The present study was carried out on 60(56 males and 4 females) stable coronary artery disease patients selected from the angiography department of Shaukat Khanum Medical & research Laboratories. Only those patients were selected as cases, who verified angiographically, as having coronary artery disease. Thirty controls were also selected from angiography department of Shaukat KhanumMedical & research Laboratories. These were the patients who on angiography were verified as having normal coronary arteries. The patients were between the ages of 30-60 years. Mean age of the cases was 43.95±5.6 years and the mean age of controls was 42.87±7.27 years (Table 1). No significant difference was found between the distribution of patients age among cases and controls. Among the cases 93% were males and 7% were females. Various risk factors which predispose to coronary artery disease were also . recorded in our study such as history of hypertension, smoking, history of hyperlipidemia, family history of coronary artery disease, obesity, serum cholesterol, serum triglyceride, serum copper and plasma Homocysteine.

Regarding the history of smoking, there were 51.7% smokers among the cases. In the control group only 30% were smokers and this difference was statistically not significant (p value 0.05) (Table 3). History of hyperlipidemia was present in 17 cases and 4 controls. The family history of coronary heart disease was seen in 33 cases and 11 controls. There was no statistical difference between the distribution or these factors among cases and controls (Table 3).

The cases had a mean BMI of 27.38±3.75and the controls had a mean BMI of 27.l4±5.56. In the control group 63.30/0 were overweight and obese and among the cases 71.6°1<> were overweight and obese. A number of biochemical tests including serum cholesterol, serum triglyceride, serum copper and plasma Homocysteine, were done on the study population. The mean serum cholesterol among the cases was 184.23±37.83mg/dl and in the controls it was 171.07±48.24mg/dl. No difference was found between the distribution of mean cholesterol levels in cases and controls (Fig 5). The mean triglyceride level was 207±84.71mg/dl among the cases and 160±71.27mg/dl in controls. The difference was statistically significant (Fig 6).

The principal observation of this study is that mean plasma tHcy of cases was significantly higher (15.21±2.67Ilmol/l) as compared to controls (10.88±1.88Ilmol/l) (p value <0.01) (Fig 7).

The other major observation was that there was a significant difference in the distribution of serum copper among cases and controls when serum copper was divided into groups (Table 8).

This study observed more patients with conventional risk factors in hyperhomocysteinemic subjects (n=36) than the patients having low Homocysteine level (n=54). In spite of this no association was found between hyperhomocysteinemia and these risk factors except serum copper (p value <0.01). The mean serum copper in subjects with normal plasma Homocysteine level was 81.96~g/dl and in the patients with hyperhomcysteinemia it was 1 00.82~g/d1. A positive correlation was found between serum copper and plasma Homocysteine (r=0.44) Coronary artery disease is associated with moderate hyperhomocysteinemia in our study and it shows a positive correlation with serum copper. It does not show any association with other risk factors.

Since hyperhomocysteinemia is commonly seen in our patients, it is prudent to manage these subjects with vitamin supplements and adequate nutrition.