Premature coronary artery disease in young (age <45) subjects: interactions of lipid profile, thrombophilic and haemostatic markers.
BACKGROUND
Intravascular thrombogenesis is influenced by a complex interplay of procoagulant, anticoagulant, fibrinolytic, endothelial damage/dysfunction and inflammatory factors. We hypothesised that abnormalities of these biological systems would contribute to coronary artery disease presenting at a young age.


METHODS
We performed a case-control study of 142 subjects presenting with MI at a young age (<or=45 years; 'cases'), who were compared with 95 controls. We assessed for abnormalities of thrombophilia [total homocysteine (tHcy), lipoprotein (a) [Lp(a)], antiphospholipid antibodies (APA)], lipid profile [total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides], fibrinogen and fibrin D-dimer (an index of thrombogenesis), endothelial damage/dysfunction (von Willebrand factor [vWF]), fibrinolysis (tissue plasminogen activator [t-PA antigen] and its inhibitor [PAI-1 antigen]) and inflammation (C-reactive protein [CRP]).


RESULTS
Cases had significantly higher Lp(a) (p=0.008), triglycerides (p=0.001), fibrinogen (p=0.006), fibrin D-dimer (p=0.006) and vWf (p=0.032), but lower HDL-C (p=0.003) levels. There were no significant differences in tHcy, APA titre, total cholesterol or LDL-C, t-PA, PAI-1 and CRP levels (all p=NS). In a multivariate analysis, the only variables independently associated with cases were levels of Lp(a) (p=0.015), fibrinogen (p=0.038) and D-dimer (p=0.005) levels.


CONCLUSIONS
Premature coronary artery disease is characterized by an unfavourable lipid profile, low concentrations of HDL-C and high triglyceride levels, in association with high Lp(a) and a hypercoagulable state (high fibrinogen and D-dimer levels).
Pineda
Javier
J
Marín
Francisco
F
Marco
Pascual
P
Roldán
Vanessa
V
Valencia
José
J
Ruiz-Nodar
Juan M
JM
Sogorb
Francisco
F
Lip
Gregory Y H
GY
D000328:Adult; D017668:Age of Onset; D015415:Biomarkers / Q000097:blood; D001779:Blood Coagulation Factors / Q000378:metabolism; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000097:blood* / Q000209:etiology*; D006801:Humans; D008055:Lipids / Q000097:blood*; D008875:Middle Aged; D019851:Thrombophilia / Q000097:blood* / Q000150:complications*
D015415:Biomarkers; D001779:Blood Coagulation Factors; D008055:Lipids