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Serum cholesterol and its components (high, low & very low density lipoproteins) in children of patients of myocardial infarction.
Correspondence Address:
Total serum cholesterol and its components high density lipoprotein, low density lipoprotein and very low density lipoprotein were estimated in serum of 409 children (212 males and 197 females) of 189 patients with myocardial infarction (MI). The patients were divided into 2 groups--1. having MI before the age of 40 years and 2. having it after 40 years. Three hundred and nine children were of parents belonging to group 1 and 100 children were of parents from group 2. Lipid patterns of these children were compared. Comparison was also carried out in subgroups made as per the age and sex of the parents. It was concluded that the disease is more likely to transfer from young patients to their children. Both paternal as well as maternal effects exist in young patients of MI but the paternal effect is dominant. In children of parents having myocardial infarct at a latter age, maternal effect is predominant. The lipid patterns of male and female case-children were also compared with the respective controls. More significant differences in the levels were observed in male case-children indicating that the disease is more likely to transfer in male case-children.
Predicting risk is only one aspect of the heart disease problem. The second part of the problem is determining whether high risk patients can take steps to avoid the fate predicted for them by the epidemiological studies. Among the various risk factors of coronary heart disease (CHD), lipoporotein have captured the imagination of the medical world[16],[18],[28],[34]. The present study was carried out on 409 children of 189 patients who suffered from acute myocardial infarction. 50 children of parents having no history of coronary artery disease or any other disease, which may influence serum lipids were taken as control, to estimate the genetic influence of MI.
The present study was carried out on 409 children (212 males and 197 females) of 189 patients of acute myocardial infarction. Distribution pattern is illustrated in [Table - 1]. The age of children varied from 1 to 20 years. None of the case-children of patients of MI had any disease or received any medicine, which may influence serum lipids. Fifty normal healthy children of normal healthy subjects (age and sex matched) were also included to serve as controls. Controls were without any family history of coronary artery disease or any other disease, which may influence serum lipids. In all cases, fasting blood samples were drawn for the estimation of total serum cholestero1[37] (Tc) high density lipoprotein (HDLc), low density lipoprotein (LDLc) and very low density lipoprotein (VLDLc)[35].
The levels of serum total cholesterol (Tc) and lipoproteins (HDLc, LDLc and VLDLc) of 50 control group children and 409 case-children are depicted in [Table - 2]. In case of 50 control- children no significant age and sex differences were noted. The lipid patterns of both the groups were compared. There was no significant increase in the level of Tc and VLDLc, however HDLc level was found to be significantly low (p < 0.001) whereas LDLc level was significantly high (p < 0.001) in case-children as compared to control group. The 409 case-children were divided according to the age of the patients. The levels of 309 children from group 1 (i.e. of young patients having MI before the age of 40) were compared with 50 control-children [Table - 3]. The comparison revealed significantly elevated levels of serum cholesterol and LDLc (p < 0.01 and p <0.001 respectively) and significantly low level of HDLc (p <0.001) in case-children as compared to those of control group. The levels of 100 children from group 2 (i.e. of old patients of MI having MI after the age of 40) were also compared with that of 50 control children. No significant increase in the level of serum cholesterol and VLDLc were noticed, whereas significantly high values of serum LDLc (p < 0.05) and low value of serum HDU (p < 0.01) were observed in case-children as compared to control group. Serum lipid levels of case-children of young and old patients were also compared with one another. No significant increase was noticed in serum cholesterol and VLDLc whereas level of HDLc was found to be significantly low and level of LDLc was significantly high (p < 0.01) in children of young patients of MI. Control vs Group 1: (a) VS (b) P<0.01 (d) VS (e) p<0.001 (g) VS (h) p<.001 (j)YS (k) N.S. Control vs Group 2: (a) VS (c) N.S. (d) VS (f) p<.01 (g) VS (i) pp< 0.05 (j) VS (l) N.S. Groupl vs Group 2: (b) VS (c) N.S. (e) VS (f) p<0.01 (h) VS (i) p<0.01 (k) VS (l) N.S. When sex of the parents with MI was also taken into consideration along with the age it was observed that serum cholesterol and LDLc levels were significantly elevated (p < 0.01, p< 0.001) and HDLc level was significantly low (p < 0.001) in children of young male patients when compared with control children [Table - 4]. When levels of children of young female patients were compared with control children, it was found that there was no significant change in levels of serum cholesterol and VLDLc whereas levels of serum HDLc and LDLc were significantly decreased and increased (p < 0.001 and p < 0.001) respectively in case-children. When the levels of case-children of young male and young female patients were compared with one another no significant change was observed in any of the parameters [Table - 4]. Comparison of serum cholesterol, LDLc and VLDLc levels of case-children of old male and female patients with control and with one another revealed insignificant results. No significant change in the level of HDLc was observed when children of old male patients were compared with control children but this level was found to be significantly decreased in case children of old female patients of MI when they were compared with control children (p <0.01) and case-children of old male patients (p <0.05) [Table - 5]. [Table - 6] represents the comparison of lipid pattern of case-and control-children when the sex-wise distribution is carried out. Levels of serum cholesterol and LDLc were found to be significantly increased (p < 0.05 and p < 0.001) respectively and HDLc significantly decreased (p < 0.001) in male case-children when they were compared with the male controls. No significant change in the levels of cholesterol, LDLc and VLDLc was observed in female case-children when they were compared with female control-children. Only the level of serum HDLc was found to be significantly decreased (p < 0.05) in female case-children.
The study pertains to the children of the age 1 to 20 years of patients of myocardial infarction. Serum cholesterol level was marginally elevated in children of parents having myocardial infarct when compared with that of control- children but the difference was not significant. The findings are in accordance with many workers[1],[12],[17] but in contrast to some studies[9],[10],[21],[24] which -reported significant increase in the level of serum cholesterol in case-children. On the other hand, the serum HPLc level of case-children was found to be significantly low when compared with control-children. These results were supported by many workers[2],[3],[6],[11],[13],[25]. The level of serum LDLc in children of patients of MI was found to be significantly increased when compared with control-children. Similar results were found by other workers[4],[14],[19],[22],[31]. No significant difference was observed in the level of VLDLc in case-children when compared with healthy control-children. Similar results were found by Pometta et al[30] in female first degree relatives and Micheli et al[17] in male first degree relatives. Thus there is a significant difference in the levels of serum HDLc and LDLc in case-children when compared with control-children, showing the increased risk of disease in children of patients of myocardial infarction. The level of serum cholesterol in children of young patients of MI was significantly increased when compared with control-children, but no change was observed in children of old patients of MI compared with control and case-children of young patients respectively. Similar observations have been reported[8],[15],[26],[29]. The serum HDLc levels of children of young and old patients were found to be significantly low compared to control and specially so in children of young patients. Similar results were obtained by Slack and Evans[32] Thordarson and Fridriksson[33] and Nupuf and Sutherland[27] who also noticed greater risk in relatives of young male patients. When the serum LDLc level of children of young and old patients were compared with control-children, significantly high values were observed in case-children. In this case, higher values were observed in children of young patients of MI. Similar observation were found by Glueck et al[8]. These results indicate that there is a greater risk of the disease in children of young patients. To, establish the dominance of maternal and paternal effect in young and old patients of MI, the case-children were grouped according to the age and sex of the patients. On comparison of serum cholesterol levels of case-children of young male and female patients with that of control-children and also with one another, it was found was that only the children of young male patients have a significantly raised cholesterol levels. When the same comparison of serum cholesterol was done in case-children of old male and female patients insignificant results were obtained. Thus for cholesterol level only young father-offspring influence was evident. These results are in favour of many workers[9],[10],[15]. In contrast, Garrison et al[1] and, Morrison et al[23], found mother-offspring correlation stronger than the father-offspring correlation. The serum HDLc levels of children of young male and female patients of MI were found to be significantly lower than that of control children. No difference was observed in the HDLc levels of children of young male and young female patients. Nupuf and Sutherland[27] also found HDLc as a possible link or predisposition to the later development of heart disease in the children of young men. The persistence of paternal effect has also been observed by Franzen and Fex[5] in a similar study. Serum HDLc levels of children of old male and female patients of MI were compared with control, and with one another. The level was found to be significantly low in children of old female patients when compared with control and children of old male patients of MI. In this comparison only maternal effect seemed to persist. Slack and Evans[32] and Mj?s et al[20] reported that mother- linked association might help to explain the high risk of ischaemic heart disease (IHD) that is transmitted from females with IHD to their first degree relatives. In a similar type of study Morrison et al[22] reported that mother-offspring correlation was higher than that for father- offspring. The level of serum LDLc in children of young male and female patients of MI against control revealed significantly high values whereas when children of old male and female patients of MI were considered, the comparison showed insignificant results. Thus paternal as well as maternal effect was evident in children of young patients. No such effect was observed for children of old male and female patients. Morrison et al[22] also found both paternal and maternal effect evident but they found mother- offspring relationship higher than that of father- offspring relationship. Slack and Evans[32] and Thordarson a Fridriksson[33] in their study reported that the relatives of younger men and older women dying of IHD had 5-7 fold increased risk of sudden death compared with general population. These observations were in accordance with the combined analysis of serum cholesterol, HDLc and LDLc levels in present study. Serum lipid levels of male and female case-children were compared with respective controls. Serum cholesterol and LDLc was found to be increased significantly in male case-children only whereas serum HDLc was found to be decreased (P < 0.05, P < 0.05) in both male and female case-children. The above results showed that there was greater parent-son correlation in case-children. The disease in more likely to transfer in male and its prevalence is also higher in male compared to female children. Wilson et al[36] reported that there were parent-son and parent-daughter relationships but prevalence rates of congenital heart disease for men were much grater than that of women. Finally it was concluded that both paternal and maternal effects exist in young patients of MI but paternal effect predominates. In children of parents having infarct at an older age, significant values were observed only in case of HDLc level, and it was found that maternal effect is predominant. Secondly it was also concluded that mal e children of the patients of MI are with greater risk of disease compared to female case-children.
The authors gratefully acknowledge the Director General, Indian Council of Medical Research, for providing the funds to carry out this project.
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