Blood viscosity increases the degree of coronary stenosis in coronary heart disease

Main Article Content

Antonius Ferika Indrianto
Indranila Kustarini Samsuria
Kusmiyati Deddy Kurniawan

Abstract

Background
Endothelial dysfunction and associated increased blood viscosity (BV) play an important role in the formation of atherosclerosis during inflammatory processes. C-reactive protein (CRP) is a biomarker of inflammation with an active role in endothelial dysfunction and development of atherosclerosis that is marked by degree of coronary stenosis (CS). The purpose of this study was to determine the relationship of BV and CRP with varying degrees of CS among coronary heart disease (CHD) patients.

Methods
This cross-sectional study involved 24 subjects taken consecutively among patients with CHD who underwent angiography. Blood viscosity levels were determined using an Ostwald viscometer, with reference limits of 1.5 to 1.72 (cP). C-reactive protein was determined by turbidimetric immunoassay, with a normal reference value of <3 mg/L. Degree of CS was examined with angiography, where 0% = no stenosis; <50% = nonsignificant stenosis; > 50% = significant stenosis. Data was analyzed using non-parametric Spearman correlation test.

Results
There were 17 male and 7 female subjects, with mean age of 55.96 ± 7.29 years. The angiography results were: non-significant stenosis in 2 subjects (8.3%), significant stenosis in 22 subjects (91.7%) and none with normal stenosis. Statistical analysis of the relationship of BV with degree of CS found a moderate significant positive relationship (r=0.549; p=0.005). A poor significant positive relationship was found between CRP and degree of CS (r=0.481; p=0.017).

Conclusion
Blood viscosity increased the degree of CS in CHD patients. Therapy should target both BV-associated risk and angiographically evident stenosis.

Article Details

How to Cite
Indrianto, A. F., Samsuria, I. K., & Kurniawan, K. D. (2015). Blood viscosity increases the degree of coronary stenosis in coronary heart disease. Universa Medicina, 34(3), 168–176. https://doi.org/10.18051/UnivMed.2015.v34.168-176
Section
Review Article

References

World Health Organization. Cardiovascular diseases. Geneva: World Health Organization; 2015.

Dinas Kesehatan Jawa Tengah. Profil kesehatan Provinsi Jawa Tengah. Dinas Kesehatan. Jawa Tengah. Available at: http://www.dinkes jatengprov.go.id/dokumen/profil/profile2004/bab5.htm. Accessed March 21, 2014.

Suwaida JA, Hamasaki S, Higano ST, et al. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation 2000;101:948-54.

Ganz P, Hsue PY. Endothelial dysfunction in coronary heart disease is more than a systemic process. Eur Heart J 2013;34:2025-7.

Froom P. Blood viscosity and the risk of death from coronary heart disease. Eur Heart J 2000; 21:513-4.

Kesmarky G, Feher G, Koltai K, et al. Viscosity, hemostasis, and inflammation in atheroscerotic heart diseases. Clin Hemorheol Microcirc 2006; 35:67-73.

Cecchi E, Mannini L, Abbate R. Role of hyperviscosity in cardiovascular and microvascular diseases. G Ital Nefrol 2009;26: 20-9.

Lee BK, Durairaj A, Mehra A, et al. Hemorheological abnormalities in stable angina and acute coronary syndromes. Clin Hemorheol Microcirc 2008;39:43-51.

Libby P, Ridker PM, Hansson GK. Inflammation in atherosclerosis.2009;54:2129-38.

Hansson GK, Robertson AK, Soderberg-Naucler C. Inflammation and atherosclerosis. Annu Rev Pathol 2006;1:297-329.

Buckley DI, Fu R, Freeman M, et al. C-reactive protein as a risk factor for coronary heart disease: a systemic review and meta-analysis for the US preventive service task force. Ann Intern Med 2009;151:483-95.

Kilicarslan A,Uysal A, Roach EC. Acute phase reactants. Acta Medica 2013;2:2-7.

Nyandak T, Gogna A, Bansal S, et al. High sensitive C-reactive protein (hs-crp) and its correlation with angiographic severity of coronary artery disease (CAD). JIACM 2007; 8:217-21.

Ulucay A, Demirbag R, Yilmaz R, et al. The relationship between plasma c-reactive protein levels and presence and severity of coronary stenosis in patients with stable angina. Angiology 2008;58:657-62.

Habib SS, Al Masri AA. Relationship of high sensitivity C-reactive protein with presence and severity of coronary artery disease. Pak J Med Sci 2013;29:1425-9.

Ergun CK, Gurel EI, Ozeke O, et al. Blood viscosity changes in slow coronary flow patients. Clin Hemorheol Microcirc 2011;47:27-35.

Ridker PM. High-sensitivity C-reactive protein potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation 2001;103:1813-8.

Chatzizisis YS, Coskun AU, Jonas M, et al. Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling. JACC 2007;49:2379–93.

Toth A, Szukits S, Varady E, et al. Hemorheology parameters in coronary artery disease detected by multi-slice CT. Korea-Australia Rheology J 2014;26:229-35.

Hasnat MA, Islam AEMM, Chowdhury AW, et al. High sensitive C-reactive protein (hs-crp) and its correlation with angiographic severity of patient with coronary artery disease (CAD). J Dhaka Med Coll 2010;19:91-7.

Momiyama Y, Ohmori R, Fayad ZA, et al. Association between plasma C-reactive protein levels and the severities of coronary and aortic atherosclerosis. J Atheroscler Thromb 2010;17: 460-7.

Piranfar MA. The correlation between high-sensitivity C-reactive protein (hscrp) serum levels and severity of coronary atherosclerosis. Int Cardiovasc Res J 2014;8:6-8.

Masood A, Jafar SS, Akram Z. Serum high sensitivity C-reactive protein levels and these verity of coronary atherosclerosis assessed by angiographic Gensini score. J Pak Med Assoc 2011;61:325-7.

Lai CL, Ji YR, Liu XH, et al. Relationship between coronary atherosclerosis plaque characteristics and high sensitivity C-reactive proteins, interleukin-6. Chin Med J 2011;124: 2452-6.

Ciccone MM, Scicchitano P, Zito A, et al. Correlation between inflammatory markers of atherosclerosis and carotid intima-media thickness in obstructive sleep apnea. Molecules 2014;19:1651-62.

Osman RL, Allier PL, Elgharib N, et al. Critical appraisal of C-reactive protein throughout the spectrum of cardiovascular disease. Vasc Health Risk Manag 2006:2:221–37.

Dawson B, Trapp RG. Basic & Clinical Biostatistics. 4th ed. New York: Lange Medical Books/McGraw-Hill;2004.