Coronary heart disease (CHD) is the leading cause of morbidity and mortality in the western world. Typical symptoms are chest pain and dyspnoea on exertion and are the result of reduced blood flow to the myocardium. The reduction in blood flow is in turn caused by atherosclerotic plaques narrowing the coronary vascular lumen and thus decreasing the nutritional blood flow. Sudden rupture or erosion of the plaque leads to acute coronary syndrome (ACS), including unstable angina (UA), acute myocardial infarction (AMI) and sudden cardiac death. Atherosclerotic plaques prone to rupture are characterized by active inflammation which is detected as increased numbers of activated inflammatory cells (macrophages, T lymphocytes and mast cells) in the lesions, and as elevated concentrations of inflammatory markers, such as interleukine-1 beta (IL-1β), tumor necrosis factor alpha (TNFα) and interleukine-8 (IL-8), in the circulation. Serum malondialdehyde (MDA) ,Sialic acids( Total Sialic acid (TSA) and lipid associated sialic acid(LSA)) , creatinne kinase MB (CK-MB) and erythrocyte sidementation rate (ESR) are related to basic CHD pathophysiology and inflammation. Aim of the study 1-To estimate IL-1β, TNFα and IL-8 in sera of patient with acute coronary syndrome (ACS), and studying the relationship between serum levels of these cytokines with exogenous cardiovascular risk factors (body mass index and age) and endogenous cardiovascular risk factors(sialic acids ,lipid profile and hypertension). 2-To evaluate oxidative stress marker (MDA) in patient with (ACS) and correlate it with (cytokine profile (IL-1β, TNFα and IL-8), lipid profile (TG, TC, HDL and LDL) and CK-MB). 3-To study the change in the levels of serum sialic acids (TSA & LSA). In Q-wave myocardial infarction (QMI), non Q-wave myocardial infarction (NQMI) and unstable angina (UA)and studying the relationship between sialic acids (TSA and LSA) with cytokine profile (IL-1β, TNFα and IL-8), and lipid profile(TG,TC,HDL and LDL) . Subjects, Materials and Methods The study was conducted during the period from March 2006 until the midst of June 2007,there were 125 individuals participated in this study, 40 individuals represent the control group(the control group was age and sex matched) and the other (85) were patients with ACS presented to the emergency department with chest pain diagnosed as myocardial infarction or unstable angina and were considered to be two separated groups cytokines profiles(including IL-1β, IL-8 and TNFα)were determined by enzyme linked immuno sorbent assay(ELISA) and serum MDA by using the Thiobarbituric acid (TBA) method of Buege and Aust were performed to the whole three groups. total Sialic acid (TSA) ,lipid associated Sialic acid(LSA) and lipid profile were measured in the sera of patients with acute coronary syndromes and healthy groups, but Creatine Kinase MB (CK-MB) enzyme was performed only for patient with myocardial infarction and unstable angina groups to establish the diagnosis. Statistical analysis using the SPSS 10.01 statistical Package for social sciences and also Excel 2003. Data analysis was done using chi-sequare test for tables with frequencies. Statistical analysis were performed using student's t-test to estimate the differences between the groups, ANOVA-test to compare among different cardic disease groups and correlation regression, taking (P < 0.05) as the lowest limit of significance. Value were considered significant when P<0.05. Results The results were compared with those of healthy groups as controls. In the present study, we noticed that the mean age for patients with acute myocardial infarction (MI) was (56.70 years) and (47.07 years) with unstable angina, with male predominance (male to female ratio) 2.5:1 where (61) 71.77% of our patients were male and (24) 28.23% were female. The serum levels of TNFα, IL-1β and IL-8 were elevated in patients with acute coronary syndromes and reach their peak within few hours after infarction. (i.e. at the time of the admission).
Our data showed a highly significant elevation in serum MDA and SA (TSA&LSA) post- infarction in Q-MI and NonQ-MI and significant elevation with UA. On the other hand the level of serum lipid profile showed a significant increase in patients with acute coronary syndromes compared with control groups. Our results also demonstrated that cardiac enzyme (CKMB) had increased level in patient with acute myocardial infarction (Q-MI and NonQ-MI).but with normal serum level in patient with unstable angina. After statistical analysis for obtained data the following correlations were observed:There was a positive correlation between serum (MDA) and change in serum lipid profile in patients with ACS. Lack of correlation was observed between chemokine (IL-8) and CKMB in QMI but positive related in non Q-MI and UA. A significant positive correlation between TG, TC and LDL with (TSA) and positively related with (LSA) in patient with acute coronary syndromes and significant negative correlation between HDL-cholesterol and (TSA) and negative correlated to (LSA) in patients with acute coronary syndromes. Conclusion Cytokine profile (TNFα, IL-1β and IL-8) are positively correlated with exogenous cardiovascular risk factor (BMI) and endogenous cardiovascular risk factor as (SA) in acute coronary syndromes. Elevated plasma levels of Oxidative stress marker (MDA) in patient with acute coronary syndromes. This study indicates that some of Cytokines profile (TNF alpha, IL-1beta, and IL-8). Sialic acids (TSA and LSA) , total lipid peroxidation expressed by MDA and Cardiac enzyme CKMB levels measured in patients with suspected ischemic heart disease could be a marker for acute coronary syndromes diagnosis.