الفهرس 
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Abstract
SUMMARY Myelodysplastic syndromes (MDS) are hematopoietic stem cell disorders characterized by ineffective hematopoiesis resulting in peripheral blood cytopenias. MDS typically occur at an advanced age. CVD is the most common disease-unrelated cause of death in MDS.
CIMT, a noninvasive measurement of the artery wall thickness and atherosclerotic plaque obtained using ultrasound imaging is associated with atherosclerotic lesions in the general population and is a traditional marker for early cardiovascular events Adhesion molecules play an important role in the regulation of normal hemopoiesis. VCAM-1 belongs to immunoglobulin-like transmembrane adhesion molecules that are involved in a variety of cell functions.
VWF is a large multimeric glycoprotein present in plasma, platelets, and vascular endothelial cells. The main roles of VWF in hemostasis are to support platelet adhesion to the damaged vessel wall, to control platelet-to-platelet interactions, and to stabilize coagulation factor VIII in plasma.
Herein, we aimed to estimate carotid intimal media thickness (a biomarker of subclinical atherosclerosis), VCAM-1, and VWF levels in elderly Egyptians with MDS and elaborate its clinical, hematologic, and cytogenetic correlation and find out the association between VWF, VCAM-1 level and subclinical atherosclerosis with myelodysplastic syndrome.
This was a prospective case-control study conducted on 54 Egyptian adults (≥55 years old) selected from the outpatients and inpatients of the Hematology units of Menoufia University Hospitals. A total of 54 Egyptian adults were divided into two groups; group 1, including 27 patients diagnosed with MDS according to the 2016 WHO criteria for classification and diagnosis of myeloid neoplasm and AML, and group 2, including 27 matched sex and age-healthy controls.
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The mean age of MDS patients was comparable to that of controls (64 ± 4.7 vs. 63.5 ± 3.5, respectively, p=0.673).
Females were more predominant in both groups, representing 74.1% in the MDS group and 51.9% in the control group. No statistically significant difference was reported between both groups as regards sex (p=0.159).
The socioeconomic status in MDS patients and controls was comparable where most of the MDS patients and controls belonged to low socioeconomic status.
The majority of MDS patients were non-smokers (81.5%) and smokers in both groups were relatively comparable with no statistically significant difference between both groups regarding smoking (p=0.224)
The median BMI of MDS patients was 29 Kg/m2, revealing that overweight is frequent among MDS patients. There was no statistically significant difference between the two groups regarding BMI (p=0.14).
Hypertension was significantly higher in MDS patients compared to the control group (p=0.002), indicating a relation between hypertension and MDS.
FBS, PPBG, HBA1c, and HOMA-IR were significantly higher in MDS patients in comparison to controls (p< 0.001, <0.001, 0.013, and p =0.013, respectively).
Homocysteine was significantly higher in MDS patients compared to controls (Median of 3.6 μmol/L vs. 2.8μmol/L, respectively; p =0.002). HB was significantly lower in MDS patients (Median of 9g/dl) in comparison to controls (13g/dl) (p <0.001). While MCV and TLC were comparable in both groups (p =0.572, and 0.142, respectively). Platelets were significantly lower in MDS patients compared to controls (94 vs. 226 units) (p <0.001).
According to the lipid profile, no statistically significant was found between MDS patients and controls in terms of LDL (p =0.229), and cholesterol
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(p =0.403). However, HDL was significantly lower in MDS patients compared to the control group (Median of 41 vs. 56, respectively, p =0.002). In addition, TG in the MDS patients (Median of 123) was significantly higher than that in controls (Median of 65) (p <0.001).
CRP was significantly higher in MDS patients (10mg/dL) compared to controls (1.2mg/dL) (p <0.001).
Both right and left CIMT in MDS patients were greater than that in controls, however, the left CIMT was significantly higher in MDS patients compared to controls (p =0.001) while on the right side, statistical significance was not achieved (p =0.078). Furthermore, we reported a significant positive correlation between the right and left CIMT (r= 0.73; p<0.001) and between left CIMT and TLC (r=0.56, p=0.02).
VCAM in MDS patients (Median of 352.7) was significantly higher than VCAM in controls (median of 82.9) (p <0.001). There was no statistically significant correlation between VCAM and different parameters in MDS patients.
VWF in MDS patients was significantly higher than VWF in controls (80.5 vs. 59, respectively; p <0.001). No statistically significant correlation was found between VWF and different parameters in MDS patients.