Assessment of homoctsteine and interleukin-6 level with some immunological and biochemical parameters in the acute coronary syndrome pateints

Acute coronary syndrome (ACS) is the most common manifestation of cardiovascular disease and represents a significant global health burden. Both non-modifiable cardiovascular risk factors, including age, sex, genetic predisposition, and ethnicity, and modifiable risk factors, such as high blood pressure, obesity, smoking, alcohol use, physical inactivity, dyslipidemia, inflammation, diabetes, metabolic syndrome, and undetected ACS, contribute to increased cardiovascular risk. Patients presenting with acute coronary syndrome were evaluated in this study into two categories: myocardial infarction (MI) and unstable angina pectoris (USAP). The most common cause of unstable angina is coronary artery narrowing caused by a non-occlusive thrombus forming over a disrupted atherosclerotic plaque, which leads to thrombosis and vasoconstriction, and cyclic flow are all symptoms of a supply-demand mismatch. Acute myocardial infarction (AMI) is one of the most serious cardiovascular diseases that damages the heart muscle due to a lack of oxygen due to blockage of blood flow to the heart; it has a significant fatality rate. Patients may survive a heart attack. Early reperfusion therapy and intensive pharmacological treatment have a significant impact on the prevention of ischemic cardiomyopathy (ICM). Certain novel potential parameters being studied are high-sensitivity C-reactive protein (hs-Crp), vitamin B12 (VB12), plasma homocysteine (Hcy), and interleukin-6 (IL-6). Interleukin-6 is a prominent cytokine with a pleiotropic effect on inflammation and immunity. Interleukin-6 (IL-6) plasma levels seem to indicate the degree of latent plaque inflammation and, thus, may indicate susceptibility to plaque rupture. Cardiovascular disorders have an essential inflammatory component. C-reactive protein (CRP), an acute phase reactant as a marker of inflammation, has been associated with the degree of heart damage in the initial phase of MI. High-sensitivity C-reactive protein (hs-CRP) is a key indicator of cardiovascular risk. It is linked to the pathogenesis of atherosclerosis, making it useful for both primary and secondary prevention. Vitamin B12 acts as a cofactor for the enzyme methionine synthetase in the reaction of methylation of homocysteine. Therefore, vitamin B12 deficiency can cause a reduction in methylene tetrahydrofolate reductase (MTHFR) activity, leading to a decrease in methionine synthesis and homocysteine accumulation. Deficiency of vitamin B12 leading onto hyperhomocysteinemia is closely related to the development of cardiovascular risk factors. The study enrolled 100 individuals with ACS. They were classed into the unstable angina group, aged 38-71 years, with 29 male and 20 female, and the myocardial infarction group, aged 39-78 years, with 30 male and 21 female attending the coronary care unit (CCU) at Kirkuk Teaching Hospital and Azadi Teaching Hospital in Kirkuk City during the period from 15th January 2022 to 15th January 2023. Both groups were classified based on the electrocardiogram (ECG) diagnostic criteria by a physician. Also, 40 apparently healthy subjects are included in the study. In this study, the homocysteine, IL-6, hs-CRP, vitamin B12, calcium levels, and some biochemical markers, such as lactate dehydrogenase (LDH), creatine phosphokinase (CPK), aspartate transaminase (AST), and alanine transaminase (ALT) enzyme activity, were measured between the three groups. The SSPS statistical package was applied for data analysis. Our study revealed that there was a highly significant increase (P ≤ 0.01) in the activity of the LDH enzyme in all patient groups in comparison with the control group. Also, there was a highly significant increase (P ≤ 0.01) in the activities of CPK and AST enzymes in the MI patients group, while their level of activity in the unstable angina group was normal, but there was no significant difference in the activity of ALT enzyme in all patients and healthy groups. Also showed a highly significant increase (P ≤ 0.01) in the concentration of IL-6 and hs-CRP in all patient groups when compared with the control group. Also, the calcium level revealed a significant difference (p < 0.001) between the groups. This suggests that Ca levels vary significantly among these groups, with patients with myocardial infarction having the lowest Ca levels on average. Vitamin B12 results reported a significant difference (p < 0.001) between the groups, with healthy individuals having the highest VB12 levels on average compared to the unstable angina and myocardial infarction groups. Homocysteine levels showed a significant difference (p < 0.001) between the study groups, with healthy individuals having the lowest Hcy levels on average compared to the unstable angina and myocardial infarction groups. Also, a direct positive correlation was found between inflammatory mediators (IL-6 and hs-CRP), indicating that these mediators may be considered as risk stratification factors and good predictors for ACS. Both serum hs-CRP and IL-6 levels can determine the stability of plaques, Hs-CRP being a sensitive indicator of inflammation. Our findings founded a moderate negative correlation between homocysteine level and VB12, this suggests that lower VB12 levels are associated with higher Hcy levels; this correlation is statistically significant. Also, our findings reported that serum vitamin B12 deficiency and hyperhomocysteinemia are related to the development of cardiovascular risk factors.