Coronary heart disease detection

There is a close correlation between myocardial infarctions and tachyarrhythmias, illustrated by the presence of complex ventricular arrhythmias among heart attack victims which are estimated to affect one-third of the survivors each year. Frequendy, the immediate cause of sudden death is ventricular fibrillation, an extreme arrhythmia that is difficult to detect or treat. In the majority of cases, victims have no prior indication of coronary heart disease. 

It is unlikely that the damaging effects of ox-LDL are relevant only to the walls of blood vessels and there is no reason to suppose they are confined to one disease. The initial histopathologjcal sign of coronary heart disease is the appearance of the fetty streak on the luminal surfece of arteries. Fatty streaks are composed of aggregated macrophages that have taken up ox-LDL via the scavenger receptor. Recently, we have detected such foam cells in the rheumatoid synovium (Section 5.5). 

No human health effects have been detected at COHb blood levels below about 2% ( background levels in non-smokers average about 0.5%). Subtle effects on the nervous system, such as reduced ability to sense certain time intervals, have been reported at blood levels of 2.5%. At COHb levels of 5% certain cardiovascular changes are detectable, especially in patients with coronary heart disease. Heavy smokers exhibit COHb levels in the range of 5-6%, and if they happen to be pregnant, the fetus can suffer the effects of oxygen deprivation. 

Relationship of serum cholesterol to deaths from coronary heart disease in 36,662 men aged 35-37 years during an average followup period of 6 years. Each point represents the median value for 5% of the population. (From Report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. NIH Publication 88-2925, 1988). 

Heterozygous carriers of functionally relevant mutations usually present with HDL cholesterol levels that are frequently below the fifth percentile. As would be expected, apoA-I levels are also frequently below the fifth percentile (i.e., < 1.05 g/1 and < 1.1 g/1 in Caucasian men and women, respectively). In most cases, heterozygous carriers of apoA-I variants do not present with specific clinical symptoms. An important exception are some structural apoA-I variants with amino acid substitutions in the amino terminus, which have been detected in patients with familial amyloidosis of the liver, the intestine, the kidney, the heart, peripheral nerves, and in the skin. In addition, some apoA-I variants like apoA-I L178P or L159P have been associated with increased risk of premature coronary heart disease or enhanced progression of carotid intima media thickness, whereas others did not show this association, or were even claimed to have reduced cardiovascular risk and advocated as possible agents for the treatment or prevention of atherosclerosis (notably apoA-I R173CMiiano) [22,43,53]. 

It has been clear for several decades that an elevated concentration of plasma cholesterol attributable to increased concentrations of atherogenic lipoproteins (low-density lipoproteins [LDL] and remnant lipoproteins) is a major risk factor for the development of coronary heart disease (CHD) (Castelli et al., 1992 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, 1993). The cholesterol biosynthetic pathway (Fig. 1) was a natural target in the search for drugs to reduce plasma cholesterol concentrations in the hope that these treatments would reduce the risk of CHD. However, early attempts to reduce cholesterol biosynthesis were disastrous. Tri-paranol, which inhibits the penultimate step in the pathway, was introduced into clinical use in the mid-1960s but was withdrawn from the... 

ATC Antithombotic Trialists Collaboration ATP III Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) CAD coronary artery disease CHD coronary heart disease CVD cardiovascular disease FDA Food and Drug Administration HF heart failure... 

The second hypothesis deals with the construction heath profiles for early detection of coronary heart disease (CHD). This research involves relationships of oxysterols and DHEAS with the pathogenesis of atherosclerosis. 

Heath Proflles for Early Detection of Coronary Heart Disease... 

Normal human blood plasma contains 130-260 mg cholesterol per 100 ml, of which two-thirds is esterified with fatty acids and one-third is present as sterol [165]. Estimation of cholesterol has attracted much attention as the increased level of blood cholesterol is directly related to coronary heart diseases such as hypertension, atherosclerosis, and myocardial infarction. The CP nanocomposites have provided a suitable pathway for the operation of the biosensor by immobilization of the biomolecule on CP for detection of different analytes. A smart, quick, accurate determination of cholesterol in blood is an urgent need in clinical diagnosis. The following biochemical reaction occurs as a result of interaction of cholesterol oxidase (ChOx) with cholesterol ... 

Detection of cholesterol plays an important role in the biomedical field and in improving the quality of life as its abonormal levels lead to the symptoms of several diseases, such as hypertension, coronary heart disease, arteriosclerosis, brain thrombosis, lipid metabolism dysfunction, and... 

Brown and Goldstein studied LDL metabolism in cells from patients with a common metabolic inherited disorder called familial hypercholesterolemia FH). People homozygous for this mutation have a 6- to 10-fold elevation of LDL levels, are born with detectable atherosclerosis, and usually do not survive childhood without a myocardial infarction. Heterozygotes have two- to fourfold elevations in LDL and suffer from coronary heart disease (CHD) during middle age (85% of FH heterozygotes have a heart attack before the age of 60.) FH is the most common inherited metabolic disorder in humans, with a gene frequency of 1 in 500, i.e., 1 in 500 people is a heterozygote for FH. 

The fact that the microbubbles are restricted to the vascular space makes them ideal for contrast echocardiography and vascular imaging. Echocardiography is used extensively to assess ischemic heart disease. Contrast-enhanced echocardiography improves visualization of the cavities of the heart, the lumen of arteries and veins, and small vessels within solid organs and perfused tissues. Effective endocardial border delineation allows assessment of global heart function and the detection of coronary insufficiency (Fig. 12). 

Lipoprotein disorders are detected by measuring lipids in serum after a 10-hour fast. Risk of heart disease increases with concentrations of the atherogenic lipoproteins, is inversely related to levels of HDL, and is modified by other risk factors (Table 35-1). Evidence from clinical trials suggests that LDL cholesterol levels of 60 mg/dL may be optimal for patients with coronary disease. Ideally, triglycerides should be below 120 mg/dL. Differentiation of the disorders requires identification of the lipoproteins involved (Table 35-2). Diagnosis of a primary disorder usually requires further clinical and genetic data as well as ruling out secondary hyperlipidemias (Table 35-3). 

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