title: Progression of coronary artery disease in young male post-infarction patients is linked to disturbances of carbohydrate and lipoprotein metabolism and to impaired fibrinolytic function.
abstract: OBJECTIVE
  To assess determinants of coronary artery disease progression in men with previous myocardial infarction.
  
  
  RESULTS
  A total of 102 unselected non-diabetic Swedish men (age 40.4 +/- 3.6, range 23-44 years) entered the study 3-6 months after a first myocardial infarction. The programme included metabolic and haemostatic investigations and routine coronary angiography at baseline, followed by re-angiography 5 years later. Of the original cohort, 76 patients underwent a second angiogram. Separate semiquantitative scoring systems were used for diffuse coronary atherosclerosis and distinct stenoses in 15 proximal coronary segments. Smoking, global severity of coronary atherosclerosis and presence of multi-vessel disease at baseline (P < 0.001) characterized patients with severe progression of both diffuse and focal lesions. Higher plasma levels of low density lipoprotein cholesterol (P < 0.01) and low density lipoprotein triglycerides (P < 0.05), a lower plasma high density lipoprotein2 cholesterol level (P < 0.05) and higher plasma plasminogen activator inhibitor-1 activity (P < 0.05), together with a high baseline stenosis score (P < 0.001) characterized patients with severe progression of coronary atherosclerosis. On the other hand, more pronounced fasting and post-prandial glycaemia (P < 0.05), together with higher plasma plasminogen activator inhibitor-1 activity (P < 0.01) characterized severe progressors with respect to coronary stenosis. Multivariate analysis identified the presence of multi-vessel disease as an independent predictor of progression of both coronary atherosclerosis (P = 0.008) and stenoses (P = 0.007), whereas a high low density lipoprotein triglyceride level (P < 0.01) was independently related to progression of coronary atherosclerosis and a high fasting glucose level (P = 0.02) to progression of coronary stenoses.
  
  
  CONCLUSIONS
  Disturbances in carbohydrate and lipoprotein metabolism and impaired fibrinolytic function are associated with progression of coronary artery disease in young male post-infarction patients.
authors.affiliation: Department of Emergency and Cardiovascular Medicine, Karolinska Hospital Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Båvenholm
authors.forename: U
authors.initials: U
authors.lastname: de Faire
authors.forename: C
authors.initials: C
authors.lastname: Landou
authors.forename: S
authors.initials: S
authors.lastname: Efendic
authors.forename: J
authors.initials: J
authors.lastname: Nilsson
authors.forename: B
authors.initials: B
authors.lastname: Wiman
authors.forename: A
authors.initials: A
authors.lastname: Hamsten
mesh_terms: D000328:Adult; D017023:Coronary Angiography; D003327:Coronary Disease / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018450:Disease Progression; D005342:Fibrinolysis; D006487:Hemostasis; D006801:Humans; D006946:Hyperinsulinism / Q000503:physiopathology; D007333:Insulin Resistance; D008074:Lipoproteins / Q000097:blood*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D008074:Lipoproteins; D017395:Plasminogen Activator Inhibitor 1