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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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