title: Mild hyperhomocysteinemia is associated with a decreased fibrinolytic activity in patients after ST-elevation myocardial infarction.
abstract: BACKGROUND
  Elevated homocysteine (Hcy) levels have been associated with increased risk for cardiovascular disease and it has been shown that hyperhomocysteinemia is associated with increased levels of t-PA antigen in individuals without evidence for coronary artery disease (CAD). The aim of this study was to examine if Hcy plasma levels are associated with plasma levels of fibrinolytic factors in patients with CAD and a history of acute myocardial infarction.
  
  
  METHODS
  We measured in 56 patients with CAD, 1 month after their first ST-elevation myocardial infarction, plasma levels of Hcy, the fibrinolytic parameters tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor-type-1 (PAI-1), and t-PA-PAI-1 complexes.
  
  
  RESULTS
  Hcy plasma levels inversely correlated with t-PA activity (r=-0.303, p<0.05). Patients with mild hyperhomocysteinemia (Hcy>15 micromol/L, n=8) showed significantly lower plasma levels of t-PA activity (p<0.05). Regression analysis revealed that out of cardiovascular risk factors and medical treatment only Hcy was significantly associated with t-PA activity.
  
  
  CONCLUSIONS
  Patients with CAD after a first myocardial infarction and hyperhomocysteinemia show a reduced t-PA activity independently from cardiovascular risk factors and medical treatment. Homocysteine lowering therapies may increase fibrinolytic activity and thereby may help to avoid atherothrombotic events in patients with CAD after a first myocardial infarction.
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna and the Ludwig Boltzman Foundation for Cardiovascular Research, Austria.
authors.forename: Walter Stefan
authors.initials: WS
authors.lastname: Speidl
authors.forename: Mariam
authors.initials: M
authors.lastname: Nikfardjam
authors.forename: Alexander
authors.initials: A
authors.lastname: Niessner
authors.forename: Andrea
authors.initials: A
authors.lastname: Zeiner
authors.forename: Nelli
authors.initials: N
authors.lastname: Jordanova
authors.forename: Gerlinde
authors.initials: G
authors.lastname: Zorn
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schreiber
authors.forename: Johann
authors.initials: J
authors.lastname: Wojta
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
mesh_terms: D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000097:blood; D005260:Female; D005342:Fibrinolysis; D006710:Homocysteine / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications; D012307:Risk Factors; D010959:Tissue Plasminogen Activator / Q000097:blood*
chemical_list: D006710:Homocysteine; D010959:Tissue Plasminogen Activator