HIGH RATIO OF MONOSIT: HIGH-DENSITY LIPOPROTEIN AS A RISK FACTOR OFCHRONIC TOTAL OCCLUSION IN PATIENTS CORONARY ARTERY DISEASE
Objective: Chronic total occlusion (CTO) is frequently found in coronary heart disease (CHD) with multivessel lesions. Patients with CTO are associated with an increased mortality rate. Management CTO requires specialized techniques, more resource utilization, and high cost. The progression of atherosclerosis can be prevented by controlling for risk factors. Monocyte to high-density lipoprotein ratio (MHR) is one of the new biomarkers used to assess the incidence of a major adverse cardiovascular event, the severity of coronary lesions, and the incidence of in-stent restenosis. This study was aimed to determine the role of MHR levels as a risk factor for the occurrence of CTO in CAD patients.
Methods: This research is a matched case–control located in Sanglah General Hospital from August 2017 until October 2017. This research consisted of 47 cases with CTO and 47 control without CTO. Case and control samples were adjusted by sex, age, and number of blood vessels involved in CAD.
Results: The cutoff value of MHR was also determined by analyzing the receiver operating curve. The optimal cut off point was 14.33 with sensitivity 83% and specificity 80.9%. Bivariate analysis showed high MHR was found strongly associated with the risk of CTO in CHD patients with odds ratio (OR)=61; IK 95% (OR)=3.211–114.15; p≤0.001. Multivariate analysis showed that high levels of MHR were significantly associated with risk of CTO after other traditional risk factors such as hypertension, diabetes mellitus, dyslipidemia, and smoking were controlled with OR=20,306; 95% IK (OR)=6.05–68.05; p≤0.001.
Conclusion: High levels of MHR were significantly associated with the risk factor of CTO in CAD patients.
2. Townsend N, Wickramasinghe K, Bhatnagar P, Smolina K, Nichols M, Leal J. Coronary Heart Disease Statistics. A Conpendium of Health Statistics. British Heart Foundation Health Promotion Research Group. Oxford, UK: Department of Public Health, University of Oxford; 2012.
3. Surya R, dan Artha JR. Prevalensi dan Karakteristik Pasien Penyakit Jantung Koroner dengan Chronic Total Occlusion di Rumah Sakit Umum Pusat Sanglah Denpasar Periode Tahun 2016; 2017.
4. Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes (2). N Engl J Med 1992;326:310-8.
5. Azzalini L, Jolicoeur EM, Pighi M, Millán X, Picard F, Tadros VX, et al. Epidemiology, Management strategies, and outcomes of patients with chronic total coronary occlusion. Am J Cardiol 2016;118:1128-35.
6. Jeroudi OM, Alomar ME, Michael TT, El Sabbagh A, Patel VG, Mogabgab O, et al. Prevalence and management of coronary chronic total occlusions in a tertiary Veterans Affairs hospital. Catheter Cardiovasc Interv 2014;84:637-43.
7. Waterhouse DF, Cahill RA, Sheehan F, McCreery C. Prediction of calculated future cardiovascular disease by monocyte count in an asymptomatic population. Vasc Health Risk Manag 2008;4:177-87.
8. Madjid M, Fatemi O. Components of the complete blood count as risk predictors for coronary heart disease: In-depth review and update. Tex Heart Inst J 2013;40:17-29.
9. Capuano V, Lamaida N, De Martino M, Mazzotta G. Association between white blood cell count and risk factors of coronary artery disease. G Ital Cardiol 1995;25:1145-52.
10. Woollard KJ, Geissmann F. Monocytes in atherosclerosis: Subsets and functions. Nat Rev Cardiol 2010;7:77-86.
11. Murphy AJ, Westerterp M, Yvan-Charvet L, Tall AR. Anti-atherogenic mechanisms of high density lipoprotein: Effects on myeloid cells. Biochim Biophys Acta 2012;1821:513-21.
12. van de Woestijne AP, van der Graaf Y, Liem AH, Cramer MJ, Westerink J, Visseren FL, et al. Low high-density lipoprotein cholesterol is not a risk factor for recurrent vascular events in patients with vascular disease on intensive lipid-lowering medication. J Am Coll Cardiol 2013;62:1834-41.
13. Ahmed HM, Miller M, Nasir K, McEvoy JW, Herrington D, Blumenthal RS, et al. Primary low level of high-density lipoprotein cholesterol and risks of coronary heart disease, cardiovascular disease, and death: Results from the multi-ethnic study of atherosclerosis. Am J Epidemiol 2016;183:875-83.
14. Aç?kgöz SK, Aç?kgöz E, ?ensoy B, Topal S, Aydo?du S. Monocyte to high-density lipoprotein cholesterol ratio is predictive of in-hospital and five-year mortality in ST-segment elevation myocardial infarction. Cardiol J 2016;23:505-12.
15. Fefer P, Knudtson ML, Cheema AN, Galbraith PD, Osherov AB, Yalonetsky S, et al. Current perspectives on coronary chronic total occlusions: The Canadian multicenter chronic total occlusions registry. J Am Coll Cardiol 2012;59:991-7.
16. Rha SW, Choi CU, Na JO, Lim HE, Kim JW, Kim EJ, et al. Comparison of 12-month clinical outcomes in diabetic and nondiabetic patients with chronic total occlusion lesions: A multicenter study. Coron Artery Dis 2015;26:699-705.
17. Galassi AR, Tomasello SD, Reifart N, Werner GS, Sianos G, Bonnier H, et al. In-hospital outcomes of percutaneous coronary intervention in patients with chronic total occlusion: Insights from the ERCTO (European Registry of Chronic Total Occlusion) registry. EuroIntervention 2011;7:472-9.
18. Linton MF, Yancey PG, Davies SS, Jerome WG, Linton EF, dan Vickers KC. The Role of Lipids and Lipoproteins in Atherosclerosis. South Dartmouth, MA: MDText.com, Inc.; 2015.
19. Ucar FM. A potential marker of bare metal stent restenosis: Monocyte count to HDL cholesterol ratio. BMC Cardiovasc Disord 2016;16:186.
20. Karata? MB, Çanga Y, Özcan KS, ?pek G, Güngör B, Onuk T, et al. Monocyte to high-density lipoprotein ratio as a new prognostic marker in patients with STEMI undergoing primary percutaneous coronary intervention. Am J Emerg Med 2016;34:240-4.
21. Gratchev A, Sobenin I, Orekhov A, Kzhyshkowska J. Monocytes as a diagnostic marker of cardiovascular diseases. Immunobiology 2012;217:476-82.
22. Yu XH, Fu YC, Zhang DW, Yin K, Tang CK. Foam cells in atherosclerosis. Clin Chim Acta 2013;424:245-52.
23. Ten Cate H, Hackeng TM, García de Frutos P. Coagulation factor and protease pathways in thrombosis and cardiovascular disease. Thromb Haemost 2017;117:1265-71.
24. Luz PL, dan Favarato D. Chronic coronary artery disease. Arq bras cardiol 1999;72:22-38.
25. Dave B. Recanalization of chronic total occlusion lesions: A critical appraisal of current devices and techniques. J Clin Diagn Res 2016;10:OE01-7.
26. Yahagi K, Kolodgie FD, Otsuka F, Finn AV, Davis HR, Joner M, et al. Pathophysiology of native coronary, vein graft, and in-stent atherosclerosis. Nat Rev Cardiol 2016;13:79-98.
27. Murphy AJ, Woollard KJ. High-density lipoprotein: A potent inhibitor of inflammation. Clin Exp Pharmacol Physiol 2010;37:710-8.
28. Brites F, Martin M, Guillas I, Kontush A. Antioxidative activity of high-density lipoprotein (HDL): Mechanistic insights into potential clinical benefit. BBA Clin 2017;8:66-77.
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