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Abstract

Background: Ischemic heart disease (IHD) is one of the leading causes of death and disability
worldwide. It is an imbalance between oxygen demand and supply. The disease is caused by
decline of blood supply to the heart muscle as a result of coronary occlusion.
Objectives: This study was designed to determine the possible new biomarkers in diagnosis of
stable angina to facilitate faster therapeutic programs and also to study the cytokines roles in
pathophysiology of stable angina.
Methods: The current case-control research was performed on 86 stable angina patients, and 86
healthy subjects in Nasiriyah Heart Center. Serum Trop I, MYO, CK-MB, H-FABP, PCT, LpPLA2 and CRP hs, were assayed by immunoassay. Lipid profile and blood sugar and detected
by photometric assays. Serum IL-9, TNF-α and IL-1β were determined by ELISA and IL-6 by
immunoassay.
Results: The study revealed that serum troponin I level was insignificantly changed in stable
angina. However, compared with control, significant increase in the level of myoglobin, CKMB, hsCRP, Lp-PLA2, PCT and H-FABP, were recorded in the stable angina patients. The
patients also showed significant increase in the serum levels of total cholesterol, triglycerides,
VLDL and LDL, while HDL was significantly decreased. Significantly elevation of serum levels
of TNF-α, IL-9, IL-6 and IL1β were also noted in the patients in comparison with healthy
control. According to these investigations, there were many variations in the levels of these
biomarkers when the patients of stable angina divided according to their weight, blood pressure
and glycemic state.
Conclusion: According to the results we conclude that, in addition to cTnI, CK-MB and MYO
several other markers such as Lp-PLA2, hs-CRP, PCT and H-FABP are sensitive, and can
utilized as indicators in diagnosis of stable angina.

Keywords

Stable angina IHD Cytokines Biomarkers Lipid profile

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References

  1. - Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. American
  2. Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and
  3. stroke statistics-2015 update: a report from the American Heart Association. Circulation
  4. ;131(4):e29-322.
  5. - Heusch G. Adenosine and maximum coronary vasodilation in humans: myth and
  6. misconceptions in the assessment of coronary reserve. Basic Res Cardiol 2010;105(1):1-5.
  7. - Mad P, Domanovits H, Fazelnia C, Stiassny K, Russmüller G, Cseh A, Sodeck G, Binder T,
  8. Christ G, Szekeres T, Laggner A, Herkner H. Human heart-type fatty-acid-binding protein as a
  9. point-of-care test in the early diagnosis of acute myocardial infarction. QJM
  10. ;100(4):203210.
  11. - Thygesen K, Alpert JS, White HD; Joint ESC/ACCF/AHA/WHF Task Force for the
  12. Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. J Am Coll
  13. Cardiol. 2007;50(22):2173-2195.
  14. - Panteghini M. Role and importance of biochemical markers in clinical cardiology. European
  15. Heart Journal 2004;25(14):1187–1196.
  16. - Brogan GX Jr, Friedman S, McCuskey C, Cooling DS, Berrutti L, Thode HC Jr, Bock JL.
  17. Evaluation of a new rapid quantitative immunoassay for serum myoglobin versus CK-MB for
  18. ruling out acute myocardial infarction in the emergency department. Ann Emerg Med
  19. ;24(4):665-671.
  20. - Gilkeson G, Stone MJ, Waterman M, Ting R, Gomez-Sanchez CE, Hull A, Willerson JT.
  21. Detection of myoglobin by radioimmmunoassay in human sera: its usefulness and limitations as
  22. an emergency room screening test for acute myocardial infarction. Am Heart J 1978;95(1):70-
  23. - Del Buono MG, Montone RA, Camilli M, Carbone S, Narula J, Lavie CJ, Niccoli G, Crea F.
  24. Coronary Microvascular Dysfunction Across the Spectrum of Cardiovascular Diseases:
  25. JACC State-of-the-Art Review. J Am Coll Cardiol 2021;78(13):1352-1371.
  26. - Mythili S, Malathi N. Diagnostic markers of acute myocardial infarction. Biomed Rep
  27. ;3(6):743-748.
  28. - Azzazy HM, Pelsers MM, Christenson RH. Unbound free fatty acids and heart-type fatty
  29. acid-binding protein: diagnostic assays and clinical applications. Clin Chem. 2006;52(1):19-29.
  30. - Servonnet A, Delacour H, Dehan C, Gardet V. Un nouveau marqueur cardiaque: la heart
  31. fatty-acid binding protein (h-FABP) [Heart fatty-acid binding protein (h-FABP): a new cardiac
  32. marker]. Ann Biol Clin (Paris) 2006;64(3):209-217.
  33. - Kashiwagi M, Tanaka A, Kitabata H, Tsujioka H, Matsumoto H, Arita Y, Ookochi K, Kuroi
  34. A, Kataiwa H, Tanimoto T, Ikejima H, Takarada S, Kubo T, Hirata K, Nakamura N, Mizukoshi
  35. M, Imanishi T, Akasaka T. Relationship between coronary arterial remodeling, fibrous cap
  36. thickness and high-sensitivity C-reactive protein levels in patients with acute coronary syndrome.
  37. Circ J 2009;73(7):1291-5.
  38. - MacPhee CH, Moores KE, Boyd HF, Dhanak D, Ife RJ, Leach CA, Leake DS, Milliner KJ,
  39. Patterson RA, Suckling KE, Tew DG, Hickey DM. Lipoprotein-associated phospholipase A2,
  40. platelet-activating factor acetylhydrolase, generates two bioactive products during the oxidation
  41. of low-density lipoprotein: use of a novel inhibitor. Biochem J 1999;338 (Pt 2):479-487.
  42. - Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Flaxman A, Murray CJ,
  43. Naghavi M. The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of
  44. Disease 2010 study. Circulation 2014;129(14):1493-1501.
  45. - Cheng X, Liao YH, Ge H, Li B, Zhang J, Yuan J, Wang M, Liu Y, Guo Z, Chen J, Zhang J,
  46. Zhang L. TH1/TH2 functional imbalance after acute myocardial infarction: coronary arterial
  47. inflammation or myocardial inflammation. J Clin Immunol 2005;25(3):246-253.
  48. - Steppich BA, Moog P, Matissek C, Wisniowski N, Kühle J, Joghetaei N, Neumann FJ,
  49. Schomig A, Ott I. Cytokine profiles and T cell function in acute coronary syndromes.
  50. Atherosclerosis 2007;190(2):443-451.
  51. - Hearse DJ. Myocardial ischaemia: can we agree on a definition for the 21st century?
  52. Cardiovasc Res 1994;28(12):1737-1744:
  53. - Tian R, Hou G, Li D, Yuan TF. A possible change process of inflammatory cytokines in the
  54. prolonged chronic stress and its ultimate implications for health. Scientific World Journal
  55. ;2014:780616.
  56. -McCarthy CP, McEvoy JW, Januzzi Jr JL. Biomarkers in stable coronary artery disease.
  57. American Heart Journal 2018; 196:82-96.
  58. -Jeong H, Baek SY, Kim SW, Park EJ, Lee J, Kim H, Jeon CH. C reactive protein level as a
  59. marker for dyslipidaemia, diabetes and metabolic syndrome: results from the Korea National
  60. Health and Nutrition Examination Survey. BMJ Open, 2019;9(8):e029861.
  61. -Beysel S, Kizilgul M, Ozbek M, Caliskan M, Kan S, Apaydin M, Ozcelik O, Cakal E. Hearttype fatty acid binding protein levels in elderly diabetics without known cardiovascular disease.
  62. Clinical Interventions in Aging 2017:2063–2068.
  63. -Ye XD, He Y, Wang S, et al. Heart-type fatty acid binding protein (H-FABP) as a biomarker
  64. for acute myocardial injury and long-term post-ischemic prognosis. Acta Pharmacol Sin
  65. ;39:1155-63.
  66. -O'Donoghue M, de Lemos JA, Morrow DA, et al. Prognostic utility of heart-type fatty acid
  67. binding protein in patients with acute coronary syndromes. Circulation 2006;114:550-7.
  68. -Viswanathan K, Kilcullen N, Morrell C, et al. Heart-type fatty acid-binding protein predicts
  69. long-term mortality and re-infarction in consecutive patients with suspected acute coronary
  70. syndrome who are troponin-negative. J Am Coll Cardiol 2010;55:2590-8.
  71. -Kilcullen N, Viswanathan K, Das R, et al. Heart-type fatty acid-binding protein predicts longterm mortality after acute coronary syndrome and identifies high-risk patients across the range of
  72. troponin values. J Am Coll Cardiol 2007;50:2061-7.
  73. -Matsumoto S, Nakatani D, Sakata Y, et al. Elevated serum heart-type fatty acid-binding
  74. protein in the convalescent stage predicts long-term outcome in patients surviving acute
  75. myocardial infarction. Circ J 2013;77:1026-32.
  76. -Mackay IR. Clustering and commonalities among autoimmune diseases. Journal of
  77. Autoimmunity 2009;33(3-4):170-177.
  78. -Sun Z, Wu W, Liu J, Ma N, Zheng Z, Li Q, Wang M, Miao J. Influence of glucose-lowering
  79. rate on CKMB and myoglobin serum levels in type-2 diabetes patients with coronary heart
  80. disease. Human Immunology, 2014;75(12):1182-1187.
  81. - Ridker PM. C-reactive protein and the prediction of cardiovascular events among those at
  82. intermediate risk: moving an inflammatory hypothesis toward consensus. J Am Coll Cardiol.
  83. ;49(21):2129-38.
  84. -Alpert J, Thygesen K, Antman E, Bassand J. Myocardial infarction redefined- a consensus
  85. document of the joint European society of cardiology/American college of cardiology committee
  86. for the redefinition of myocardial infarction. J Am Coll Cardiol. 2000;36(3):959-69.
  87. -Engoren M, Zacharias A, Habib RH, Schwann TA, Riordan CJ, Durham SJ, Shah A. The
  88. effect of diabetic medications on creatine kinase-myocardial band levels in patients undergoing
  89. coronary artery bypass surgery. Interactive CardioVascular and Thoracic Surgery 2009; 9(5):
  90. -796.
  91. -Cusack MR, Marber MS, Lambiase PD, Bucknall CA, Redwood SR. Systemic inflammation
  92. in unstable angina is the result of myocardial necrosis. Journal of the American College of
  93. Cardiology 2002; 39(12):1917-1923.
  94. -Ottani F, Galvani M, Nicolini F, et al. Elevated cardiac troponin levels predict the risk of
  95. adverse outcome in patients with acute coronary syndromess. Am Heart J 2000;140:917-27.
  96. -Roxin LE, Cullhed I, Groth T, Hällgren T, Venge P. The value of serum myoglobin
  97. determinations in the early diagnosis of acute myocardial infarction. Acta Med Scand.
  98. ;215(5):417-425.
  99. -Kubasik NP, Guiney W, Warren K, D'Souza JP, Sine HE, Brody BB. Radioimmunoassay of
  100. serum myoglobin: evaluation and modification of a commercial kit and assessment of its
  101. usefulness for detecting acute myocardial infarction. Clin Chem. 1978;24(11):2047-2049.
  102. -Yang L, Liu Y, Wang S, Liu T, Cong H. Association between Lp-PLA2 and coronary heart
  103. disease in Chinese patients. Journal of International Medical Research. 2017; 45(1): 159–169.
  104. -Epps KC, Wilensky RL. Lp-PLA2- a novel risk factor for high-risk coronary and carotid
  105. artery disease. J Intern Med. 2011; 269: 94–106.
  106. -Ling Y, Tang S, Cao Y, Fu C. Relationship between plasma lipoprotein-associated
  107. phospholipase A2 concentrations and apolipoprotein in stable coronary artery disease patients.
  108. Dis Markers. 2020 ;2020:8818358.
  109. -Zannad F, De Backer G, Graham I, Lorenz M, Mancia G, Morrow DA, et al. Risk
  110. stratification in cardiovascular disease primary prevention – scoring systems, novel markers, and
  111. imaging techniques. Fundam Clin Pharmacol. 2012;26:163–174.
  112. -Tousoulis D, Papageorgiou N, Androulakis E, Stefanadis C. Lp-PLA2-a novel marker of
  113. atherosclerosis: to treat or not to treat? Int J Cardiol. 2013;165: 213–216.
  114. -Yang N, Feng JP, Chen G, Kou L, Li Y, Ren P, Zhao LL, Qin Q. Variability in lipid profile
  115. among patients presented with acute myocardial infarction, unstable angina and stable angina
  116. pectoris. Eur Rev Med Pharmacol Sci 2014;18(24):3761-3766.
  117. -Gorog DA, Ahmed N, Davies GJ. Elevated plasma lipid peroxide levels in angina pectoris
  118. and myocardial infarction. Cardiovasc Pathol 2002;11(3):153-157.
  119. - Ling Y, Tang S, Cao Y, Fu C. Relationship between Plasma Lipoprotein-Associated
  120. Phospholipase A2 Concentrations and Apolipoprotein in Stable Coronary Artery Disease
  121. Patients. Dis Markers. 2020;2020:8818358.
  122. -Kelly D, Khan SQ, Dhillon O, Quinn P, Struck J, Squire IB, Davies JE, Ng LL. Procalcitonin
  123. as a prognostic marker in patients with acute myocardial infarction. Biomarkers. 2010; 15: 325-
  124. -Hashemipour SV, Pourhosseini H, Hosseinsabet A. Correlation between the serum
  125. procalcitonin level and the extension and severity of coronary artery disease in patients with nonST-segment elevation myocardial infarction. Cardiovasc Endocrinol Metab. 2019;8(2):62-66.
  126. -Ataoğlu HE, Yilmaz F, Uzunhasan I, Cetin F, Temiz L, Döventaş YE, Kaya A, Yenigün M.
  127. Procalcitonin: A novel cardiac marker with prognostic value in acute coronary syndrome. J Int
  128. Med Res 2010;38:52-61
  129. -Tang JN, Shen DL, Liu CL, Wang XF, Zhang L, Xuan DX, Zhang JY, Cui LL. lasma levels
  130. of Cl q/TNF-Rrelated protein 1 and interleukin 6 in patients with acute coronary syndrome or
  131. stable angina pectoris. The American Journal of Medical Sciences 2015; 349(2):130-136.
  132. -Ozdemir O, Gundogdu F, Karakelleoglu S, Sevimli S, Pirim I, Acikel M, Arslan S, Serdar S.
  133. Comparison of serum levels of inflammatory markers and allelic variant of interleukin-6 in
  134. patients with acute coronary syndrome and stable angina pectoris. Coron Artery Dis.
  135. ;19(1):15-19.
  136. -Simon AD, Yazdani S, Wang W, Schwartz A, Rabbani LE. Circulating levels of IL-1beta, a
  137. prothrombotic cytokine, are elevated in unstable angina versus stable angina. J Thromb
  138. Thrombolysis. 2000;9(3):217-22.
  139. -Lubrano V, Gabriele M, Puntoni MR, Longo V, Pucci L. Relationship among IL-6, LDL
  140. cholesterol and lipid peroxidation. Cell Mol Biol Lett. 2015;20(2):310-322.
  141. -Sepehri ZS, Masoomi M, Ruzbehi F, Kiani Z, Nasiri AA, Kohan F, Sheikh Fathollahi M,
  142. Kazemi Arababadi M, Kennedy D, Asadikaram GA. Comparison of serum levels of IL-6, IL-8,
  143. TGF-β and TNF-α in coronary artery diseases, stable angina and participants with normal
  144. coronary artery. Cell Mol Biol (Noisy-le-grand). 2018;64(5):1-6.
  145. -Martins TB, Anderson JL, Muhlestein JB, Horne BD, Carlquist JF, Roberts WL, Carlquist JF.
  146. Risk factor analysis of plasma cytokines in patients with coronary artery disease by a
  147. multiplexed fluorescent immunoassay. Am J Clin Pathol. 2006;125(6):906-913.
  148. -Ridker PM, Rifai N, Pfeffer MA, Sacks F, Braunwald E. Long-term effects of pravastatin on
  149. plasma concentration of C-reactive protein. The Cholesterol and Recurrent Events (CARE)
  150. Investigators. Circulation. 1999;100(3):230-235.
  151. -Zhu Y, Xian X, Wang Z, Bi Y, Chen Q, Han X, Tang D, Chen R. Research progress on the
  152. relationship between atherosclerosis and inflammation. Biomolecules. 2018;8(3):80.
  153. -Bai YJ, Li ZG, Liu WH, Gao D, Zhang PY, Liu M. Effects of IL-1β and IL-18 induced by
  154. NLRP3 inflammasome activation on myocardial reperfusion injury after PCI. Eur Rev Med
  155. Pharmacol Sci. 2019;23(22):10101-10106.
  156. -Ørn S, Ueland T, Manhenke C, Sandanger Ø, Godang K, Yndestad A, Mollnes TE, Dickstein
  157. K, Aukrust P. Increased interleukin-1β levels are associated with left ventricular hypertrophy and
  158. remodelling following acute ST segment elevation myocardial infarction treated by primary
  159. percutaneous coronary intervention. J Intern Med. 2012;272(3):267-276.
  160. -Pluijmert NJ, Atsma DE, Quax PHA. Post-ischemic myocardial inflammatory response: A
  161. complex and dynamic process susceptible to immunomodulatory therapies. Front Cardiovasc
  162. Med. 2021;8:647785.
  163. -Toldo S, Mauro AG, Cutter Z, Abbate A. Inflammasome, pyroptosis, and cytokines in myocardial
  164. ischemia-reperfusion injury. Am J Physiol Heart Circ Physiol. 2018;315(6):H1553H1568.
  165. -Cappuzzello C, Di Vito L, Melchionna R, Melillo G, Silvestri L, Cesareo E, Crea F, Liuzzo G,
  166. Facchiano A, Capogrossi MC, Napolitano M. Increase of plasma IL-9 and decrease of plasma IL-5, IL-7,
  167. and IFN-γ in patients with chronic heart failure. J Transl Med. 2011;9:28.
  168. -Ormstad H, Aass HC, Lund-Sørensen N, Amthor KF, Sandvik L. Serum levels of cytokines and Creactive protein in acute ischemic stroke patients, and their relationship to stroke lateralization, type, and
  169. infarct volume. J Neurol. 2011;258(4):677-685.
  170. -Gregersen I, Skjelland M, Holm S, Holven KB, Krogh-Sørensen K, Russell D, Askevold ET, Dahl CP,
  171. Ørn S, Gullestad L, Mollnes TE, Ueland T, Aukrust P, Halvorsen B. Increased systemic and local
  172. interleukin 9 levels in patients with carotid and coronary atherosclerosis. PLoS One. 2013;8(8):e72769.
  173. -Zhang W, Tang T, Nie D, Wen S, Jia C, Zhu Z, Xia N, Nie S, Zhou S, Jiao J, Dong W, Lv B, Xu T,
  174. Sun B, Lu Y, Li Y, Cheng L, Liao Y, Cheng X. IL-9 aggravates the development of atherosclerosis in
  175. ApoE-/- mice. Cardiovasc Res. 2015;106(3):453-464.
  176. -Biasucci LM, Vitelli A, Liuzzo G, Altamura S, Caligiuri G, Monaco C, Rebuzzi AG, Ciliberto G,
  177. Maseri A. Elevated levels of interleukin-6 in unstable angina. Circulation. 1996;94(5):874-877.

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