The Effects of Age and Sex on Amylin, Preptin Hormones and Some Biochemical Parameters in Cardiovascular Disease with Type 2 Diabetic

Risk factors for cardiovascular disease (CVD) include hyperglycemia, high blood pressure, a high body mass index (BMI), and hypercholesterolemia. The two sexes have an increased risk of CHD with age, but the rise has been found greater in women. The research aimed to assess the effects of sex and age on parameters of amylin, preptin, SOD, MDA, fasting blood glucose (FBG), and CAT in CVD patients without and with type 2 diabetes (T2D) in comparison to healthy individuals. There were 150 participants in the study: 50 normal volunteers, or control subjects who were thought to be healthy, and 100 patients with cardiovascular disease, of which 50 had type 2 diabetes and the remaining 50 did not. Participants in the study varied in age from 40 to 70 years old and had type 2 diabetes and CVD but were not obese. The study's findings demonstrated a substantial relationship between sex and the concentrations of CAT, preptin, amylin, MDA, and SOD. Age affects the parameters that are evaluated in patients with cardiovascular disease, including those with and those without type 2 diabetes. The primary cardiovascular risk factors have accounted for a considerable fraction of sex difference in CHD risk. Higher levels of risk factors were associated with an age-related increase in the incidence of CHD and death in the two genders, yet in women more so.


Introduction
People with Type 2 Diabetes Mellitus (T2DM) have a higher risk of developing coronary artery disease (CAD), which has also been known as DM-CAD, which raises mortality and morbidity rates.
Its complex etiology is caused by many factors, including genetic susceptibility, endogenous factors, and diverse environmental influences such as a high-fat diet, a sedentary lifestyle, and ongoing stress [1].Inadequate glycemic control in type 2 diabetes will impact heart pathophysiology even in the absence of CAD and hypertension.An increase in body fat is believed to affect how tissues react to insulin, leading to insulin resistance and a decline in the balance between fat and glucose.Prolonged elevation in blood sugar levels can result in severe consequences such as impaired vision, renal failure, and nerve damage.These can cause abnormalities in the functioning of the urinary, cardiovascular, and gastrointestinal systems [2].Since myocardial infarction (MI) represents a common CVD indicator, the World Health Organization (WHO) recommended utilizing MI rates as a proxy for CVD rates in epidemiological research [3,4].MI represents a clinical condition defined as acute myocardial necrosis resulting from an imbalance between myocardial demand and coronary blood supply, according to Azmi and Kesarwani (2014) [5].MI, which leads to tissue death, is brought on by the sudden blockage of at least one coronary artery which supplies the heart muscle with oxygenrich blood [6,7].An increase in heart mass in reaction to an external stimulus is known as cardiac hypertrophy, which is a broad term for a higher workload.[8].Congestive heart failure (HF), the last stage of most cardiac disorders, is defined as a progressive illness [9], a result of the prolongation of such a process.MI is characterized by ventricular dilatation, decreased systolic and diastolic function, and in the end congestive heart failure (HF) [10].
Patients who have acute MI might present with a broad spectrum of nonspecific symptoms.Even though they are not frequently used in diagnostics, being aware of their presence concerning infarction is crucial to avoiding incorrect interpretation or diagnosis of other disorders [11,12].Smoking, advanced age, high blood pressure, using amphetamines and cocaine, elevated levels of some lipids (TG and LDL cholesterol) and low HDL cholesterol levels, high blood pressure, diabetes, chronic renal illness, obesity, and excessive alcohol consumption are all associated with an early onset of CVD [13,14].Those enzymes include NADH oxidase, glutathione peroxidase, catalase, and other peroxidases such as cytochrome c [25].One of the vital enzymes, which is referred to as the catalase uses hydrogen peroxide, which is a non-radical ROS, as substrate.This enzyme is responsible for degrading hydrogen peroxide to neutralize it and keeping the molecule at the right concentration within the cell, which is necessary for processes related to cellular signaling.

Hyperamylinemia
Enzyme's participation in several infections and diseases, both indirectly and directly, serves as evidence of its relevance [26].This study compared patients with acute myocardial infarction who had T2D to those who did not, looking at the effects of age and gender on levels of oxidants and antioxidants, amylin hormone, preptin hormone, and FBG.

Excluding Criteria
The study excluded patients with neuropathy, retinopathy, thyroid problems, and liver disorders Table 1: Data of the studied groups

AMI without T2DM
)27/23) serum malonaldehyde (MDA) was assessed utilizing the thiobarbituric acid method, and serum blood glucose was measured with the use of a Biolabo (France) kit, according to Fong et al. [27].

Statistical Analysis
The results of the statistical analyses have been represented in the form of (mean ±SD) with LSD with the use of SPSS version 15.0.The oneway ANOVA test has been utilized for examining the variables between the various research groups.
A P-value has been deemed statistically significant if it was (P≤0.050).

Results and Discussion
Comparison for all studied Parameters based on Age

Fasting Blood Glucose Concentration
In study group C and group B, there has been a significant difference (p≤0.050) in blood FBG concentration between age groups G2, G1, and G3.
Nonetheless, it was shown that there has been a significant (p≤0.05)difference in serum FBG concentration across age groups (G2 & G1).In study group A, there has not been any significant variation in serum FBG concentrations across any of the age groups (G2, G1, and G3) (p≤0.05).In age groups G2, G1, and G3, there has been a significant difference (p≤0.05) in blood FBG concentrations between study groups B, A, and C (Sivakami and George, [28] indicates that glucose is vital to the aging process and age-related disorders since the signs of hyperglycemia and natural aging, including cataracts, are identical.It seems that more complex glycosylation end products will emerge as a result of the subsequent hyperglycemia.Permanent physiological changes brought on by aging have been related to increased risks of disease [29].Agerelated declines in insulin sensitivity and changes in or insufficient beta cell activity compensation in response to increased insulin resistance are the main contributing factors [30,31].A decline in beta cell proliferative potential and an apoptotic sensitivity increase are factors associated with aging [31].such deposits constitute the main β-cell toxicity source, which leads to β-cell mortality and, subsequently in T2D, a decrease in insulin production and amylin levels [32].

According to Sex Fasting Blood Glucose Concentration
The serum FBG concentrations of the male and female research groups (A, B, & C; p≤0.05) did not significantly differ from one another.Furthermore, the blood FBG concentrations in the male and female sex groups as well as the three study groups (A, B, and C) show significant differences (p≤0.05).

Serum Amylin and Preptin Concentrations
Table 7 demonstrates that the serum amylin levels in the male and female study groups (B and C) differed significantly (p≤0.05).In study group (A), there has not been any significant difference in serum amylin levels between the female and male groups.For female as well as male sex groups, Table 6 shows a statistically significant difference (p≤0.05) in the serum amylin concentrations between Study Group B and Study Groups A and C.
The female and male study groups (C and A) did not significantly differ in their serum amylin levels.
Table 7 shows that the serum preptin levels in the female and male study groups (C and B) differed significantly (p≤0.05).Nevertheless, in the study group (A), there has not been any appreciable variation in the serum preptin concentrations between female and male groups (p≤0.05).For both the female and male sex groups, there is a significant difference (p≤0.05) in serum concentration of preptin between study groups B, A, and C. The female and male study groups (C and A) did not significantly differ in their serum preptin concentrations, though (p≤0.05).Women reported greater prevalence levels of Amylin and Preptin (10%) compared to men, which is comparable to the 20% higher percentage of women compared to men who have impaired glucose tolerance [36].Since the molecular explanations that have been proposed have centered on the effects of estrogen, which could decrease after menopause and raise the risk of CHD in women, women have higher quantities of amylin and preptin [37].

Table 6: FBG levels for all sex groups
Note: every value represents mean ± SD values with the non-identical superscript (a, b, or c…etc), which have been considered as significant differences (P≤ 0.05).
-No: Number of subjects.
-A: Control Group.
-B: Acute myocardial infarction with type 2 diabetic patient group.
-C: Acute myocardial infarction without type 2 diabetic patient group.Serum Malondialdehyde (MDA) Concentration Table 8 showed that there has not been any statistically significant difference in serum MDA levels between study group (A) male and female groups.The male and female groups in (B and C) groups had significantly different serum MDA levels (p≤0.05).Furthermore, all three study groups (A, B, and C) show a significant difference in blood MDA concentrations (p≤0.05) between male and female sex groups.Oxidative stress is a significant player in CVD pathogenesis.Postmenopausal women are more susceptible to CVD since they have lower levels of accessible estrogen and higher levels of oxidative stress.Menopause causes a systemic pro-oxidant situation because it reduces the production of estrogen, a naturally occurring antioxidant [38].

Serum Superoxide Dismutase (SOD) and Catalase (CAT) Concentrations
Table 9 showed that there has been no significant difference in blood SOD levels between study group (A) female and male groups.The female and male groups in the (C and B) groups had significantly different serum SOD levels (p≤0.05).Furthermore, in all three research groups (B, A, and C), there is a significant difference (p≤0.05) in serum SOD concentration levels between female and male sex groups, as shown in this table.Table 9 shows that there has been no significant difference in the serum CAT levels between the study group (A) male and female groups.The female and male groups in the (B and C) groups had significantly different serum CAT concentrations (p≤0.05).Furthermore, all three study groups (B, A, and C) show a significant difference (p≤0.05) in blood CAT concentrations between the female and male sex groups.Oxidative stress arises from an imbalance between the body's antioxidant defense systems and ROS/RNS.When ROS generation exceeds cellular antioxidant capacity, it might upset the delicate balance.This can therefore result in lipid and protein peroxidation, DNA mutagenesis, and other possibly hazardous effects.In addition to causing direct damage to cells [39].This study shows that women have lower amounts of antioxidants (CAT and SOD) than men.Following menopause, a crucial stage of female senescence takes place.Premenopausal women have a lower incidence of CVD in comparison to men, whereas postmenopausal women have a much higher incidence of CVD than males, according to epidemiological data.This incident proves that estrogen does protect the cardiovascular system.From the perspective of oxidative stress, estrogen functions through the estrogen receptor to regulate the cardiovascular system, providing menopausal women with heart issues with therapy choices [40].
The presented work was carried out from October 2022 to April 2023 at the AL-Nasiriyah Heart Center, ALAzher Privet Hospital, the College of Science's Biochemistry Laboratory, and specialized clinical settings.It included (150) subjects, which have been classified into controls (50) and patients (100).The investigation was carried out on the entire population of presumably healthy people and patients, who were split into: Control group: Fifty (50) ostensibly healthy participants, 25 of whom were male and 25 of whom were female, with ages that range from 40 to 70, made up the control group.DM/AMI group: included fifty (50) patients with T2DM and Acute myocardial infarction [22 females and 28 males] with age range (40-70) years.AMI group: included fifty (50) patients with Acute myocardial (40-70) years [27 males and 23 females] without any history of systematic illness at (40−70) years of age range.Inclusion Participants in the study varied in age from 40 to 70 years old and had type 2 diabetes and cardiovascular disease but were not obese.Similar pharmacological guidelines were in place, but insulin injections were not.

Table 2 :
Serum FBG levels for all age groups.
G2:The second age group ranges from (51-60 years).G3: The third age group ranges from (61-70 years).A: represents the Control Group.B: represents the acute myocardial infarction with T2D patients' group.C: represents the acute myocardial infarction without T2D patients' group.

Table 3 :
Serum Amylin and Preptin levels for all age groups.
-Legend as in table 2.

Table 5 :
Serum SOD and CAT levels for all age groups.

Table 7 : Serum Amylin and preptin levels for all sex groups
-Legend as in Table6

Table 8 :
Serum MDA levels for all sex groups -Legend as in Table6

Table 9 :
Serum SOD and Catalase levels for all sex groups.
-Legend as in table 6.