Evaluation of Clinical and Laboratory Predisposing Factors of Acute Coronary Syndrome in Military Staff

Document Type : Original Article

Authors

1 Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.

2 Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: Cardiovascular diseases are the leading cause of death in the third millennium. Acute coronary syndrome (ACS) is the most fatal cardiovascular disease, and various factors are involved in the development of this disease. These factors include clinical and laboratory factors as well as stress. Occupational stress is a risk factor for heart disease, and it also increases the risk of coronary heart disease. Military work is universally considered to be stressful. The aim of this study was to evaluate the clinical and laboratory predisposing factors of ACS in military staff.
 
Methods: In this prospective study, 260 patients admitted to Baqiyatallah Hospital were enrolled and divided into 2 groups: 130 patients with ACS and 130 patients with stable coronary artery disease. The study population was studied for various variables, including occupational stress, sedentary lifestyle, and some laboratory markers, including the neutrophil-to-lymphocyte ratio (NLR), the ratio of monocytes to high-density lipoprotein (HDL), and red cell distribution width (RDW).
 
Results: There were significant differences between the 2 groups in terms of physically demanding tasks (case: 61% vs control: 43%; P = 0.036), an average daily sitting time of more than 3 hours (case: 58.5% vs control: 43.8%; P = 0.048), and an average daily television watching time of more than 2 hours (case: 56.9% vs control: 42.3%; P = 0.048). There was a significant difference concerning NLR between the case and control groups (case: 4.8 ±1.4 vs control: 2.2 ± 0.5; P = 0.011) regarding the ratio of monocytes to HDL (case: 16.6 ± 5.6 vs control: 10.6 ± 3.1; P = 0.034) and RDW (case: 14.5 ± 1.9 vs control: 12.8 ± 1.4; P = 0.041).
 
Conclusions: According to our findings, an increase in NLR and the ratio of monocytes to HDL are predisposing factors of ACS; in addition, RDW is a predicting factor of ACS in military personnel. A sedentary lifestyle and work stress are also contributing factors to the development of ACS in this population. (Iranian Heart Journal 2021; 22(1): 66-73)

Keywords


 Hamm CW, Braunwald E. A classification of unstable angina revisited. Circulation. 2000; 102: 118–122.
Goldstein JA, Demetriou D, Grines CL, et al. Multiple complex coronary plaques in patients with acute myocardial infarction. N Engl J Med. 2000; 343: 915–922.
Davies MJ, Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med. 1984; 310: 1137–1140.
Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation. 1995; 92: 657–671
Davies MJ. Stability and instability: two faces of coronary atherosclerosis. Circulation. 1996; 94: 2013–2020.
Davies MJ. The pathophysiology of acute coronary syndromes. Heart 2000;83:
361–366.
Arbab-Zadeh A, Nakano M, Virmani R, Fuster V. Acute coronary events. Circulation 2012; 125:1147–1156.
Davies MJ, Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med 1984; 310:1137–1140.
Burke AP, Farb A, Malcom GT, Liang YH, Smialek J, Virmani R. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med 1997; 336:1276–1282.
Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC) Eur Heart J. 2011;32(23):2999–3054.
Loftus I. Mechanisms of Plaque Rupture. In: Fitridge R, Thompson M, editors. Mechanisms of Vascular Disease: A Reference Book for Vascular Specialists [Internet]. Adelaide (AU): University of Adelaide Press; 2011. 4. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534259/
Gordon DJ and Rifkind BM. High-density lipoprotein—the clinical implications of recent studies. N Engl J Med. 1989; 321:1311–6
Genest J Jr., Marcil M, Denis M and Yu L. High density lipoproteins in health and in disease. J Investig Med. 1999; 47:31–42.
Stein O and Stein Y. Atheroprotective mechanisms of HDL. Atherosclerosis. 1999; 144:285–301.
von Eckardstein A and Assmann G. Prevention of coronary heart disease by raising high-density lipoprotein cholesterol? Curr Opin Lipidol. 2000; 11:627–37.
R Peter, et al. “Psychosocial work environment and myocardial infarction: improving risk estimation by combining two complementary job stress models in the SHEEP Study” J Epidemiol Community Health 2002;56:294–300
Bo Netterstrøm, et al. “Relation between job strain and myocardial infarction: a case-control study” Occup Environ Med 1999;56:339–342
Claes Held, et al. “Physical activity levels, ownership of goods promoting sedentary behaviour and risk of myocardial infarction: results of the INTERHEART study” European Heart Journal (2012) 33, 452–466
Peter T Katzmarzyk, et al. “Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis” BMJ Open 2012; 2:e000828. doi:10.1136/bmjopen-2012-000828
Ozaki, Y., et al. (2013). "High-density lipoprotein cholesterol level is associated with fibrous cap thickness in acute coronary syndrome." Circ J 77(12): 2982-2989.
Hagstrom, E., et al. (2016). "Association Between Very Low Levels of High-Density Lipoprotein Cholesterol and Long-term Outcomes of Patients With Acute Coronary Syndrome Treated Without Revascularization: Insights From the TRILOGY ACS Trial." Clin Cardiol 39(6): 329-337.
Chen, C., et al. (2018). "Neutrophil to lymphocyte ratio as a predictor of myocardial damage and cardiac dysfunction in acute coronary syndrome patients." Integr Med Res 7(2): 192-199.
Abrahan, L. L. t., et al. (2018). "Red Cell Distribution Width and Mortality in Patients With Acute Coronary Syndrome: A Meta-Analysis on Prognosis." Cardiol Res 9(3): 144-152.
Bo Netterstrùm et al, Relation between job strain and myocardial infarction: a case-control study, Occup Environ Med 1999;56:339_342
 R. Peter et al, Psychosocial work environment and myocardial infarction: improving risk estimation by combining two complementary job stress models in the SHEEP Study, J Epidemiol Community Health 2002;56:294_300
 Peter T Katzmarzyk et al, Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis, BMJ Open 2012; 2:e000828. doi:10.1136/bmjopen-2012-000828
 Claes Held et al, Physical activity levels, ownership of goods promoting sedentary behaviour and risk of myocardial infarction: results of the INTERHEART study, European Heart Journal (2012) 33, 452–466, doi:10.1093/eurheartj/ehr432