Relevance of post-methionine homocysteine and lipoprotein (a) in evaluating the cardiovascular risk in young CAD patients.
BACKGROUND
Aims of our study were to evaluate the prevalence of high lipoprotein (a) [Lp(a)] and homocysteine levels - both in the fasting state (FHcy) and post-methionine (PMHcy) - in young coronary artery disease (CAD) patients, and to investigate the role of genetic and environmental factors for hyperhomocysteinaemia.


METHODS
We studied 140 patients with angiographically documented CAD (24 women </= 55 years and 116 men </= 50 years) and 140 healthy subjects as controls.


RESULTS
Both FHcy [13.2 (5.4-45.8) vs. 9.0 (5.1-24) micromol L(-1)); P < 0.0001] and PMHcy [(39.4 (9.0-66.4) vs. 25.2 (16.4-33.9); P < 0.0001] were significantly higher in patients than in controls. Lp(a) levels were significantly higher in patients than in controls (200 (3-1486) mg L(-1) vs. 97 (10-412) mg L(-1); P < 0.0001). At the multivariate analysis, adjusted for the classical cardiovascular risk factors and creatinine levels, the OR (95% CI) for CAD at young age significantly increased in the fourth quartile of the distribution of FHcy, PMHcy and Lp(a) levels [FHcy: 14.9 (4.1-58), P < 0.0001; PMHcy: 19.2 (4.0-86.3); P < 0.0001; Lp(a): 19.6 (4.7-78.6): < 0.0001]. Vitamin deficiencies were detected in 28/140 (20%) patients. The prevalence of the homozygous C677T (+/+) methylenetetrahydrofolatereductase genotype was higher, but not significantly different, in patients (22.8%) than in controls (18.6%). The allele frequency of the 844ins68 insertion variant in the cystathionine beta-synthase gene was 0.08 in the control group and 0.06 in the patient group.


CONCLUSIONS
Results of the present study indicate the usefulness of including fasting and post-methionine Hcy, and Lp(a) determination in the diagnostic panels of young CAD patients, in order to obtain a better assessment of their cardiovascular risk profile.
Marcucci
R
R
Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. r.marcucci@dac.unifi.it
Brunelli
T
T
Fedi
S
S
Pepe
G
G
Giusti
B
B
Gori
A M
AM
Prisco
D
D
Falai
M
M
Margheri
M
M
Abbate
R
R
Gensini
G F
GF
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D016022:Case-Control Studies; D002614:Chelating Agents; D003327:Coronary Disease / Q000097:blood* / Q000150:complications / Q000235:genetics; D005215:Fasting; D005260:Female; D005494:Folic Acid Deficiency / Q000150:complications; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D017270:Lipoprotein(a) / Q000032:analysis*; D008297:Male; D008715:Methionine; D008875:Middle Aged; D012306:Risk; D018709:Statistics, Nonparametric; D013925:Thromboplastin / Q000032:analysis; D014806:Vitamin B 12 Deficiency / Q000150:complications
D015415:Biomarkers; D002614:Chelating Agents; D017270:Lipoprotein(a); D006710:Homocysteine; D013925:Thromboplastin; D008715:Methionine