Pharmacognosy Magazine
Search Article 
  
Advanced search 
   Journal of Cardiovascular Disease Research
 
 
 
Home  |  About us  |  Editorial board  |  Search  |  Ahead of print  |  Current Issue  |  Archives  |  Instructions  |  Subscribe  |  Contact us |    Login  Users online: 14
Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
 


 
   Table of Contents  
ORIGINAL ARTICLE
Year : 2012  |  Volume : 3  |  Issue : 4  |  Page : 287-289  

Comparison of microalbuminuria with hs-CRP and low density lipoprotein levels in nondiabetic, nonhypertensive myocardial infarction patients


1 Department of Biochemistry, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
2 Department of Pathology, KMC, Manipal University, Manipal, India
3 Department of Nursing, Vidya Nursing College, Kapu, Udupi, India
4 Department of Biochemistry, JSS Medical College, JSS University, Mysore, India
5 Department of Biochemistry, Father Muller Medical College, Mangalore, India
6 Department of Biochemistry, Siddartha Medical College, Tumkur, India
7 Department of Pathology and Medical Director, SIMS, Mukka, Mangalore, India

Date of Web Publication19-Oct-2012

Correspondence Address:
B K Manjunatha Goud
Department of Biochemistry, RAK Medical and Health Sciences University, Ras Al Khaimah
United Arab Emirates
Login to access the Email id

PMC citations1

DOI: 10.4103/0975-3583.102702

PMID: 23233772

Get Permissions

   Abstract 

Introduction: Microalbuminuria (MA), defined as urine albumin to urine creatinine ratio (UACR) of 30 to 300 mg/G of creatinine, is an established risk factor for cardiovascular morbidity and mortality and for end-stage renal disease in individuals with an adverse cardiovascular risk profile such as those with hypertension or/and diabetes mellitus. Materials and Methods: Thirty five patients were included in the study and equal number of age- and sex-matched controls were also included. 2 ml of venous blood was collected for hs-CRP determination and early morning mid stream urine sample was collected under strict aseptic precautions. The lipid profile was estimated in cobas autoanalyzer. Results: There was significant increase in levels of Low density lipoprotein (LDL) cholesterol, microalbumin, and hs-CRP (P< 0.001) in patients with myocardial infarction compared to healthy controls. Conclusion: Therefore, MA and hsCRP evaluation may have potential role in improving cardiovascular risk prediction, when used along with traditional lipid profiles.

Keywords: Low density lipoprotein cholesterol, microalbumin, myocardial infarction, Non diabetics


How to cite this article:
Manjunatha Goud B K, Nayal B, Devi OS, Devaki R N, Avinash S S, Satisha T G, Raghuveer C V. Comparison of microalbuminuria with hs-CRP and low density lipoprotein levels in nondiabetic, nonhypertensive myocardial infarction patients. J Cardiovasc Dis Res 2012;3:287-9

How to cite this URL:
Manjunatha Goud B K, Nayal B, Devi OS, Devaki R N, Avinash S S, Satisha T G, Raghuveer C V. Comparison of microalbuminuria with hs-CRP and low density lipoprotein levels in nondiabetic, nonhypertensive myocardial infarction patients. J Cardiovasc Dis Res [serial online] 2012 [cited 2013 Apr 19];3:287-9. Available from: http://www.jcdronline.com/text.asp?2012/3/4/287/102702


   Introduction Top


Microalbuminuria (MA), defined as urine albumin to urine creatinine ratio (UACR) of 30 to 300 g/mg of creatinine, [1] is an established risk factor for cardiovascular morbidity and mortality and for end-stage renal disease in individuals with associated cardiovascular risk conditions such as hypertension or/and diabetes mellitus. [2],[3] Accordingly, national and international guidelines recommend screening for microalbuminuria in patients with diabetes or hypertension. [4],[5],[6]

Atherosclerosis is currently regarded as an active inflammatory process, not as a passive accumulation of lipids, fibrin, and extracellular matrix components in the walls of blood vessels, as described in earlier theories. It is a process consisting of intravascular development of a chronic inflammatory condition, resulting from local interactions between modified lipoproteins, macrophages, lymphocytes and thrombocytes with normal components of the wall of veins and arteries. [7] One of the most significant markers of inflammation appearing in the course of atherosclerosis is C-reactive protein (CRP). This is formed in the liver in response to the development of the inflammatory condition or due to infections.

There appears to be a significant relationship between an increase in plasma CRP concentration particularly hsCRP and local disturbances in the structure and function of blood vessels particularly with lipid status. [8] The low density lipoprotein (LDL) to a large extent, is responsible for the changes occurring in blood vessels.

On the contrary an important role in the transport of lipids to the extracellular space is played by the high-density lipoprotein fraction (HDL). It has been shown that high LDL or low HDL concentrations are important stimuli in the formation of the atheromatous plaque. Thus, they are commonly accepted risk factors in the development of atherosclerosis and later myocardial infarction. [9]

The present study was undertaken to measure the levels of microalbumin in urine with serum hs-CRP and serum LDL levels in nondiabetic, nonhypertensive acute myocardial infarction patients to know the relationship between MA with hs-CRP and LDL levels and to compare their levels with healthy controls.


   Materials and Methods Top


Study sample

In the present study, we investigated the relation between the MA with hsCRP and LDL cholesterol in nondiabetic and nonhypertensive patient. The study was carried out on patients who suffering from myocardial infarction for the first time and were admitted in cardiology department. Thirty-five patients were enrolled for the study and equal number of age- and sex-matched controls were also included. The sample size was calculated using statistical software.

The patients with history of diabetes, hypertension, urinary tract infection, arthritis, nephropathy (serum creatinine >1.0 mg/dl) at the time of admission to the ICU, myocardial infarction following surgery, patients on cholesterol lowering medications and major trauma were excluded from the study as these conditions will affect independently the parameters to be estimated.

Two milliliter of venous blood was collected for hs-CRP determination and early morning midstream urine sample was collected under strict aseptic precautions. The lipid profile was recorded from the patient data.

Biochemical estimations

Estimation of CRP was done in serum sample by using RX Daytona analyzer. [10] Sample reacts with specific antiserum to form a precipitate which is measured turbidimetrically at 340 nm. Serum total cholesterol, HDL-cholesterol, triglycerides, and VLDL levels were estimated by enzymatic method. [11] LDL-cholesterol was calculated by Friedwalds formula. [12] Albumin in urine was estimated by Turbidimetric method [13] and creatinine was determined by alkaline picrate method [14] and the ratio was determined. The presence of MA in early morning mid stream urine samples was defined as urinary albumin excretion in the range of 30--300 mg/G creatinine.

Statistical analysis

The results were expressed as mean ± standard error of mean (SEM). A P< 0.05 was considered statistically significant. Statistical analysis was performed using the statistical package for social sciences (SPSS-16, Chicago, USA). Independent student 't' test was used to compare the mean between the groups. The Pearson's correlation was done between the parameters in cases as well in controls.


   Results Top


As depicted in [Table 1] there was significant increase in levels of LDL cholesterol, microalbumin, and hs-CRP (P< 0.001) in patients with myocardial infarction (MI) compared to healthy controls. On applying Pearson's correlation microalbumin levels correlated positively with LDL cholesterol levels (P = 0.010, r = 0.952) but found to be statistically not significant. The other parameters show no significance.
Table 1: LDL, hs-CRP, and microalbumin levels in controls and cases (values expressed in mean ± SD)

Click here to view



   Discussion Top


Many researches have been focused on the use of high-sensitivity C-reactive protein (hs-CRP), as a marker of inflammation, in the detection of patients at increased risk for cardiovascular disease. Several prospective studies have demonstrated that hs-CRP is an independent predictor of future risk for cardiovascular events among healthy individuals, as well as among patients with acute coronary syndromes. In several studies, it has been reported that there is a correlation between serum CRP levels and microalbuminuria in diabetic patients and even in the general population. [15] These observations suggest that low-grade inflammation, reflected by high serum hs-CRP levels, may play a role in the induction of microalbuminuria, which can be considered as a risk factor for cardiovascular diseases. [16]

Based on these facts our study observed that hsCRP levels along with microalbumin and LDL cholesterol levels were significantly higher in patients with MI compared to healthy individuals. The correlation study between the parameters in case found no significance and needs to be concluded by large-scale study.

The studies have suggested that measurement of the serum hs-CRP level may improve risk stratification among patients suspected of having CAD (coronary artery disease). The strong correlations of serum hs-CRP with LDL may be due to the putative proinflammatory effects of these two parameters which can lead to increase in the concentration of both. [17]

The CRP measurement has a lot of advantages. Firstly it is a stable compound and secondly it can be measured at any time of the day. [18]

In conclusion, the hsCRP levels along with lipid parameters are increased in non-diabetic, non-hypertensive patients with MI. The MA seen in these patients will prove the association of inflammatory markers and LDL-cholesterol plays an important role in diagnosis of MI.

So, MA and hsCRP evaluation may have the potential role in improving cardiovascular risk prediction, when used along with traditional lipid profiles.


   Acknowledgments Top


All the authors would like to thank Dr. Ullas Kamath, Professor of Biochemistry and Dean, Melaka Manipal Medical College, Manipal for their guidence and support.

 
   References Top

1.American Diabetes Association. Clinical recommendations 2001: Diabetic nephropathy. Diabetes Care 2001;24(suppl 1):S69-72.  Back to cited text no. 1
    
2.Jensen JS, Feldt-Rasmussen B, Strandgaard S, Schroll M, Borch-Johnsen K. Arterial hypertension, microalbuminuria, and risk of ischemic heart disease. Hypertension 2000;35:898-903.  Back to cited text no. 2
[PUBMED]    
3.Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001;286:421-6.  Back to cited text no. 3
    
4.American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2004;27(Suppl 1):S5-10.  Back to cited text no. 4
[PUBMED]    
5.Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report. JAMA 2003;289:2560-72.  Back to cited text no. 5
    
6.European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003;21:1011-53.  Back to cited text no. 6
    
7.Langheinrich AC, Bohle RM. Atherosclerosis: Humoral and cellular factors of inflammation. Virchows Arch 2005;446:101-11.  Back to cited text no. 7
    
8.Slater J, Rill V. Coronary artery disease: New insights into the pathophysiology, prevalence, and early detection of a monster menace. Semin Ultrasound CT MR 2004;25:113-21.  Back to cited text no. 8
    
9.Tarchalski J, Guzik P, Wysocki H. Correlation between the extent of coronary atherosclerosis and lipid profile. Mol Cell Biochem 2003;246:25-30.  Back to cited text no. 9
    
10.Claus DR, Osmand AP, Gewurz H. Radioimmunoassay of human C-reactive protein and levels in normal sera. J Lab Clin Med 1976;87:120-8.  Back to cited text no. 10
    
11.Wybenga DR, Pileggi VJ, Dirstine PH, Di Giorgio J. Direct manual determination of serum total cholesterol with single stable reagent. Clin Chem 1970;16:980-4 .  Back to cited text no. 11
    
12.Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein - cholesterol in plasma without use of the preoperative ultracentrifuge. Clinical Chem 1972;18: 499-502.  Back to cited text no. 12
    
13.Schmitz A, Vaeth M. Microalbuminuria: A major risk factor in non insulin dependent diabetes. A 10 year follow up study of 503 patients. Diabet Med 1988;5:126-34.  Back to cited text no. 13
    
14.Bonsnes RW, Taussky HH. The colorimetric determination of creatinine by the Jaffe's reaction. J Biol Chem 1945;158:581.  Back to cited text no. 14
    
15.Brownlee M, Aiello LP, Friedman E, Vinik AI, Nesto Rw, Boulton AJ. Complications of diabetes mellitus. In: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, editors. Endocrinology. 10 th ed. Philadelphia: WB Saunders; 2003. p. 1509-40.  Back to cited text no. 15
    
16.Mangili R. Microalbuminuria in diabetes. Clin Chem Lab Med 1998;36:941-6.  Back to cited text no. 16
    
17.Kazemi-Bajestani SM, Ghayour-Mobarhan M, Ebrahimi M, Moohebati M, Esmaeili HA, Ferns GA. C-reactive protein associated with coronary artery disease in Iranian patients with angiographically defined coronary artery disease. Clin Lab 2007;53:49-56.  Back to cited text no. 17
    
18.Meier-Ewert HK, Ridker PM, Rifai N, Price N, Dinges DF, Mullington JM. Absence of diurnal variation of C-reactive protein levels in healthy human subjects. Clin Chem 2001;47:426-30.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
  • Manjunatha Goud B K
  • Nayal B
  • Devi OS
  • Devaki R N
  • Avinash S S
  • Satisha T G
  • Raghuveer C V
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Acknowledgments
    References
    Article Tables

 Article Access Statistics
    Viewed363    
    Printed32    
    Emailed0    
    PDF Downloaded106    
    Comments [Add]    

Recommend this journal