Relationship between ischemia modified albumin (IMA) in Different Age Groups and Gender Variance


The purpose of the study was to find the relationship between ischemia modified albumin (IMA) in different age groups and gender variance.IMA has been found to be present in high levels in cardiac ischemic patients. Many studies have been done on the relationship of other biomarkers such as troponin to gender and different age groups (Rodriguez-Ospina, 331; Wiviott et al, 1415).Therefore, further research need to be done to find out whether there exist differences in the levels of IMA between different age groups, and also in gender. The results of the study will be helpful in correct diagnosis of cardiac ischemia among patients, in addition to stratification of the patients that suffer from acute chest pains. Correct diagnosis means immediate treatment and management of the cardiac ischemia before it destroys the myocytes.


Cardiac bio makers According to Rodriguez-Ospina et al (14) are substances released by the heart into the blood stream when it is stressed or damaged. Measurement of the released bio makers in the blood stream is helpful in diagnosis, monitoring, risk stratification and in management of people suspected to have cardiac ischemia and acute coronary syndrome (ACS). Cardiac ischemia results when blood supply that goes to the tissues of the heart is not enough to meet the needs of the heart. This results in a sudden blood decrease and oxygen that reaches the heart. Tousoulis et al (15) highlighted some of the different types of cardiac biomarkers tests but the most used and effective one is the troponin test. However, cardiac troponin is only specific and sensitive for detection of damage in myocardium, but sometimes may not rise in there is reversible myocardial ischemia. Further research is needed to clarify whether pathophysiological differences that are gender related exist in acute coronary syndromes presentation. The aim of the study was to find out the levels of IMA in different age groups and gender variance


Ninety six patients with acute chest pain between age group 30-60years admitted in ICCU of hospital participated in the study. Among these subjects, 40 were male and 56 were female.  Of the 96 patients, 16 of them had no evidence of myocardial ischemia. They were categorized as group II. The remaining 80 patients with evidence of myocardial ischemia were categorized into group I. About 41% of the patients of group I was between 50-60 years of age. The control group of healthy subjects was 28, of which 10 were males and 18 females.

Patients were evaluated as being non ischemic or potentially ischemic through standard coronary disease indicators [(CK), CK-MB, LDH and electrocardiography findings and were tested by a Co (II)-albumin binding assay for IMA. The patients of ischemic group (group 1) were further divided in to three groups based on their age &sex as follows; 30-40 years (M&F), 40-50 years (M&F), and 50-60 years (M&F).



Table: Age wise distribution of cardiac markers in Ischemic group     



Age 30-40yrs 40-50yrs 50-60yrs
Sex Males (n=11) Females (n=13) Males (n=9) Females (n=14) Males (n=14) Females (n=19)
CK (IU/l)

Mean ± SD

102±18.0 80±22.0 96±28.0 94±26.0 115±48.0 124±36.0
CK-MB (IU/l)

Mean ± SD

10±1.26 12±2.6 18±1.0 24±1.6 52±6.0 56±4.8

Mean ± SD

210±6.0 160±5.0 156±4.8 166±6.5 198±10.6 225±6.4

Mean ± SD

0.31±0.06 0.28±0.04 0.30±0.02 0.36±0.05 0.48±0.06 0.51±0.06



Many important findings regarding IMA in different age groups and gender variance in Ischemic patients presenting with Co (II)-albumin binding assay for IMA have emerged from the analysis. Similarly, Women had a higher likelihood of having IMA biomarker compared to men who were ischemic; this is in correlation to a study done by Kazanis et al (78). Further analysis indicated that, as age increases (from 40 to 60 years) IMA levels get elevated among the ischemic patients. The study also shows correlation to a study done by Bar-Or et al (12) where myocardial ischemic patients had elevated assay levels ((0.529±0.086)), and for the age group of 50 to 60 years which had higher levels of IMA. The clinical diagnosis was assigned and correlated with standard biomarker (CK, CK-MB, and LDH) test results which were high compared with group II (0.316±0.092) with no evidence of myocardial ischemia (Bar-Or et al, 12). High levels of the IMA in women and the elderly is an indication that the accuracy of diagnosis of coronary heart diseases such as cardiac ischemia has been increased. The application of IMA to detect ischemia before destruction of the myocardium muscles will be helpful in treating the elderly who mostly suffer from the cardiac diseases such as cardiac ischemia. Furthermore, it would be helpful in stratification of the patients who have cardiac ischemic and normal chest pains (radha et al, 225).  In the recent studies have indicated that Ischemia Modified Albumin (IMA) is very sensitive and effective biochemical marker of ischemia (Gaze, 337; Sinha et al, 209|).  During ischemic attack, IMA is produced and is present in blood in concentrations that is easily detectable. Recent studies have also indicated that there exist differences in the levels of biomarkers in gender but minimal differences in different age groups (Kazanis et al, 2; Mowafy et al, 146). Chawla et al (79) indicated that diagnosis of diseases of the coronary artery in women is more difficult. This is because of lower diagnostic accuracy of the non invasive tests and lower symptoms specificity. In their study, they found out that in patients with Non-ST-Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA), there existed different patterns of biomarkers presentation. For instance, men had had a higher likelihood of elevated troponins and creatine kinase-MB. Women, on the other hand, had a higher likelihood of having elevated brain natriureitic peptide and C-reactive protein. Similarly, age differences exist in the level of bio makers. The levels of Brain Natriuretic peptide (BNP) are higher in older populations and women compared to men (Yakut et al, 173).


In conclusion, despite the gender and age differences, IMA were higher in women, and gets elevated as age increases in ischemic patients. This is a breakthrough for the elderly and the women who are ailing from cardiac ischemia or just experience chest pain. Correct diagnosis would enable them get people treatment on time.


Work Cited

Bar-Or, D, E Lau, and JV Winkler. “A Novel Assay for Cobalt-Albumin Binding and Its Potential As a Marker for Myocardial Ischemia-a Preliminary Report.” The Journal of Emergency Medicine. 19.4 (2012): 311-5. Print., Govender, Radha, De Greef, Jacques, Delport, Rhena, Becker, Piet J., & Vermaak, William J.H.”Biological Variation of Ischaemia-Modified Albumin in Healthy Subjects. Clinics Cardiv, 2009.” Internet resource.

Rodriguez-Ospina, LF, CP Rosales-Alvarez, and A Lopez-Mas. “Cardiac Biomakers for the Evaluation of Acute Coronary Syndrome.” Boletín De La Asociación Médica De Puerto Rico. 101.4 (2009). Print.

Sinha, M, Roy, D, Gaze, D, Collinson, P, & Kaski, J. “Role of “ischemia Modified Albumin”, a New Biochemical Marker of Myocardial Ischaemia, in the Early Diagnosis of Acute Coronary Syndromes.” BMJ Group, 2014. Print

Wiviott, Stephen D, Christopher P. Cannon, David A. Morrow, Kausik K. Ray, Marc A. Pfeffer, and Eugene Braunwald. ” Differential Expression of Cardiac Biomarkers by Gender in Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction.” Journal of the American College of Cardiology. 46.8 (2011): 1411-1416. Print.

Januzzi, James L. Cardiac Biomarkers in Clinical Practice. Sudbury, Mass: Jones and Bartlett Publishers, 2009. Print.

Tousoulis, Dimitris, and Christodoulos Stefanadis. Biomarkers in Cardiovascular Diseases. Boca Raton: CRC Press, 2013. Print.

Kazanis, K, M Dalamaga, C Nounopoulos, AS Manolis, N Sakellaris, G Jullien, and A Dionyssiou-Asteriou. “Ischemia Modified Albumin, High-Sensitivity C-Reactive Protein and Natriuretic Peptide in Patients with Coronary Atherosclerosis.” Clinica Chimica Acta; International Journal of Clinical Chemistry. 408 (2009): 1-2. Print.

Mowafy, H.H, M Hamdi, M Khaled, and M Ashraf. “The Role of Ima in Ruling Out Ischemia in Patients Presenting with Chest Pain, and Its Relation with the Extent of Coronary Artery Disease.” Egyptian Journal of Critical Care Medicine. 1.3 (2013): 145-149. Print.Chawla, R, N Goyal, R Calton, and S Goyal. “Ischemia Modified Albumin: a Novel Marker for Acute Coronary Syndrome.” Indian Journal of Clinical Biochemistry : Ijcb. 21.1 (2010): 77-82. Print.

Yakut, Ibrahim, Cüneyt Tayman, Osman Oztekin, Mehmet Namuslu, Fahri Karaca, and Aydın Kosus. “Ischemia-modified Albumin May Be a Novel Marker for the Diagnosis and Follow-Up of Necrotizing Enterocolitis.” Journal of Clinical Laboratory Analysis. 28.3 (2014): 170-177. Print.

Gaze, DC. “Ischemia Modified Albumin: a Novel Biomarker for the Detection of Cardiac Ischemia.” Drug Metabolism and Pharmacokinetics. 24.4 (2009): 333-41. Print.

Aparci, M, E Kardesoglu, N Ozmen, O Ozcan, BS Cebeci, BY Cingozbay, and M Dincturk. “Prognostic Significance of Ischemia-Modified Albumin in Patients with Acute Coronary Syndrome.” Coronary Artery Disease. 18.5 (2011): 367-73. Print.

Charpentier, Sandrine, Jean L. Ducassé, Maxime Cournot, Françoise Maupas-Schwalm, Meyer Elbaz, Cécile Baixas, Henri Juchet, Thierry Lang, and Dominique Lauque. “Clinical Assessment of Ischemia-Modified Albumin and Heart Fatty Acid-Binding Protein in the Early Diagnosis of Non-St-Elevation Acute Coronary Syndrome in the Emergency Department.” Academic Emergency Medicine. 17.1 (2010): 27-35. Print.

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