Abstract
Search of pathogenetic mechanisms and risk factors of atherosclerosis in the employees of the cleaning service in Tbilisi.
As a result of a preliminary survey and examination of 200 employes of Tbilisi cleaning service aged 25-45 years (2014-2016), 22 patients with angina, hypercholesterolemia, intimae-media thickness > 0.65 mm, were selected into I group, and 23 individuals without these disorders into II group. In the blood plasma of the selected patients the intensity of oxidative metabolism parameters, TAA and MDA were determined. The variance and correlation analysis (АNOVA) was used for conducting the comparative analysis of the levels of studied parameters.
In the combined group (I+II) there are several reliable correlations between the Age -TCol, Age-MDA, BMI-Tg, BMI-MDA, LDLChol-HDLChol, LDLChol-TChol, HDLChol-TChol, LDLChol-MDA, LDLChol-TAA. no correlation between these parameters in individual groups (I and II) was found. That indicates that we have an imaginary correlation related to the large intergroup difference between the average values of the group indicators, that is the values of various indicators change during the development of the pathological process, but there is no causal relationship between these alterations.
The reliable TAA-MDA correlation in the combined group (I+II) is related to the high anticorrelation between these parameters and the significantly higher average value of TAA in the low-risk group (II) in comparison to the high-risk group (I).
The results analysis indicates both the diagnostic value of redox status indicators and their leading role in the atherogenesis processes. In populations with a high risk of atherosclerosis, monitoring of serum TAA is recommended.
Author Contributions
Copyright© 2020
Kantaria Murman, et al.
License
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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Competing interests The authors have declared that no competing interests exist.
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Introduction
Atherosclerosis, as a major cause of myocardial infarction, stroke, and thrombosis, is a significant contributor to early disability and high mortality, and is, therefore, one of the most important medical and social problems. Atherosclerosis is characterized by the formation of plaques contributing to an increase in the thickness of the coronary artery wall resulting in reduced blood flow. Plaque rupture and the consequent thrombosis may lead to sudden blockage of arteries and causing stroke and heart attack. The recent tendency to increase and rejuvenate the disease makes this problem even more relevant. Given the urgency of the problem, the search for new risk factors for atherosclerosis and the emergence of yet unknown pathogenetic mechanisms is naturally one of the major issues of modern medicine Our investigation aimed to determine the main risk factors for atherosclerosis and its main pathogenetic mechanisms in the employees of the cleaning service in Tbilisi (Georgia).
Materials And Methods
As a result of a preliminary survey and examination of 200 employees of Tbilisi, Cleaning service aged 25-45 years, conducted by an initiative group of medical workers of the N. Kipshidze University Clinic (2014-2016) within the framework of the State program of Universal Insurance of the population (physical examination, filling out the questionnaire, parameters of lipid metabolism (total cholesterol (TChol), high-density lipoprotein cholesterol (HDL-Chol), low-density lipoprotein cholesterol (LDL-Chol), triglycerides) (Tg)), Fibrinogen (Fn), C reactive protein (CRP) content in blood, intimate media thickness), 45 people were selected. 22 patients with angina, hypercholesterolemia, intimae-media thickness > 0.65 mm, were grouped into I group (high risk of atherosclerosis), and 23 individuals without angina had normal cholesterol levels in blood and intimae-media layer thickness <0.55 mm - into II group (low risk of atherosclerosis). The study protocol was approved by the Ethical Committee of the David Aghmashenebeli University of Georgia. The intima-media thickness was measured by ultrasound with LOGIQ 7 (N. Kipshidze University Clinic). The TChol, HDL-Chol, and Tg levels were measured by the enzymatic method on a fully automated chemistry analyzer (Roche diagnostics) (Laboratory of Tbilisi Republican hospital named after acad. N. Kipshidze). LDL-Chol level was calculated by the Friedewald equation Plasma Fn level was measured by a fully automated coagulation analyzer (Diagnostica STAGO), plasma CPR level was tested by immunoassay (ELISA) with a fully automated chemistry analyzer (Roche diagnostic GmbH) (Laboratory of N. Kipshidze University Clinic). Electrocardiography (ECG) registration was performed at rest condition with the device ECG300G (three-channel electrocardiograph CONTEC) (Laboratory of N. Kipshidze University Clinic). In the blood of the patients from the selected groups, the intensity of oxidative metabolism was determined by total antioxidant activity (TAA) of the blood serum and the Malondialdehyde (MDA) content. TAA was determined in deproteinized blood serum by using the 2.2-diphenyl-1-picrylhidrazyl (DPPH)-scavenging assay, which was adapted from the study conducted by Chrzczanowicz et al. To obtain serum, blood samples (3 ml) were placed in the tubes and incubated for 30 minutes at 37° C and then centrifuged for 10 minutes (1500 g, 4°C). Serum samples (2 The supernatant (1 ml) of deproteinized serum was collected, dried and dissolved in 0.5 ml of methanol, the DPPH (3 ml) was added. The absorption of the test samples was measured by the spectrophotometer at 515 nm. The percent of neutralization in the samples was calculated on gallic acid; the absorbance values were interpolated by using the calibration curve built for gallic acid. The total antioxidant activity (TAA) of the blood serum samples was determined by the time (t, in seconds) required for neutralization of 50% radical; the less time is necessary for the neutralization of the DPPH-radicals, the higher is the antioxidant activity of the blood serum. For evaluating of TAA of blood serum samples, we use the parameter K inverse to the time indicator (t), (K = 1/t [sec- MDA in blood plasma was determined by Thiobarbituric acid (TBA) assay The variance and correlation analysis (АNOVA) was used for conducting the comparative analysis of the levels of studied parameters. The analysis and visualization
Results
Results of patients' investigation are shown in Ages patients (35-45 years) – 72.7% vs. 17.4%, p<0.02; Persons with obesity (body mass index (BMI) > 30) – 31.8% vs. 4.3%, p< 0.02; Persons with arterial hypertension (> 140/90 mm Hg) – 81.8% vs. 47.8%, p< 0.02; High level of LDL-Chol in blood (> 3,0 mMol / l) – 6..6% vs. 21.7%, p> 0/02; High level of MDA ((>2,9 µMol / l) – 90.9% vs. 52.2%; p> 0.01; Low TAA (TAA<0,022 sec-1) – 45,6% vs. 21,7%, p< 0,01. Individuals in the group I had significantly higher lipid peroxidation parameters (MDA content), and low level of TAA in the blood compared to group II ( Thus, the factors that predominated in the I group of the investigated population (age, obesity, arterial hypertension, and high LDLChol) play an important role in the formation of atherosclerosis ( Oxidative stress also participates in the pathogenesis of atherosclerotic cardiovascular disease. In the general population, increased concentrations of lipid peroxidation products are associated with coronary artery calcification and increase of the carotid intima-media thickness, non-invasive measures of atherosclerosis, which predict of the long term cardiovascular outcomes - statistically significant correlations Correlation analysis of investigated parameters in observed patients of the combined group (I +II) indicate a negative correlation between blood plasma TAA and MDA content (r = -0.75), LDLChol (r = -0.44) and TChol (r = -0.40) content; MDA content in blood plasma correlates with patient age (r = 0.42), obesity (BMI) (r = 0.43), and parameters of lipid metabolism (LDLChol: r = 0.47, Tg: r = 0.39); TChol content in the patients' blood plasma increased with increasing age (r = 0.56), that is followed by elevation of LDLChol (r = 0.71) and HDLChol (r = 0.40) content and intensification of oxidative stress (for MDA: r = 0.51, for TAA: r = -0,4); elevation of Tg content in blood plasma correlated with BMI (r = 0.38) and MDA (r = 0.39). LDLChol content correlates wirh patients age and blood palsma oxidative stress parameters (TAA, MDA). At the same time analysis of investigated parameters of patients from I and II groups ( - statistically significant correlations - statistically significant correlations
N
Parameters
I Group %
n
II Group %
N
P
1
Age
25-34
27.3
6
82.6
19
<0.02
35-45
72.7
16
17.4
4
<0.02
2
Myocardial Infarct
9.1
2
-
0
3
Stroke
4.6
1
-
0
4
Family history
22.7
5
4.4
1
5
Smoking
Never
4.5
1
-
0
10
27.3
6
21.7
5
>20
36.4
8
39.1
9
>40
22.7
5
17.4
4
6
BMI
25
18.2
4
56.5
13
>25
50
11
39.1
9
>30
31.8
7
4.3
1
7
Meat Consumption
Animal fat
54.5
12
47.8
11
Plant oil
45.5
10
52.2
12
Meat
81.8
18
78.3
18
Fish
18.2
4
21.7
5
Carbohydrates
81.8
18
78.3
18
Vegetable/fruits
18.2
4
21.7
5
8
Nervous stress
77.3
17
60.9
14
No
22.7
5
39.1
9
9
Arterial Pressure (mm Hg)
Normal (<140/90)
18.2
4
52.2
12
<0.02
High (>140/90)
81.8
18
47.8
11
10
LDLChol (mmol/l)
Normal (<3.0)
36.4
8
78.3
18
<0.02
High (>3.0)
63,6
14
21,7
5
<0,02
11
Tg (mmol/l)
Normal (<2,0)
63,6
14
78.3
18
High (>2.0)
36.4
8
21.7
5
12
HDLChol (mmol/l)
Normal (>1.0)
9.1
2
13.0
3
Low (<1.0)
90.9
20
87.0
20
13
Fn (gr/l)
Normal (<2.9)
68.2
15
69.6
16
High (>2.9)
31.8
7
30.,4
7
14
CRP (mkg/ml)
Normal (<3.0)
50
11
39,1
9
High (>3.0)
50
11
60.9
14
15
MDA (µmol/l)
Normal (<2.9 µmol/l)
9
2
47.8
11
<0.01
High (>2.9 µmol/l)
90.9
20
52.2
12
<0.01
16
TAA(sec-1)
Normal (0.022 40.1
9
34.8
8
Low (TAA<0.022)
45.6
10
21.7
5
0.01
High (TAA>0.025)
13.3
3
43.5
10
<0.01
Dependent Variable
Test Whole Model
F
P
Age
17.66
>0.001
BMI
18.14236
>0.001
LDLChol
14.19975
>0.001
Tg
9.02388
>0.001
HDLChol
0,83863
0.36
Fn
0.21152
0.65
CRP
0.08291
0.77
MDA
33.08732
>0.001
TChol
15.75541
>0.001
TAA
9.23448
0.005
Means
Std.Dev.
Age
BMI
LDLChol
Tg
HDLChol
TChol
Fn
CRP
MDA
TAA
Age
34,52
8,13
1,00
0,27
0,51
0,32
0,26
0,56
0,32
-0,06
0,42
-0,18
BMI
27,27
3,35
0,27
1,00
0,33
0,38
0,05
0,23
0,02
-0,19
0,43
-0,13
LDLChol
3,18
1,51
0,51
0,33
1,00
0,27
0,41
0,71
0,08
-0,31
0,47
-0,44
Tgl
2,06
1,29
0,32
0,38
0,27
1,00
0,13
0,14
0,09
0,02
0,39
-0,11
HDLChol
0,85
0,31
0,26
-0,07
0,15
-0,07
1,00
0,40
0,10
0,19
0,10
-0,09
Fn
2,79
0,69
0,32
0,02
0,08
0,09
-0,07
0,02
1,00
-0,02
-0,17
0,15
CRP
3,45
2,10
-0,06
-0,01
-0,32
0,06
0,19
-0,20
0,53
1,00
-0,14
0,11
MDA
3,36
0,50
0,42
0,43
0,47
0,39
0,22
0,51
-0,17
-0,30
1,00
-0,75
TChol
4,52
1,40
0,56
0,23
0,71
0,14
0,40
1,00
0,02
-0,20
0,51
-0,40
TAA
0,02
0,00
-0,18
-0,13
-0,44
-0,11
-0,19
-0,4
0,15
0,22
-0,75
1,00
Means
Std.Dev
Age
BMI
LDLChol
Tg
HDLChol
Fn
CRP
MDA
TChol
TAA
Age
39,800
5,4798
1,0000
-0,0911
0,584584
0,135850
0,17510
0,29635
0,6696
0,183852
0,412271
-0,3049
BMI
29,467
3,0907
-0,091
1,0000
-0,098097
0,183024
-0,1019
0,01045
-0,0335
-0,14693
-0,46261
0,17742
LDLChol
4,089
1,4820
0,5846
-0,0981
1,000000
0,030930
0,41698
0,32359
-0,4676
-0,01789
0,443866
-0,1461
Tg
2,725
1,5490
0,1359
0,1830
0,030930
1,000000
0,04411
-0,0059
0,12601
0,15177
-0,29461
0,15367
HDLChol
0,870
0,3531
0,1751
-0,1519
0,433476
-0,16656
1,00000
-0,0021
0,45992
0,19448
0,419743
-0,1057
Fn
2,855
0,6133
0,2964
0,01045
0,323585
-0,00592
-0,2336
1,0000
-0,4786
-0,06360
0,153854
-0,3208
CRP
3,212
1,7199
0,00336
-0,0335
-0,467556
0,126006
0,45993
-0,4786
1,00000
-0,14102
-0,21027
0,32235
MDA
3,747
0,35023
0,1839
-0,1469
-0,017899
0,151768
0,19398
-0,0636
-0,14102
1,00000
0,375023
-0,45
TChol
5,401
1,1418
0,41223
-0,4626
0,443866
-0,29461
0,39380
0,15385
-0,21027
0,37502
1,000000
-0,4437
TAA
0,022
0,0034
-0,3049
0,17742
-0,146125
0,153674
-0,1771
-0,3208
0,322351
-0,45
-0,44372
1,00000
Means
Std.Dev.
Age
BMI
LDLChol
Tg
HDLChol
Fn
CRP
MDA
TChol
TAA
Age
30,1111
7,38750
1,0000
-0,2113
0,02287
-0,0510
0,27102
0,35899
0,26903
-0,15047
0,266078
0,39189
BMI
25,4444
2,33193
-0,2113
1,00000
0,10281
0,02756
-0,2934
-0,08237
-0,17892
0,12770
0,10780
0,29759
LDL Chol
2,4144
1,06599
0,02287
0,10281
1,00000
-0,0821
0,17523
-0,20956
-0,20429
0,27045
0,72013
-0,3272
Tg
1,5133
0,67082
-0,0510
0,02758
-0,08214
1,00000
-0,1423
0,17619
0,18359
-0,05889
-0,06151
0,20173
HDLChol
0,73899
0,23639
0,27102
-0,3800
-0,00505
-0,18523
1,00000
0,261370
-0,04763
-0,33535
0,204694
0,09268
Fn
2,7428
0,75713
0,35899
-0,0824
-0,20956
0,17619
0,18798
1,00000
0,14902
-0,5176
-0,14665
0,5141
CRP
3,42933
2,42523
0,26903
0,06806
-0,28679
0,08272
0,04763
0,312157
1,00000
-0,17570
-0,22048
-0,0141
MDA
3,0389
0,35337
-0,1505
0,12770
0,27045
-0,0589
-0,2549
-0,5176
-0,33246
1,00000
-0,00953
-0,66
TChol
3,7917
1,17389
0,26608
0,10780
0,72013
-0,0615
0,40520
-0,14665
-0,11236
-0,00953
1,00000
0,01292
TAA
0,0257
0,00396
0,39186
0,29759
-0,32718
0,20173
0,07880
0,5141
0,11784
-0,6593*
0,01292
1,0000
Conclusion
Results of the correlation analysis between the studied parameters of patients show that age, obesity, arterial hypertension, and high LDLChol level reveal as independent risk-factors of atherosclerosis; the nervous stress, obesity excess consumption of the carbohydrates, smoking and low HDLChol level play the additional pathogenic role. The results analysis indicates both the diagnostic value of redox status indicators and their leading role in the atherogenesis processes. In populations with a high risk of atherosclerosis, monitoring of serum TAA is recommended. TChol – total cholesterol LDLChol – low-density lipoprotein cholesterol HDLChol – high-density lipoprotein cholesterol Tg – triglycerides Fn – fibrinogen; CPR - C reactive protein ECG – Electrocardiography TAA - total antioxidant activity MDA – Malondialdehyde TBA - Thiobarbitoric acid ANOVA - Analysis of variance BMI - body mass index