The Level of Ischemic Modified Albumin (IMA) as Risk Marker for Cardio Vascular D isease (CVD) among some diabetic patients (type II) in Khartoum state -Sudan

Abstract

Background. Recent literature reports show large interest in ischemic modified albumin (IMA) biochemical marker for detection of myocardial injury. Special attention is focused in estimation of IMA test for the diagnosis and evaluation of myocardial ischemia as well as others acute coronary syndrome in emergency patients.

Objective : evaluation of ischemia-modified albumin (IMA) in well controlled and uncontrolled patients with type 2 diabetes mellitus and estimation of its connection with cardiovascular disease.Measurement thelevelof IMA asrisk marker forcardio vascular disease (CVD) in diabetic patients that arrivedtoemergency department with signs and symptoms of CVD.

Methodology. 140 subjects enrolled in thisstudy ,70 diabetes mellitus patients with signs and symptoms of CVD, and other 70 apparently non diabetic healthy subjects' as controls, , the levels of biomarker IMA was measured as the risk marker ofCVDin controlled and uncontrolleddiabeticpatients with type2,the Diagnostic potential was evaluated by receiver operating characteristic analysis and their relationships were analyzed. This study was donein Shab Hospital, Khartoum.Period from 1st of February 2015 to October 2015.

Results: The results showed that CVD were predominant among diabetic female 57 % and peaked at age 75.5 years among 40-75 year old. The IMA was significantly increase in diabetic patients when compare with normal healthy group with cut off value ( 0.97 IU/L ), and there is also significantly increase in IMA level in uncontrolled diabetic patients (Mean ± SD; 14.70 + 10.66) that presented with acute chest pain and havea signs and symptoms of cardiac ischemia when compared with the well-controlled diabetic patients(Mean ± SD; 3.74 + 3.68). controlled and uncontrolled diabetic patients were determined by the level of their HBA1c and comparison with the means of IMA level in their serum.

Conclusions: increase IMA level in poor control and long stand diabetic patients could help to identify the higher risk for develop to CVD, and The most common complication such as suffering from local or systemic hypoxic conditions, as acute ischemic stroke, peripheral vascular disease.

Keywords: Ischemia, Type 2 diabetes mellitus, cardiovascular disease, Ischemic Modified Albumin

References
[1] A. Piwowara, K. Knapik-Kordecka, and M. Warwasa, Hypertension and Diabetology of, in Hypertension and Diabetology of, 2, p. 4, Wroclaw Medical University, DiseaseMarkers, 2008.

[2] D. Bar-Or, E. Lau, and J. V. 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, no. 4, 311–315, (2000).

[3] E. Bourdon, N. Loreau, and D. Blache, Glucose and free radicals impair the antioxidant properties of serum albumin, The FASEB Journal, 13, no. 2, 233–244, (1999).

[4] D. Borderie, Y. Allanore, C. Meune, J. Y. Devaux, O. G. Ekindjian, and A. Kahan, High ischemia-modified albumin concentration reflects oxidative stress but not myocardial involvement in systemic sclerosis, Clinical Chemistry, 50, no. 11, 2190– 2193, (2004).

[5] M. Montagnana, G. Lippi, and A. Volpe, Evaluation of cardiac laboratory markers in patients with systemic sclerosis, Clinical Biochemistry, 39, no. 9, 913–917, (2006).

[6] M. A. Refaai, R. W. Wright, C. A. Parvin, A. M. Gronowski, M. G. Scott, and C. S. Eby, Ischemia-modified albumin increases after skeletal muscle ischemia during arthroscopic knee surgery, Clinica Chimica Acta, 366, no. 1-2, 264–268, (2006).

[7] S. R. Laver and A. Padkin, Does hyperglycaemia precede the clinical onset of myocardial ischaemia? Resuscitation, 66, no. 2, 237–239, (2005).

[8] M. Montagnana, G. Lippi, C. Fava, P. Minuz, C. L. Santonastaso, E. Arosio, and G. C. Guidi, Ischemia-modified albumin and NT-prohormone-brain natriuretic peptide in peripheral arterial disease, Clinical Chemistry and Laboratory Medicine, 44, no. 2, 207–212, (2006).

[9] F. Paneni, J. A. Beckman, M. A. Creager, and F. Cosentino, Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I, European Heart Journal, 34, no. 31, 2436–2446, (2013).

[10] Federation Middle East and North Africain

[11] H.-M. Lakka, D. E. Laaksonen, T. A. Ladda, L. Niskanen, E. Kumpusalo, T. P. Tuomainen, and J. T. Salonen, where populations have experienced a nutrition transition toward western diets and reduced physical activity levels, Journal of the American Medical Association, 288, no. 21, 2709–2716, (2002).

[12] D. Bar-Or, E. Lau, N. Rao, N. Bampos, J. Winkler, and C. Curtis, Reduction in the cobalt binding capacity of human albumin with myocardial ischemia, Annals of Emergency Medicine, 34, no. 4, p. S56, (1999).

[13] K. Dahiya and K. Aggarwal, Veenasingh k, Type 2 DM without vascular complications and Ischemic Modified Albumin, (2010).

[14] A. Piwowar, M. Knapik-Kordecka, and M. Warwas, Ischemia-modified albumin level in type 2 diabetes mellitus—preliminary report, Disease Markers, 24, no. 6, 311–317,(2008).

[15] K. Ukinc, S. Eminagaoglu, and H. O. Ersoz, A novel indicator of widespread endothelial damage and ischemia in diabetic patients: ischemia-modified albumin, Endocrine Journal, 36, no. 3, 425–432, (2009).

[16] A. Kumar, R. Sivakanesan, and S. Singh, Oxidative stress, endogenous antioxidant and ischemia-modified albumin in normolipidemic acute myocardial infarction patients, Journal of Health Science, 54, no. 4, 482–487, (2008).

[17] R. A. DeFronzo, Pathogenesis of type 2 diabetes: Metabolic and molecular implications for identifying diabetes genes, Diabetes Reviews, 5, no. 3, 177–269,(1997).