الفهرس 
Introductions & Aim of the workOnly 14 pages are availabe for public view
 |  | from | 218 |  |  |
| | | from | 218 | | |
Abstract
Ghrelin, the natural secretagogue for growth hormone that was identified at 1999, had attracted many researchers due to the nature of secretion from the stomach as 28 amino acids peptide and its acyl modification at the serine-3 residue which is essential for receptor binding and eliciting its biological activity. Although, initially recognized as the only peripheral hunger hormone and appetite regulation, the cardiovascular system has also been recognized as a potentially important target for ghrelin.
Numerous studies have reported that ghrelin has a wide array of beneficial cardiovascular properties such as vasodilation and beneficial hemodynamic effects in healthy humans as well as improvement of left ventricular dysfunction and cardiac cachexia.
Accumulating data indicates that ghrelin has also effects on the cardiovascular and immune systems. Interestingly, ghrelin has been claimed to have anti-inflammatory actions that may have an important role in the development of atherosclerosis.
Plasma ghrelin concentrations have been shown to be decreased in obese, and type 2 diabetes patients, compared with normal control individuals. Obesity and type 2 diabetes are considered risk factors for atherosclerotic cardiovascular diseases.
Carotid intima-media thickness is a marker of generalized atherosclerosis that correlates with the extent of coronary artery disease in adults and predicts future car¬diovascular events. Factors associ¬ated with increased CIMT in the adult population include hypertension, dyslipidemia, obesity, and diabetes.
The aim of this study is to investigate the association of plasma ghrelin concentrations with atherosclerosis measured as CIMT and other cardiovascular risk factors like hs.CRP and insulin resistance parameters.
This study was conducted on 86 subjects who were selected after randomization from the Outpatient Clinic of Internal Medicine Departments, Ain Shams University Hospital during the period from July 2012 to June 2013.
They were divided into 2 groups, the first group included 50 patients with Type 2 diabetes of both sexes (males were 28 while females were 22 patients) older than 25 years with onset of diabetes of less than 5 years with normal hepatic and renal profile and blood pressure less than 130/80mmhg and have no clinical or laboratory endocrine problems, no overt cardiovascular diseases, not using lipid lowering drugs or steroids and have no Inflammatory or infectious disease. They were divided into 2 subgroups according to the BMI into diabetic obese and non obese patients, each group included 25 individuals.
The second group included 36 non diabetic healthy subjects as a control group. They were age and sex matched (males were 20 while females were 16 subjects). This group was also further subdivided into two subgroups; non obese and obese non diabetic according to their BMI, each subgroup included 18 subjects.
In our present study fasting plasma ghrelin level was measured in all participants (diabetics and non diabetics, obese and non obese individuals). In addition, FPG, fasting insulin and HbA1C were also measured. The insulin resistance was assessed in all these subjects by using the HOMA score for insulin resistance (IRHOMA) and the degree of atherosclerosis was also assessed in all of them by measuring the CIMT, and lastly the lipid profile (including the total cholesterol, the high-density lipoprotein cholesterol ”HDL-C”, the low-density lipoprotein cholesterol ”LDL-C”, and the triglycerides ”TG”) of all subjects was also measured in addition to hs.CRP.
The results of this study revealed that plasma ghrelin level is significantly lower in the diabetic obese patients than the other groups and the highest level was in the non diabetic non obese individuals.
CIMT and hs.CRP were significantly higher in the diabetic obese group of patients than the other groups, while, they were significantly lower in the non diabetic non obese individuals than the other groups.
We concluded from our work that plasma ghrelin could be a marker of atherosclerosis in the diabetic obese patients as shown in our result by the presence of significant negative correlation between plasma ghrelin and CIMT in the diabetic obese patients.
We concluded also that plasma ghrelin had significant negative correlation with obesity and insulin resistance as measured by HOMA-IR in the diabetic obese patients.
BMI, waist circumference, FBG, HbA1c, total cholesterol, and triglycerides were strong predictors for atherosclerosis as measured by CIMT.
Further studies are needed to be done on larger number of the population and longer duration to assess the casual relationship between ghrelin and atherosclerosis because of the controversy between studies as regard the correlation between plasma ghrelin and CIMT, and whether, it is negative, positive, or no correlation. Therefore, elucidation of the precise mechanism by which ghrelin regulates atherosclerosis may provide key insights into ghrelin’s administration in atherosclerosis therapy.