Case Control Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Dec 15, 2023; 14(12): 1754-1765
Published online Dec 15, 2023. doi: 10.4239/wjd.v14.i12.1754
Comparative analysis of Nε-carboxymethyl-lysine and inflammatory markers in diabetic and non-diabetic coronary artery disease patients
Dharmsheel Shrivastav, Desh Deepak Singh, Rashid Mir, Pratishtha Mehra, Vimal Mehta, Pradeep Kumar Dabla
Dharmsheel Shrivastav, Desh Deepak Singh, Amity Institute of Biotechnology, Amity University, Jaipur 303002, Rajasthan, India
Dharmsheel Shrivastav, Pradeep Kumar Dabla, Department of Biochemistry, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Delhi 110002, India
Rashid Mir, Department of Medical Lab Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, India
Pratishtha Mehra, Vimal Mehta, Department of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Delhi 110002, India
Co-corresponding authors: Pradeep Kumar Dabla and Desh Deepak Singh.
Author contributions: Dabla PK and Singh DD conceived, designed the study protocol; Shrivastav D, Dabla PK and Mehta V were involved in the data collection; Shrivastav D, Dabla PK, Singh DD, Mir R, Mehta V and Mehra P analyzed the data; Shrivastav D drafted the manuscript; Dabla PK, Singh DD, Mir R, Mehta V and Mehra P refined the manuscript; All authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript. The reasons for designating Dabla PK and Singh DD as co-corresponding authors are that they conceived and designed the study protocol, the collaborative effort, the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper and ensuring effective communication post submission. Further, the overall research team encompassed authors with a variety of expertise and skills from different fields with important contributions to complete the study and the resultant paper. This promotes the most comprehensive and in-depth examination of the research topic, ultimately enriching readers' understanding by offering various expert perspectives. Dabla PK, Singh DD as co-corresponding authors of is fitting for our manuscript as it accurately reflects our team's collaborative spirit, contributions, and diversity.
Institutional review board statement: The study was approved by the ethics committee of the Institutional Ethical Committee of Maulana Azad Medical College and associated hospitals, Delhi, India (F1/IEC/MAMC/85/03/21/no.422; Dt-30.08.2021).
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. All authors declare no conflicts of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at pradeep_dabla@yahoo.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pradeep Kumar Dabla, MD, Professor, Department of Biochemistry, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, J L N Marg, Delhi 110002, India. pradeep_dabla@yahoo.com
Received: August 21, 2023
Peer-review started: August 21, 2023
First decision: September 29, 2023
Revised: October 11, 2023
Accepted: November 3, 2023
Article in press: November 3, 2023
Published online: December 15, 2023
Processing time: 114 Days and 22.1 Hours
Abstract
BACKGROUND

Coronary artery disease (CAD) is a major cause of death worldwide, and India contributes to about one-fifth of total CAD deaths. The development of CAD has been linked to the accumulation of Nε-carboxymethyl-lysine (CML) in heart muscle, which correlates with fibrosis.

AIM

To assess the impact of CML and inflammatory markers on the biochemical and cardiovascular characteristics of CAD patients with and without diabetes.

METHODS

We enrolled 200 consecutive CAD patients who were undergoing coronary angiography and categorized them into two groups based on their serum glycosylated hemoglobin (HbA1c) levels (group I: HbA1c ≥ 6.5; group II: HbA1c < 6.5). We analyzed the levels of lipoproteins, plasma HbA1c levels, CML, interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and nitric oxide.

RESULTS

Group I (81 males and 19 females) patients had a mean age of 54.2 ± 10.2 years, with a mean diabetes duration of 4.9 ± 2.2 years. Group II (89 males and 11 females) patients had a mean age of 53.2 ± 10.3 years. Group I had more severe CAD, with a higher percentage of patients with single vessel disease and greater stenosis severity in the left anterior descending coronary artery compared to group II. Group I also exhibited a larger left atrium diameter. Group I patients exhibited significantly higher levels of CML, TNF-α, and IL-6 and lower levels of nitric oxide as compared with group II patients. Additionally, CML showed a significant positive correlation with IL-6 (r = 0.596, P = 0.001) and TNF-α (r = 0.337, P = 0.001) and a negative correlation with nitric oxide (r=-4.16, P = 0.001). Odds ratio analysis revealed that patients with CML in the third quartile (264.43-364.31 ng/mL) were significantly associated with diabetic CAD at unadjusted and adjusted levels with covariates.

CONCLUSION

CML and inflammatory markers may play a significant role in the development of CAD, particularly in diabetic individuals, and may serve as potential biomarkers for the prediction of CAD in both diabetic and non-diabetic patients.

Keywords: Coronary artery disease; Diabetes; Nε-carboxymethyl-lysine; Inflammatory markers; Interleukin-6; Tumor necrosis factor alpha; Nitric oxide

Core Tip: Coronary artery disease (CAD) incidence is substantial in India.Its development is linked to the accumulation of Nε-carboxymethyl-lysine (CML). We assessed the impact of CML and inflammatory markers on biochemical and cardiovascular characteristics in diabetic and non-diabetic CAD patients. Diabetic patients exhibited elevated CML, tumor necrosis factor alpha, and interleukin 6 levels with reduced nitric oxide levels. CML levels displayed a significant correlation with interleukin 6, tumor necrosis factor alpha, and nitric oxide. The third quartile of CML was associated with diabetic CAD, suggesting its role as a biomarker in CAD prediction for diabetic and non-diabetic patients.