Distribution of ABO Blood Group and Major Cardiovascular Risk Factors with Coronary Heart Disease

AdvisorAsst.prof. Aungsana Yothinarak

Presentaion by Mrs.Buaphet Sriphet 5401225 Miss Amornrat klongkaew 5400404

Introduction

ABO blood groupThe ABO blood group

system is the most important blood type system (or blood group system) in human blood transfusion. The associated anti-A and anti-B antibodies are usually IgM antibodies, which are produced in the first years of life by sensitization to environmental substances such as food, bacteria, and viruses. ABO blood types are also present in some other animals, for example rodents, apes such as chimpanzees, bonobos, and gorillas.

History

• The ABO blood group system is widely credited to have been discovered by the Austrian scientist Karl Landsteiner, who identified the O, A, and B blood types in 1900.

• Landsteiner originally described the O blood type as type "C", and in parts of Europe it is rendered as "0" (zero), signifying the lack of A or B antigen. Landsteiner was awarded the Nobel Prize in Physiology or Medicine in 1930 for his work.

• Alfred von Decastello and Adriano Sturli discovered the fourth type, AB, in 1902.

ABO blood group antigens present on red blood cells

and IgM antibodies present in the serum

Coronary Heart disease

Is the most common type of heart disease and cause of heart attacks.The disease is caused by plaque building up along the inner walls of the arteries of the heart, which narrows the arteries and reduces blood flow to the heart.

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Risk factors

• Hypercholesterolemia

• Smoking• Hypertension • Hyperglycemia • Genetics• High levels of

Lipoprotein(a)

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Diagnosis

• Baseline electrocardiography (ECG)

• Exercise ECG – Stress test• Exercise radioisotope test

(nuclear stress test, myocardial scintigraphy)

• Echocardiography (including stress echocardiography)

• Coronary angiography• Intravascular ultrasound• Magnetic resonance imaging

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Atherosclerosis

Cardiac Marker

Reviews

M. H. Fox (1986)

H. Egawa,(2004)

the explanation for the association between ABO blood groups types in a biracial sample of youths. dependent variables included blood pressure , serum lipid and lipoprotein levels anthropometric variables .showed variables including beta-lipoprotein cholesterol, systolic blood pressure, and the ponderal index were sufficient to discriminate between individuals possessing the B antigen (B and AB) and those not possessing the B antigen (A and O) ABO group system has been of interest, due to its medical importance in intrahepatic biliary complications and hepatic necrosis in ABO-incompatible living-related grafts (18% and 8%, respectively) was significantly (P<0.0001) greater than in ABO-compatible and ABO-identical grafts (both 0.6% and 0%, respectively).

Reviews

Ohira T. (2007 )

Biswas S . (2008)

The ABO blood group system is the most important system for blood group compatibility. However may have additional consequences on other factors that might also contribute to the risk of thrombosis for sex, race, body mass index, diabetes mellitus and FVIII c reduces the OR: 1.31 (95% CI, 1.02-1.68). Factor V Leiden (FV Leiden) . found that frequency of A blood group was more than any other ABO blood groups in CHD patients. found apoB (OR 2.96; 95% CI 1.02-8.54), apoB/HDL-c (OR 4.14; 95% CI 1.33-12.83), non HDL-c (OR 5.41; 95% CI 2.08-14.10), apoB/apoA I (OR 6.64; 95% CI 2.37-18.57), and LDL particle size (9.59; 95% CI 2.92-31.54) were independently associated with CHD. Area under the ROC curves derived from the model (AUROC 0.947; 95% CI 0.916-0.977) are significantly higher than any other variables.

Background

Blood type may affect heart disease risk , blood type affect their risk for heart disease, study that finds people with blood type A, B or AB were more likely to develop the disease than those with type O.

• Explore the relation between ABO blood group and coronary heart disease in Asian Indian Bengali population of eastern part of India.

• Examine the relation between ABO blood group and cardiovascular risk factors

Objective

Subject: Asian Indian Bengali population of eastern part of India.

Method

Patients(n = 250) Coronary heart disease

Controls (n = 250)Healthy

Inclusion criterias• Angina and evidence of ischemia or

infarction after electrocardiographic study, tread mill test, stress echo

• Chest pain• Bengali eastern part of IndiaExclusion criterias• Taken any lipid-lowering drugs

The study was approved by the ethics committee of the institute involved.

All patients were admitted to the hospital within 12 hours of the onset of chest pain.

Blood samples for biochemical analysis.

Blood samples were collected by vein puncture into vacuum tubes containing EDTA.

Method

ABO blood group

TC,HDL-c,TG,LDL-c.

ABO blood group by Slide MethodPrinciple

• The direct or forward grouping requires known anti-A and anti-B typing antiserums for testing unknown cells.

• The forward typing antigen-antibody reaction results in visible agglutination of the red blood cells determining the blood groups A and B and AB.

• No agglutination with anti-A, anti-B, determines the amorphous, group O.

Total cholesterol(CHOD-PAP method)

Principle

Cholesterol ester + H2O Cholesterol

esterase Cholesterol + fatty acidCholesterol + O2 Cholesterol

oxidase Cholest-4-ene-3-one + H2O2

2H2O2+phenol+4-aminoantipyrine Peroxidase

quinoneimine+ 4H2O

Biochemical substance analysis

• Cholesterol esters are enzymatically hydrolyzed by cholesterol

esterase (CE) to cholesterol and free fatty acids.• Free cholesterol, including that originally

present, is then oxidizedby cholesterol oxidase (CHOD) to cholest-4-en-3-one and H2O2.• In presence of peroxidase (POD), the

formed hydrogen peroxideformed effects the oxidative coupling of phenol and 4-aminoantipyrine (4-AAP) to form a red-colored quinoneimine dye. • The intensity of the color produced is

directly proportional to cholesterolconcentration. It is determined by measuring the increase in absorbance at500 – 550 nm.

High density lipoprotein cholesterol (HDL-c)

Precipitation method• Precipitating reagents such as divalent

cations and polyanions(heparin-Mn2+,polyethylene glycol) are used to remove apo B-containing Lipoproteins except HDL

• Enzymatic method for total cholesterol measurement in HDL

Principle• When the serum is reacted with the

Polyethylene Glycol contained in the precipitating reagent, all the VLDL and LDL are precipitated.

• The HDL remains in the supernatant and is then assayed as a sample for cholesterol using the Cholesterol (CHOD/PAP) reagent.

• The intensity of the color produced is directly proportional to cholesterol concentration. It is determined by measuring the increase in absorbance at500–550 nm.

Triglyceride(Enzymatic-colorimetric method)

Principle

• Used the enzymatic hydrolysis of the triglycerides by lipase to glycerol and free fatty acid.

• The glycerol released is subsequently measured by a coupled enzymatic reaction system.

• The glycerol formed in reaction 1 is phosphorylated to glycerol-3-phosphate in a reaction catalyzed by glycerol kinase.

• The glycerol-3-phosphate is oxidized by glycerol phosphate oxidized producing dihydroxyacetone phosphate and hydrogen peroxide.

• Peroxidase catalyzes the redox-coupled reaction of H2O2 with 4-aminoantipyrine and 4-chlorophenol,producing a brilliant purple color.

• The absorbance is measured at 540nm.

Triglyceride Lipase glycerol + fatty acidsGlycerol +ATP GK Glycerol-3-phosphate +ADPGlycerol-3-phosphate+O2

GPO Dihydroxyacetone-phosphate +H2O2

2H2O2+4-aminoantipyrine+4chlorophenol POD

quinoneimine+HCl + 4H2O

LDL-cholesterol(mg/dL) = Total cholesterol − HDL-cholesterol - Triglyceride

5

***Limit at Triglyceride≤400mg/dL

low density lipoprotein cholesterol (LDL-c) Friedewald formula

Statistic analysis

• The association between different parameter and risk of CHD was examined by estimating odd ratios(ORs) with corresponding 95% confidence intervals(Cis)

• using univariate logistic regression analysis.Multivariate analysis was performed using multiple logistic regression to assess

• the independent adjusted relationship between different variables and CHD with independent variables being those with P ≤0.05

Results

• In the present study, we determined the frequency of ABO blood antigens in CHD patients and healthy controls.

• Our result showed that the AB blood group decreases the risk of CHD in healthy controls, while the O blood group is more frequent in CHD patients and increases the risk of CHD.

• The results obtained in this study show that, in this Bengali Asian Indian population of, the prevalence of CHD in blood group O is invariably higher than in all other ABO blood groups, but Whincup et al. from England and from other parts of Europe or USA found that frequency of A blood group was more than any other ABO blood groups in CHD patients.

Discussion

• In the analyses of the relation between the ABO blood group and major cardiovascular risk factors the only association of note was that O blood group, probably by association with lower HDL-c levels, smoking habit, and family history, significantly increases the risk of CHD and contributes sub-stantially to the incidence of CHD in the studied populations.

• In the two previous reports only association was found between blood group A and serum total cholesterol concentration among the major cardiovascular risk factors. The higher concentrations of HDL-c in subjects of blood group AB seemed to contribute to the protective role of CHD events in subjects of controls group.

• The limitation of the present study is the lack of follow- up data, mostly due to the lack of patient compliance. We have also a limitation in our study regarding the estimation of the extent and burden of atherosclerosis by doing coronary angiography and multidetector row computed tomography.

• The racial and ethnic distribution of blood groups and size of sample are important factors for predicting the CHD risk.

• Blood type needs to be considered together with other risk factors to understand the individual patient’s risk.

• The identification of genetic and environmental factors among racial and ethnic groups should offer some insights into the observed epidemiological data and advance opportunities to better understand the control and development of CHD.

Conclusion

Structure of ABO blood

group

Steps to Atherosclerosis

Formation

Electrocardiography

 is the recording of the electrical activity of the heart. Traditionally this is in the form of a transthoracic (across the thorax or chest) interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the surface of the skin and recorded or displayed by a device external to the body.[3] The recording produced by this noninvasive procedure is termed an electrocardiogram (also ECG or EKG). It is possible to record ECGs invasively using an implantable loop recorder.

Cardiac stress test

is a test used in medicine and cardiology to measure the heart's ability to respond to external stress in a controlled clinical environment.The stress response is induced by exercise or drug stimulation. Cardiac stress tests compare the coronary circulation while the patient is at rest with the same patient's circulation observed during maximum physical exertion, showing any abnormal blood flow to the heart's muscle tissue (the myocardium). The results can be interpreted as a reflection on the general physical condition of the test patient. This test can be used to diagnose ischemic heart disease, and for patient prognosis after a heart attack (myocardial infarction).

Scintigraphy

 is a form of diagnostic test used in nuclear medicine, wherein radioisotopes (here calledradiopharmaceuticals) are taken internally, and the emitted radiation is captured by external detectors (gamma cameras) to form two-dimensional[1]

 images. In contrast, SPECT and positron emission tomography (PET) form 3-dimensional images, and are therefore classified as separate techniques to scintigraphy, although they also use gamma cameras to detect internal radiation. Scintigraphy is unlike a diagnostic X-ray where external radiation is passed through the body to form an image.

Coronary catheterizationA coronary

catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of theheart using a catheter. It is performed for both diagnostic and interventional (treatment) purposes.

Electrocardiography

Echocardiogram, often referred to as a cardiac echo or simply an echo, is a sonogram of the heart. (It is not abbreviated as ECG, which in medicine usually refers to an electrocardiogram.) Echocardiography uses standard two-dimensional, three-dimensional, andDoppler ultrasound to create images of the heart.

Intravascular ultrasound

Intravascular ultrasound (IVUS) is a medical imaging methodology using a specially designed catheter with a miniaturized ultrasoundprobe attached to the distal end of the catheter. The proximal end of the catheter is attached to computerized ultrasound equipment. It allows the application of ultrasound technology, such as piezoelectric transducer or CMUT, to see from inside blood vessels out through the surrounding blood column, visualizing the endothelium (inner wall) of blood vessels in living individuals.

Magnetic resonance imaging

Magnetic resonance imaging (MRI), nuclear magnetic resonance imaging (NMRI), or magnetic resonance tomography(MRT) is a medical imaging technique used in radiology to investigate the anatomy and function of the body in both health and disease. MRI scanners use strong magnetic fields and radiowaves to form images of the body. The technique is widely used in hospitals for medical diagnosis, staging of disease and for follow-up without exposure to ionizing radiation.

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