric method. Table I compares
the children and parents in the two groups.
TABLE I
Comparison of Children and Parents in the Two Groups
|
Children |
Parents |
|
Cases |
Controls |
P Value |
Cases |
Controls |
P Value |
|
(n=45) |
(n=45) |
|
(n=20) |
(n=19) |
|
Age
(years) |
12.06 ± 4.19 |
12.24 ± 4.27 |
0.842 |
40.80 ± 4.84 |
41.42 ± 2.98 |
0.631 |
Weight
(kg) |
37.94 ± 15.78 |
35.05 ± 14.35 |
0.367 |
76.20 ± 10.87 |
63.562 ± 11.34 |
0.001 |
Height
(m) |
1.40 ± 0.20 |
1.41 ± 0.21 |
0.772 |
1.68 ± 5.43 |
1.64 ± 6.50 |
0.051 |
BMI
(kg/m2) |
18.28 ± 3.51 |
16.55 ± 2.56 |
0.009 |
26.90 ± 3.06 |
23.41 ± 2.94 |
0.001 |
Abd.
Girth (cm) |
61.39 ± 9.68 |
56.74 ± 8.25 |
0.016 |
98.58 ± 6.71 |
86.70 ± 5.34 |
0.001 |
SBP (mm
Hg) |
104.75 ± 14.30 |
104.00 ± 10.81 |
0.778 |
139.60 ± 25.72 |
116.10 ± 7.16 |
0.001 |
DBP (mm
Hg) |
67.37 ± 10.98 |
61.20 ± 9.12 |
0.005 |
87.50 ± 15.17 |
76.31 ± 5.62 |
0.005 |
Sugar
(mg/dL) |
99.88 ± 17.46 |
90.28 ± 9.84 |
0.002 |
144.60 ± 43.79 |
103.36 ± 10.32 |
0.001 |
TG (mg/dL) |
123.93 ± 43.41 |
127.55 ± 34.08 |
0.661 |
165.40 ± 77.47 |
151.78 ± 33.22 |
0.478 |
Cholesterol (mg/dL) |
171.64 ± 35.48 |
152.62 ± 25.40 |
0.004 |
236.60 ± 32.50 |
202.89 ± 15.55 |
0.001 |
HDL (mg/dL) |
37.35 ± 6.19 |
39.51 ± 6.96 |
0.124 |
35.55 ± 8.13 |
38.36 ± 6.40 |
0.236 |
LDL(mg/dL) |
109.51 ± 36.92 |
87.60 ± 21.60 |
0.001 |
167.66 ± 30.62 |
134.16 ± 18.05 |
0.001 |
Fibrinogen (mg/dL) |
313.75 ± 80.021 |
275.46 ± 53.76 |
0.009 |
422.45 ± 96.18 |
338.36 ± 45.76 |
0.002 |
Homocysteine (µmol/L) |
9.04 ± 4.77 |
5.93 ± 1.45 |
<0.001 |
18.06 ± 13.92 |
8.10 ± 1.25 |
0.005 |
All values depict
mean ± SD. |
In the study group, BMI and abdominal girth of children
had significant correlation with that of their parents. This suggests that
obesity, more so apple type obesity in form of increased intra-abdominal
fat is a risk factor for development of CAD in Indian population, and that
it has a familial predisposition. There was significant difference in
diastolic blood pressure between the two groups, both in children and
their parents. Among the study cases, DBP of children had significant
correlation with that of their parents, suggesting that increased DBP is
an important risk factor for later development of CAD in Indian
population. Blood sugar, serum total cholesterol and serum LDL cholesterol
also differed significantly between cases and controls, both for the
children and their parents. The findings of various other studies
correspond to our findings [3-6].
Plasma fibrinogen level differed significantly between
study cases and controls, both for the children and their parents.
Correlation of plasma fibrinogen with age was positive in children in the
case as well as in the control group. There was no correlation with sex in
either group. Significant correlation was found for plasma fibrinogen of
children with their parents in both the groups in our study. It supports
the hypothesis that since plasma levels of fibrinogen have a genetic
component, it could be a useful marker in identifying children at high
risk for coronary artery disease. Plasma homocysteine levels also differed
significantly between cases and controls, both for the children and their
parents, as also reported earlier [7,8].
We conclude that apple type obesity, increased
diastolic blood pressure, insulin resistance and a deranged lipid profile
in form of increased serum total cholesterol and serum LDL cholesterol are
potential risk factors of CAD, and they start operating early in life.
Plasma levels of fibrinogen and homocysteine could be a useful marker for
identifying children at high risk for coronary artery disease.
Contributors: AK: design, drafting and revision;
KM; data acquisition, draft; SK: editing, literature review; VM:
biochemical analysis. All authors approved the manuscript.
Funding: None.
Competing interests: None stated.
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