CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 2, March/April 2010
AFRICA
103
Cardiovascular Topics
Inflammation and dyslipidaemia: a possible interplay
between established risk factors in North Indian males
with coronary artery disease
BINITA GOSWAMI, MEDHA RAJAPPA, BHAWNA SINGH, PC RAY, SURESH KUMAR, V MALLIKA
Summary
Objectives:
Coronary artery disease (CAD) is a leading cause
of morbidity and mortality in the developed world and is
rapidly assuming epidemic proportions in developing coun-
tries, including India. This has led to extensive research to
determine the risk factors and the pathways that may predis-
pose to the elevated risk of this disease. Important among
them include lipoproteins, homocysteine, lipoprotein (a),
pro-inflammatory cytokines and others. The following study
was undertaken to determine a possible inter-relationship
between inflammation and dyslipidaemia, which are impor-
tant risk factors for CAD in the atherosclerosis-prone North
Indian male population.
Methods:
The study groups comprised 150 clinically assessed
North Indian male patients with acute myocardial infarction
(AMI), diagnosed on electrocardiographic and biochemi-
cal criteria, and 150 healthy controls. Apolipoprotein-AI
(Apo-AI), apolipoprotein-B (Apo-B) and C-reactive protein
(CRP) levels were estimated using kits based on the immu-
noturbidimetric assay from Randox, UK. Tumour necrosis
factor-
α
(TNF-
α
) and lipoprotein (a) were assayed using
commercially available ELISA kits from Diaclone Research,
Belgium and Innogenetics, Belgium, respectively.
Results:
The patients with AMI showed highly significant
elevations in the levels of total serum cholesterol, triglycer-
ides, LDL cholesterol,Apo-B and a significant decline in HDL
cholesterol, compared with healthy controls. Significantly
elevated serum levels of inflammatory markers, TNF-
α
and
CRP were seen in patients withAMI, compared to the control
subjects. A significantly positive correlation of TNF-
α
was
observed with lipoprotein (a) in patients with CAD.
Conclusion:
The data clearly underlines a possible interplay
between inflammation and dyslipidaemia in the pathogenesis
of CAD in the Indian context. This insight into the aetio-
pathogenesis of CAD will prove highly beneficial for devising
better preventive measures and pharmacological interven-
tions for CAD.
Keywords:
coronary artery disease, C-reactive protein, tumour
necrosis factor-
α
, apolipoprotein-AI, apolipoprotein-B
Submitted 17/11/09, accepted 3/2/10
Cardiovasc J Afr
2010;
21
: 103–108
The last century has seen a rapid increase in the global preva-
lence of coronary artery disease (CAD). Results from the Global
Burden of Disease study estimated that India is facing the great-
est burden due to CAD.
1-3
It has been projected that by the year
2010, 60% of the world’s patients with heart disease will be in
India. Moreover, in India about 50% of CAD-related deaths occur
in people younger than 70 years of age, compared with only 22%
in the west.
4
Another interesting feature of CAD among Indians
is the lower prevalence of conventional risk factors, such as
hypertension, obesity, cigarette smoking, hypercholesterolemia,
and others. The explanation for this paradox has been a matter of
intense research in the last few decades.
5
In the recent past, newer risk factors such as lipoprotein
(a) [Lp(a)], homocysteine, apolipoproteins, pro-inflammatory
mediators, hypercoagulability, platelet aggregation, and insulin
resistance have caught the attention of clinicians and researchers
as the probable conglomeration of novel risk factors responsible
for CAD in Indians.
6
Hence it is clear that both nature (genetic
predisposition) and nurture (environmental or lifestyle factors)
are responsible for the disease burden in Asians.
7
Atherosclerosis, a progressive disease characterised by the
accumulation of lipids and fibrous elements in the large arteries,
constitutes the single most important contributor to this growing
burden of CAD. The hypotheses regarding the pathophysiology
of this important malady have evolved substantially over the last
few decades. The link between lipids and atherosclerosis has
dominated the thinking up to the 1970s, based on strong experi-
mental and clinical relationships between hypercholesterolaemia
and atheroma formation. The emerging knowledge on vascular
biology led to a focus on growth factors and the proliferation of
Department of Biochemistry, GB Pant Hospital, New Delhi,
India
BINITA GOSWAMI, MD, DNB,
BHAWNA SINGH, MD
V MALLIKA, MD
Department of Ocular Biochemistry, Dr Rajendra Prasad
Centre for Ophthalmic Sciences, All India Institute of
Medical Sciences, Ansari Nagar, New Delhi, India
MEDHA RAJAPPA, MD, DNB, MNAMS,
Department of Biochemistry, Maulana Azad Medical College
and associated Lok Nayak Hospital, New Delhi, India
PC RAY, MD
Department of Medicine, Maulana Azad Medical College and
associated Lok Nayak Hospital, New Delhi, India
SURESH KUMAR, MD
