Discussion Of The Risk Factors Of Acute Myocardial Infarction And Effects Of Folic Acid On Homocysteine Levels

Objective Through inquiring in full the age,gender,family history,the history of smoking and drinking,body weight,body height,the history of hypertension disease and diabetes of the patients,and checking the levels of blood glucose,blood fat and plasma homocysteine(Hcy), to discuss the risk factors and the states of coronary artery pathological changes of acute myocardial infarction(AMI) in middle-age and young patients ; to understand the relation of the plasma Hcy levels and the morbility of AMI; to determine the role of folic acid in the plasma Hcy levels in the patients.Methods The middle-age and young patient group comprised 21 AMI patients who were less than or equal to 60 years old. The old patient group comprised 30 AMI patients who were greater than or equal to 60 years old, otherwise,the control group was composed of 22 patients who were removed the diagnosis of coronary artery disease(CAD).The risk factors and the states of coronary artery pathological changes were analyzed in two groups of AMI patients.All 73 patients took 5mg of folic acid every day for 12 weeks.drew blood before and after the treatment.The plasma Hcy levels were measured by using enzyme-labeled immunosorbent assay(ELISA). Then observed the change of the plasma Hcy levels before and after the treatment,and understood the relation of the plasma Hcy levels and the morbility of AMI and the effect of the gender on the plasma Hcy levels.Results 1. The pairing Chi-square test showed that male,the family history of early onset CAD ,excessive smoking,excessive drinking and hyperhomocysteinemia were concerned with middle- age and young AMI patients(p<0.05, p<0.01) and the history of hypertensive disease and diabetes,hyperlipoidemia and hyperhomocysteinemia were relevant to old AMI patients (p<0.05,p<0.01). By single and multivariate non-conditional Logistic regression analysis,The final model was composed of male(OR=1.636), hyperhomocysteinemia (OR=1.554), excessive drinking(OR=5.556), excessive smoking(OR=14.006)and the family history of early onset CAD(OR=4.765),which was significant relation with middle-age and young AMI patients;but diabetes(OR=4.581), hypertensive disease (OR= 3.764), hyperhomocysteinemia(OR=1.297) and hyperlipoidemia were obvious relation with old AMI patients.2. The levels of total cholesterol,triglycerides and blood glucose of the old AMI patients group were higher than those of the middle-age and young AMI patients group.There was statistical significance;but the levels of plasma homocysteine of the middle-age and young AMI patients group were obviouly greater than those of the old AMI patients group.The difference was same striking(p<0.01).3. The middle-age and young AMI patients often generated pathological changes in one coronary artery and the incidence exceeded the old AMI patients evidently.The difference was obvious(p<0.01);but the old AMI patients usually developed pathological changes in many coronary arteries and the incidence of three coronary arteries was higher than that of middle-age and young AMI patients,there was statistical significance (p<0.05).4. After 12-week folic acid administration,the decrease of the plasma Hcy level in the middle-age and young AMI patients or in the old AMI patients was significantly higher than that of the controls[(11.23±4.40)μmol/l, (6.70±1.86)μmol/l vs (1.49±1.66)μmol/l,separately,p<0.01]; the plasma Hcy level was (22.44±6.06)μmol/l and (11.86±2.93)μmol/l respectively before and after treatment of the two groups of AMI patients with hyperhomocysteinemia, and the decrease of the plasma Hcy level was (11.19±3.18)μmol/l.There was significant change before and after treatment (p<0.01).5. There were only 3 hyperhomocysteinemia patients of 22 cases in the control group(13.64﹪),but there were 28 hyperhomo- cysteinemia patients of 51 cases in two AMI groups(54.90﹪),the latter kept away from the former.6. The plasma Hcy levels of the male were (19.48±6.97)μmol/l in two AMI groups,however,those of the female were only(14.09±2.24)μmol/l,the former exceeded the latter (p<0.05).Conclusion1.Male,the family history of early onset CAD,excessive smoking,excessive drinking and hyperhomocysteinemia are probably the most important risk factors of AMI in middle-age and young AMI patients;The history of hypertensive disease and diabetes, hyperlipoidemia and hyperhomocysteinemia are possibly the main risk factors in old AMI patients.2.The middle-age and young AMI patients often generated pathological changes in one coronary artery, but the old AMI patients usually developed pathological changes in many coronary arteries.3.The plasma Hcy levels increase obviously in AMI patients, hyperhomocysteinemia is one of risk factor in AMI patients.4.The plasma Hcy levels of the male are higher than those of the female in AMI patients.5. Folic acid can decrease strongly the plasma Hcy level in AMI patients with hyperhomocysteinemia.