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Published on: May 14, 2013
Homocysteine, lipoprotein(a), and restenosis after percutaneous transluminal coronary angioplasty: a prospective
S E Miner1, R A Hegele, J Sparkes
1Terrence Donnelly Heart Centre, Department of Hematology, St Michael's Hospital, University of Toronto, Ontario, Canada.
Insights
Novel risk factors like homocysteine, lipoprotein(a), and MTHFR 677T do not appear to increase restenosis risk after angioplasty. This study found no significant association between these markers and restenosis rates in patients.
Area of Science:
- Cardiology
- Genetics
- Biochemistry
Background:
- Restenosis affects 30-40% of angioplasty procedures and may involve novel risk factors beyond traditional ones.
- Homocysteine, lipoprotein(a), and MTHFR 677T are emerging risk factors for coronary artery disease.
- The specific roles and potential interactions of these factors in restenosis remain largely unexamined.
Purpose of the Study:
- To investigate the relationship between homocysteine, lipoprotein(a), and MTHFR 677T genotypes with restenosis after percutaneous transluminal coronary angioplasty.
- To explore potential synergistic effects between homocysteine and lipoprotein(a) in the context of restenosis.
Main Methods:
- Prospective enrollment of patients undergoing successful percutaneous transluminal coronary angioplasty or stenting.
- Fasting blood samples collected for homocysteine, lipoprotein(a), and MTHFR 677T analysis.
- Quantitative analysis of follow-up coronary angiography at 6 months to assess restenosis.
Main Results:
- Overall angiographic restenosis rate was 31% in 144 patients.
- No significant differences in homocysteine or lipoprotein(a) levels were observed between patients with and without restenosis.
- MTHFR 677T homozygosity was not associated with an increased risk of restenosis, and no interaction between homocysteine and lipoprotein(a) was detected.
Conclusions:
- Homocysteine, lipoprotein(a), and MTHFR 677T are not significantly associated with restenosis following percutaneous transluminal coronary angioplasty.
- These novel risk factors do not appear to play a major role in the development of restenosis in this patient cohort.
Background:
Restenosis complicates 30% to 40% of angioplasty procedures and may be unrelated to traditional coronary risk factors. Homocysteine, lipoprotein(a), and methylenetetrahydrofolate reductase (MTHFR 677T) (a genetic determinant of plasma homocysteine concentrations) are novel risk factors for coronary artery disease. Their roles in restenosis are unclear, and the potential synergism between homocysteine and lipoprotein(a) has not previously been studied. The objective of this study was to determine the relations among homocysteine, lipoprotein (a), MTHFR 677T, and restenosis after percutaneous transluminal coronary angioplasty.
Methods:
This prospective study enrolled patients with successful elective percutaneous transluminal coronary angioplasty or stenting of a single, de novo, native coronary lesion. Fasting blood was drawn the morning of the procedure for homocysteine, lipoprotein(a), and MTHFR 677T. Follow-up angiography was performed 6 months after the procedure or earlier if clinically indicated. All cineangiograms were analyzed quantitatively.
Results:
A total of 144 (92%) of 156 eligible patients underwent follow-up coronary angiography. The overall angiographic restenosis rate (residual stenosis >50%) was 31%. Mean homocysteine concentration was 10.1 +/- 3.7 micromol/L. Plasma homocysteine concentrations were not significantly different in patients with or without angiographic restenosis (9.6 +/- 3.3 vs 10.3 +/- 3.8 micromol/L; P =.31). Mean lipoprotein(a) concentration was 21.2 +/- 20.1 mg/dL. Plasma lipoprotein(a) concentrations were not significantly different in patients with or without restenosis (21.9 +/- 21.8 vs 20.9 +/- 19.5 mg/dL). Homozygosity for MTHFR 677T was present in 6.5% and was not associated with increased restenosis. No interaction between homocysteine and lipoprotein(a) was detected.
Conclusions:
Homocysteine, lipoprotein(a), and MTHFR 677T are not associated with restenosis after percutaneous transluminal coronary angioplasty.
