title: Oxidized LDL, lipoprotein (a) and other emergent risk factors in acute myocardial infarction (FORTIAM study).
abstract: OBJECTIVE
  To determine the prevalence of acute myocardial infarction (AMI) without classical risk factors, and to ascertain whether affected patients exhibit a higher prevalence of emergent risk factors and whether the presence of specific emergent risk factors influence prognosis at 6 months.
  
  
  METHODS
  The FORTIAM (Factores Ocultos de Riesgo Tras un Infarto Agudo de Miocardio) study is a multicenter cohort study that includes 1371 AMI patients who were admitted within 24 hours of symptom onset. Strict definitions were used for classical risk factors and the concentrations of the following markers were determined: lipoprotein (a) [Lp(a)], oxidized low-density lipoprotein (oxLDL), high-sensitivity C-reactive protein, fibrinogen, homocysteine and antibody to Chlamydia. The end-points observed during the 6-month follow-up were death, angina and re-infarction.
  
  
  RESULTS
  The prevalence of AMI without classical risk factors was 8.0%. The absence of classical risk factors did not affect the 6-month prognosis. The only emergent risk factors independently associated with a poorer prognosis were the Lp(a) and oxLDL concentrations. Cut-points were determined using smoothing splines: 60 mg/ dL for Lp(a) and 74 U/L for oxLDL. The associated hazard ratios, adjusted for age, sex and classical risk factors, were 1.40 (95% confidence interval, 1.06-1.84 ) and 1.48 (95% confidence interval, 1.06-2.06), respectively.
  
  
  CONCLUSIONS
  The proportion of AMI patients without classical risk factors was low and their prognosis was similar to that in other AMI patients. Both oxLDL and Lp(a) concentrations were independently associated with a poorer 6-month prognosis, irrespective of the presence of classical risk factors.
authors.affiliation: Servicio de Cardiología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Gómez
authors.forename: Vicente
authors.initials: V
authors.lastname: Valle
authors.forename: Fernando
authors.initials: F
authors.lastname: Arós
authors.forename: Ginés
authors.initials: G
authors.lastname: Sanz
authors.forename: Joan
authors.initials: J
authors.lastname: Sala
authors.forename: Miquel
authors.initials: M
authors.lastname: Fiol
authors.forename: Jordi
authors.initials: J
authors.lastname: Bruguera
authors.forename: Roberto
authors.initials: R
authors.lastname: Elosua
authors.forename: Lluís
authors.initials: L
authors.lastname: Molina
authors.forename: Helena
authors.initials: H
authors.lastname: Martí
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Covas
authors.forename: Andrés
authors.initials: A
authors.lastname: Rodríguez-Llorián
authors.forename: Montserrat
authors.initials: M
authors.lastname: Fitó
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Suárez-Pinilla
authors.forename: Rocío
authors.initials: R
authors.lastname: Amezaga
authors.forename: Jaume
authors.initials: J
authors.lastname: Marrugat
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015415:Biomarkers; D015331:Cohort Studies; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood*; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D017270:Lipoprotein(a); D008077:Lipoproteins, LDL; C099252:oxidized low density lipoprotein