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Panminerva Medica 2001 June;43(2):77-80

lingua: Inglese

Serum lipoprotein(a) changes in acute myocardial infarction

Motta M., Giugno I., Bosco S., Pistone G., Ruello P., Maugeri D., Malaguarnera M.

From the Depart­ment of Inter­nal Med­i­cine and Ger­i­at­rics, Uni­ver­sity of Cata­nia, Cata­nia, Ita­ly


Back­ground. A ­strong cor­re­la­tion ­between ­high ser­um Lp(a) lev­els, a genet­ic mod­ifi­ca­tion of cho­les­te­rol-low den­sity lipop­ro­teins (c-LDL), and ­increased cor­o­nary ­heart dis­ease ­rate has ­been ­found. Tran­sient ­increased ser­um lev­els of ­this lip­o­pro­tein dur­ing ­acute myo­car­dial infarc­tion (AMI) and sur­gi­cal inter­ven­tions ­have ­been ­found.
Meth­ods. Experi­men­tal ­design: we ­assessed com­plete lipid­ic pat­tern in a ­study ­series com­posed of 19 ­patients ­with AMI. We ­also eval­u­at­ed the chang­es of Lp(a) ser­um lev­els with­in the ­first ­week of the dis­ease in ­order to ­assess wheth­er a cor­re­la­tion ­between ­this param­e­ter and ­extent of necrot­ic myo­car­dial ­area is ­present. ­Patients: ­study ­series was ­made up of 19 ­patients (13 ­males, 6 ­females; ­mean age 57.94±10.7 ­years) ­with AMI com­pared to 25 con­trol sub­jects (12 ­males and 13 ­females; ­mean age 51.12±15.34 ­years). Meas­ures: we ­also with­drew a ­blood sam­ple on ­days 1, 3 and 7 ­from the ­onset of the AMI. On the ­first day we eval­u­at­ed the ser­um lev­els of the fol­low­ing param­e­ters: gly­cae­mia, azo­te­mia, crea­tin­i­ne­mia, ury­cae­mia, ­total cho­les­te­rol, ­high den­sity lip­o­pro­tein cho­les­te­rol (c-HDL), low den­sity lip­o­pro­tein cho­les­te­rol (c-LDL), tri­gly­ce­rides, fibrino­gen, crea­tin­phos­phok­i­nase, aspar­tate ami­no­trans­phe­rase, throm­bo­plas­tine ­time and pro­throm­bin­ic activ­ity. Lp(a) has ­been eval­u­at­ed on day 1, 3 and 7 and ­after 6 ­months ­from AMI. We per­formed an ultra­sound scan­ning (US) of the ­heart in day 7 for eval­u­a­tion of the ­extent of necrot­ic myo­car­dial ­area by obser­va­tion of ''seg­men­tal kinet­ic ­area''.
­Results. ­Mean ­basal Lp(a) ser­um lev­el was 28.94±29.78 mg/dl (as ­median 17), (nor­mal val­ues 0 to 25 mg/dl). ­This val­ue was not ­changed on day 3 (­mean 29.47±30.46 mg/dl, ­median 18), ­while sig­nif­i­cant­ly ­increased on day 7 (39.84±42.77, ­median 26, p=0.05). ­Spearman’s ­rank cor­re­la­tion ­test ­showed a ­strong cor­re­la­tion ­between the ­increase of Lp(a) ser­um lev­els on day 7 and ­extent of necrot­ic myo­car­dial ­area (r=0.696, p=0.001).
Con­clu­sions. The pos­i­tive cor­re­la­tion ­between ­mean Lp(a) val­ues on day 1 and 7, and the ­size of the necrot­ic ­area, sug­gest ­that Lp(a) has an ather­o­gen­ic and pro­throm­bot­ic ­role. More­over, ele­vat­ed Lp(a) val­ues ­were relat­ed to great­er tis­sue dam­age. We ­believe ­that peri­od­i­cal deter­mi­na­tion of Lp(a) val­ues in sub­jects ­with cor­o­nary dis­ease is use­ful in ­order to pre­dict fur­ther ­acute vas­cu­lar ­events.

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