Determination of Vitamin K2, Lipoprotein (a) and N-Terminal pro Brain Natriuretic Biomarkers in Diabetic Hypertensive Patients with Acute Myocardial Infarction for Clinical Intervention

Ghaith Kamil Jawad ^1*, Abdulsamie Hassan Alta'ee ² , Oday Jasim Alsalihi ³

This study showed the biomarkers like NT-proBNP, Lp(a), and vitamin K2 might be valuable for AMI prognosis, aiding risk stratification and therapeutic decisions.

Abstract

Background: Severe Myocardial Infarction is a highly stark manifestation of heart illness, often accompanied with additional complications such as diabetes mellitus (DM) and hypertension (HTN). The hormone within the body enables glucose to enter the cells and burn them up as fuel. HTN is a common vascular disorder that represents a major cardiovascular condition.  Methods: The study was conducted at the Biochemistry Department of the College of Medicine from April 2022 to May 2023 and used the Human Vit K2 ELISA Kit, Human Lp(a) ELISA Kit, and Human N-terminal ProBST ELISA Kit to estimate the serum levels of vitamin K2, lipoprotein (a) (Lp(a)), and N-terminal of the Pro brain natriuretic peptide (NT-proBNP). Results: The results showed a important decrease in VK2 levels in AMI patients with DM and HTN than the other two groups (less than AMI patients group with and without HDL-c). On the other hand, Lp(a), and NT-pro BNP levels were significantly increased in AMI patients with DM and HTN than the other two groups (less than AMI patients group with no DM and HTN). As the diagnostic accuracy of tests increased, the area under the ROC curve for NTproBNP for diagnosing AMI achieved the highest 0.988. NTproBNP showed a promising ability to differentiate AMI patients from DM+ HTN group with 0.971 (AUC). Conclusions: In diabetic hypertensive patients with acute myocardial infarction, a low level of vitamin K2 and a high level of lipoprotein(a) might be risk markers for the onset of myocardial infarction.

Keywords: AMI, DM, HTN, Biomarkers, Risk Stratification

References

Ajam, Z. A., Mohammed, S. B., & Alabedi, R. F. (2023). Association of C-peptide with novel hormones in children with type 1 diabetes: A rising potentials for more reliable biomarkers. Chemical Biology Letters, 10(3), 551-551.‏

Aladag, N., & Atabey, R. D. (2021). The role of concomitant cardiovascular diseases and cardiac biomarkers for predicting mortality in critical COVID-19 patients. Acta Cardiologica,  76(2), 132-139.‏

Al-Anbari, A. A., Alta'ee, A. H., & Al-Saad, S. F. (2022). A study of arginase-1 activity and lipid profile in patients with myocardial infarction. J Adv Biotechnol Exp Ther, 5(3), 553-561.‏

American Diabetes Care, Summary of Revisions for the  Clinical Practice Recommendations.(2010) 1.1-8.7.

Awuchi CG, Echeta CK&Igwe V S. (2020). Diabetes and the nutrition and diets for its prevention and treatment: a systematic review and dietetic perspective. Health Sciences Research,  6(1), 5-19.‏

Balaji R, Duraisamy R & Kumar MP. (2019). Complications of diabetes mellitus: A review. Drug Invention Today,  12(1).‏

Chaulin, A. M. (2021). Elevation mechanisms and diagnostic consideration of cardiac troponins under conditions not associated with myocardial infarction. Part 2. Life, 11(11), 1175.‏

Chen, Z., Venkat, P., Seyfried, D., Chopp, M., Yan, T., & Chen, J. (2017). Brain–heart interaction: cardiac complications after stroke. Circulation research,  121(4), 451-468.

Davies, A., Wellard-Cole, L., Rangan, A., & Allman-Farinelli, M. (2020). Validity of self-reported weight and height for BMI classification: A cross-sectional study among young adults. Nutrition,  71, 110622.‏

Dicks L, Kirch N, Gronwald D, Wernken K, Zimmermann BF, Helfrich HP&Ellinger S. (2018). Regular intake of a usual serving size of flavanol-rich cocoa powder does not affect cardiometabolic parameters in stably treated patients with type 2 diabetes and hypertension—A double-blinded, randomized, placebo-controlled trial. Nutrients, , 10(10), 1435.‏

Fakhree NK, Mhaibes SH & Khalil HH. (2021). Impact of Vitamin K on Human Health. Iraqi Journal of Pharmaceutical Sciences (P-ISSN: 1683-3597, E-ISSN: 2521-3512),  30(1), 1-13.‏

Glavinovic T, Thanassoulis G, de Graaf J, Couture P, Hegele RA &Sniderman AD. (2022). Physiological Bases for the Superiority of Apolipoprotein B Over Low-Density Lipoprotein Cholesterol and Non–High-Density Lipoprotein Cholesterol as a Marker of Cardiovascular Risk. Journal of the American Heart Association,  11(20), e025858.‏

Jadhav N, Ajgaonkar S, Saha P, Gurav P, Pandey A, Basudkar V & Nair S. (2022). Molecular Pathways and Roles for Vitamin K2-7 as a Health-Beneficial Nutraceutical: Challenges and Opportunities. Frontiers in Pharmacology,  13, 896920.‏

Jirak, P., Stechemesser, L., Moré, E., Franzen, M., Topf, A., Mirna, M. & Salmhofer, H. Clinical implications of fetuin-A. Advances in clinical chemistry, 2019, 89, 79-130.

Kristensen, J. S., Melholt, L., Kristensen, K. L., Dahl, M., & Lindholt, J. S. (2021). Vitamin K2 Dependent Matrix Gla Protein Relating to Abdominal Aortic Aneurysm and Overall Mortality: A Combined Case Control and Cohort Study. European Journal of Vascular and Endovascular Surgery,  62(2), 267-274.‏

Kurnia, Y., Siswoyo, H., & Hatta, M. (2020). The role of Lipoprotein(a) as a predictor of cardiovascular events in patients with Acute Coronary Syndrome. The Egyptian Heart Journal, 72(1), 1-5.

Lee HC, Akhmedov A&Chen CH. (2022). Spotlight on very-low-density lipoprotein as a driver of cardiometabolic disorders: Implications for disease progression and mechanistic insights. Frontiers in Cardiovascular Medicine,  9, 993633.‏

Liu, H. H., Cao, Y. X., Jin, J. L., Guo, Y. L., Zhu, C. G., Wu, N. Q. & Li, J. J. (2021). Prognostic value of NT-proBNP in patients with chronic coronary syndrome and normal left ventricular systolic function according to glucose status: a prospective cohort study. Cardiovascular Diabetology, 20(1), 84.

Lu, L., Liu, M., Sun, R., Zheng, Y., & Zhang, P. (2015). Myocardial infarction: symptoms and treatments. Cell biochemistry and biophysics, 72, 865-867.‏

Majid A, Blackwell M, Broadbent RS, Barker DP, Al-Sallami HS, Edmonds L & Wheeler BJ. (2019). Newborn vitamin K prophylaxis: a historical perspective to understand modern barriers to uptake. Hospital Pediatrics, , 9(1), 55-60.‏

Mohammed, A., Smaism, M. F., & Alsalihi, O. J. (2021). polymorphism of mthfr c677t gene and the associations with the acute coronary syndrome in iraqi patients. Turkish Journal of Physiotherapy and Rehabilitation, 32, 3.‏

Nishikimi T & Nakagawa Y. (2021). Potential pitfalls when interpreting plasma BNP levels in heart failure practice. Journal of Cardiology,  78(4), 269-274.‏

Pöss, J., Köster, J., Fuernau, G., Eitel, I., de Waha, S., Ouarrak, T. & Desch, S. (2017). Risk stratification for patients in cardiogenic shock after acute myocardial infarction. Journal of the American College of Cardiology,  69(15), 1913-1920.‏

Robinson, S. (2021). Cardiovascular disease. In Priorities for Health Promotion and Public Health (pp. 355-393). Routledge..‏

Shanker, U., & Rani, M. (Eds.). (2022). Liquid and Crystal Nanomaterials for Water Pollutants Remediation. CRC Press.

Tilea, I., Varga, A., & Serban, R. C. Past, present, and future of blood biomarkers for the diagnosis of acute myocardial infarction—promises and challenges. Diagnostics, 2021, 11(5), 881.‏

Tziakas, D., Chalikias, G., Al-Lamee, R., & Kaski, J. C. (2021). Total coronary occlusion in non ST elevation myocardial infarction: Time to change our practice?. International Journal of Cardiology, 329, 1-8.‏

Virani, S. S., Brautbar, A., Davis, B. C., Nambi, V., Hoogeveen, R. C., Sharrett, A. R., ... & Ballantyne, C. M. (2012). Associations between lipoprotein (a) levels and cardiovascular outcomes in black and white subjects: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation, 125(2), 241-249.

Wang, X. Y., Zhang, F., Zhang, C., Zheng, L. R., & Yang, J. (2020). The biomarkers for acute myocardial infarction and heart failure. BioMed research international, 2020.‏

Who, E. C. (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet (London, England), 363(9403), 157.‏

Xu, S. C., Wu, W., & Zhang, S. Y. (2022). Manifestations and mechanism of SARS-CoV2 mediated cardiac injury. International Journal of Biological Sciences, 18(7), 2703.‏

Yano Y, Reis JP, Colangelo LA, Shimbo D, Viera AJ, Allen NB & Lloyd-Jones DM. (2018). Association of blood pressure classification in young adults using the 2017 American College of Cardiology/American Heart Association blood pressure guideline with cardiovascular events later in life. Jama, 320(17), 1774-1782.‏

Yin J, Wang S, Liu Y, Chen J, Li D& Xu T. (2021). Coronary microvascular dysfunction pathophysiology. Microcirculation, 28(7), e12718.‏

Zhang, Y., Ding, X., Hua, B., Liu, Q., Gao, H., Chen, H. & Li, H. (2020). High triglyceride-glucose index is associated with adverse cardiovascular outcomes in patients with acute myocardial infarction. Nutrition, Metabolism and Cardiovascular Diseases,  30(12), 2351-2362.‏