Haptoglobin Polymorphism as a Determinant of Adverse Outcome After Cardiac Surgery in Diabetic Patients
| Status: | Completed |
|---|---|
| Conditions: | Peripheral Vascular Disease, Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 5/14/2016 |
| Start Date: | September 2010 |
| End Date: | May 2015 |
Specific aim 1a will test the hypothesis that diabetic patients with 2-2 haptoglobin
genotype have higher indices of postoperative myocardial injury (creatine kinase MB
isoenzyme , Troponin I ) and renal injury (as indicated by elevated creatinine, cytostatin C
and glomerular filtration rate). Of note, significantly elevated levels (>5 times the upper
normal limit) of creatine kinase MB isoenzyme and troponins postoperatively have been
associated with postoperative myocardial ischemia/infarction and are a predictor of
short-term and long-term mortality after cardiac surgery.
Specific aim 1b will evaluate preoperative and postoperative indices of oxidative stress
(such as isoprostane f2 alpha and malondialdehyde) and will evaluate whether patients with
type 2-2 haptoglobin express increased oxidative stress. The investigators will also try to
correlate whether patients with increased oxidative stress are those with elevated indices
of myocardial and/or renal injury Specific aim 1c will try to evaluate whether patients with
type 2-2 haptoglobin also have increased levels of inflammatory indices (C-reactive
protein,[interleukin] IL-1, IL-2, IL-6, TNF[tumor necrosis factor]) and try to correlate the
findings with postoperative myocardial and or renal injury.
The incidence of atrial fibrillation after coronary artery bypass graft ranges from 19% to
27%. The investigators will also look at any correlation of the type 2-2 haptoglobin and the
incidence of post-operative atrial fibrillation.
genotype have higher indices of postoperative myocardial injury (creatine kinase MB
isoenzyme , Troponin I ) and renal injury (as indicated by elevated creatinine, cytostatin C
and glomerular filtration rate). Of note, significantly elevated levels (>5 times the upper
normal limit) of creatine kinase MB isoenzyme and troponins postoperatively have been
associated with postoperative myocardial ischemia/infarction and are a predictor of
short-term and long-term mortality after cardiac surgery.
Specific aim 1b will evaluate preoperative and postoperative indices of oxidative stress
(such as isoprostane f2 alpha and malondialdehyde) and will evaluate whether patients with
type 2-2 haptoglobin express increased oxidative stress. The investigators will also try to
correlate whether patients with increased oxidative stress are those with elevated indices
of myocardial and/or renal injury Specific aim 1c will try to evaluate whether patients with
type 2-2 haptoglobin also have increased levels of inflammatory indices (C-reactive
protein,[interleukin] IL-1, IL-2, IL-6, TNF[tumor necrosis factor]) and try to correlate the
findings with postoperative myocardial and or renal injury.
The incidence of atrial fibrillation after coronary artery bypass graft ranges from 19% to
27%. The investigators will also look at any correlation of the type 2-2 haptoglobin and the
incidence of post-operative atrial fibrillation.
Diabetes mellitus is a major risk factor for postoperative morbidity and mortality after
cardiac surgery, mainly because of accelerated atherosclerosis and target-organ injury that
predispose these patients to increased incidence of postoperative morbidity (such as but not
limited to, postoperative adverse cardiac events, renal injury or stroke) and mortality.
Over the past several years haptoglobin has been identified as a risk factor that predicts
the development of cardiovascular complications in diabetics. There are 3 major haplotypes
of haptoglobin: 1-1; 1-2 and 2-2. Several studies have demonstrated that diabetic
individuals with the 2-2 genotype have up to 5 fold increased risk to develop cardiovascular
complications as compared to diabetic patients with a non-2-2 haptoglobin genotype. There is
no data in the literature that evaluated whether the haptoglobin 2-2 genotype is a risk
factor for increased postoperative morbidity and/or mortality after cardiac surgery in
patients with DM.
Therefore, the aims of the study are to evaluate whether diabetic patients with the 2-2
genotype are at increased risk for postoperative morbidity and/or mortality after cardiac
surgery.
Preliminary studies in diabetic patients demonstrated that those with haptoglobin 2-2
genotype are at increased risk for cardiovascular complications of diabetes. Moreover, these
patients were found to have increased in-hospital mortality after acute MI compared to
diabetic individuals that do not have the 2-2 genotype, and they also suffer from increased
incidence of post catheterization stent thrombosis compared to diabetics that do not have
the 2-2 genotype
cardiac surgery, mainly because of accelerated atherosclerosis and target-organ injury that
predispose these patients to increased incidence of postoperative morbidity (such as but not
limited to, postoperative adverse cardiac events, renal injury or stroke) and mortality.
Over the past several years haptoglobin has been identified as a risk factor that predicts
the development of cardiovascular complications in diabetics. There are 3 major haplotypes
of haptoglobin: 1-1; 1-2 and 2-2. Several studies have demonstrated that diabetic
individuals with the 2-2 genotype have up to 5 fold increased risk to develop cardiovascular
complications as compared to diabetic patients with a non-2-2 haptoglobin genotype. There is
no data in the literature that evaluated whether the haptoglobin 2-2 genotype is a risk
factor for increased postoperative morbidity and/or mortality after cardiac surgery in
patients with DM.
Therefore, the aims of the study are to evaluate whether diabetic patients with the 2-2
genotype are at increased risk for postoperative morbidity and/or mortality after cardiac
surgery.
Preliminary studies in diabetic patients demonstrated that those with haptoglobin 2-2
genotype are at increased risk for cardiovascular complications of diabetes. Moreover, these
patients were found to have increased in-hospital mortality after acute MI compared to
diabetic individuals that do not have the 2-2 genotype, and they also suffer from increased
incidence of post catheterization stent thrombosis compared to diabetics that do not have
the 2-2 genotype
Inclusion Criteria:
- 18 years of age and older
- Scheduled for an elective cardiac surgery on pump
- Diabetic -type I or type II
- Informed consent
Exclusion Criteria:
- Patients with chronic hemolytic disorders;
- Patients with hemoglobinopathies
- Enrollment in another interventional clinical trial
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