Relationship between IMA in Different Age Groups and Gender Variance

Relationship between IMA in Different Age Groups and Gender Variance

Abstract

The purpose of the study was to find the relationship between 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.

Introduction

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. ACS results from plaque rapture that causes blood clot formation in the coronary arteries. This results in a sudden blood decrease and oxygen that reaches the heart. Rodriguez-Ospina 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. In contrast, recent studies have indicated that Ischemia Modified Albumin (IMA) is very sensitive and effective biochemical marker of ischemia (Wiviott et al, 1414; 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 (Sinha et al, 72; radha et al, 225). Wiviott et al (1413) 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 (Wiviott et al, 1413). 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

Methods

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.

Of the 80 ischemic patients (group I) 34 were males and 46 females. The mean±SD age for the males was 50± 6.8 years and the female was 58±10.1 years. The control group was made up of 10 males and 18 females, and the mean±SD age was 45±8.6 years and 56±10.6 years respectively.

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).

Results

The mean±SD of CK-MB for the age group 30-40 years was normal in both males and females. But for the females of age group 40-50years it was higher (24±1.6) compared to males. Likewise, in the age group of 50-60 years in females the CKMB values (56±4.8) had high mean than males (52±6.0) .In addition  to CK-MB, the LDH values were also higher in females (225±6.4)  than males (198±10.6) .The LDH levels were  normal in other  two  groups. 

Discussion

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. Women had a higher likelihood of having IMA biomarker compared to men who were ischemic. 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 D, Lau E, Winkler JV where myocardial ischemic patients had elevated assay levels, and for the age group of 50 to 60 years which had higher levels of IMA (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).

Conclusion

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

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, 2004. Print

[email protected], 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, 2008.” Internet resource.

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 (2005): 1411-1416. Print.

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 (2000): 311-5. Print.

Appendix:

Table No I: Age distribution in ischemic and control groups:

Ischemic subjects

(n=80)

Control group

(n=28)

Males(n=34)

Mean ± SD

Females(n=46)

Mean ± SD

Males(n=10)

Mean ± SD

Females(n=16)

Mean ± SD

50±6.8Years 58±10.1Years 45±8.6Years 56±10.6Years

 Table no II: Age wise distribution of cardiac markers in Ischemic group      

Table no III Mean ± SD of males & females in Ischemic & non isch

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