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[Homocysteine, lipoprotein (a): risk factors for coronary heart disease]
A Laraqui1, N Bennouar, F Meggouh
1Laboratoire de la ligue cardiovasculaire, Hôpital Ibn-sina, BP 1326, Rabat, Maroc.
Insights
Elevated homocysteine and lipoprotein Lp(a) levels are independent risk factors for coronary heart disease. This study found significant associations between higher levels of both markers and increased risk of significant coronary artery stenosis.
Area of Science:
- Cardiovascular Medicine
- Clinical Biochemistry
- Medical Diagnostics
Context:
- Coronary heart disease (CHD) is a leading cause of mortality worldwide.
- Identifying novel risk factors is crucial for effective prevention strategies.
- Hyperhomocysteinemia and elevated lipoprotein Lp(a) are implicated in cardiovascular pathology.
Purpose:
- To investigate the association between plasma homocysteine and lipoprotein Lp(a) levels and the presence of coronary artery disease.
- To determine if these markers act as independent risk factors for CHD.
- To explore potential interactions between these markers and other known risk factors.
Summary:
- This study analyzed 178 patients undergoing cardiac examination, measuring homocysteine and Lp(a) levels alongside traditional risk factors.
- Significantly higher homocysteine and Lp(a) levels were observed in patients with significant coronary artery stenosis (cases) compared to controls.
- Homocysteine and Lp(a) demonstrated strong, independent associations with CHD, with odds ratios indicating substantially increased risk at higher levels.
Impact:
- The findings highlight homocysteine and Lp(a) as significant, independent risk factors for coronary heart disease.
- This underscores the importance of monitoring these biomarkers in cardiovascular risk assessment.
- Further research may elucidate mechanisms and inform targeted therapeutic interventions for CHD prevention.
Abstract:
Our data suggest that the hyperhomocysteinemia and/or increased plasma level of lipoprotein Lp(a) are risk factors for coronary heart disease. We investigated 178 patients who underwent complete cardiac examination comprising coronary angiography and biological analysis (CT, HDL-c, LDL-c, TG, and apoAI, apoB, homocysteine and Lp(a)). Patients presenting a significant stenosis of the coronary artery ( 50% of the vascular lumen) were considered as cases (113 patients). Those without stenosis or with non-significant stenosis (< 50% of the vascular lumen) were used as controls (65 subjects). Homocysteinemia was significantly higher in cases than in control subjects (8.26 mol/L (2.34 versus 17.85 (2.34, p < 0.001). A strong association between coronary heart disease and homocystein has been found (Eta(2) = 0.76). The OR were 0.16 when homocystein level was lower than 15 mol/L, and 27.78 when homocysteine level was upper than or equal to 15 mol/L. The RR was 5.16 (95% IC = 3.66-6.66, p < 0.001). Even though there was a significant correlation between tabagic impregnation and homocysteinemia (Spermann's rho = 0.37, p < 0.05), there was no interactive effect between these two factors and coronary disease (Wald khi2 = 0.086, p > 0.05). Therefore, no association was found between homocyteinemia and other coronary heart disease risk factors. The Lp(a) levels were significantly higher in cases than in controls subjects (188 (84 mg/L in control subjects versus 590 (199 in cases, p < 0.001). A stronger relationship was noted between coronary heart disease and Lp(a) (Eta (2) = 0.66). The OR were 0.09 when lipoprotein (a) levels were lower than 350 mg/L, and 5,88 when Lp(a) levels were higher than or equal to 350 mg/L. The estimate RR was 6.47 (95% IC = 4.39-8.55, p < 0.001). The level of Lp(a) was positively correlated with the severity of coronary heart disease (Spermann's rho = 0.95, p < 0.001). A weak correlation between Lp(a) and LDL-c was observed (Spermann's rho = 0.12, p = 0.048). But the multivariate analysis didn't show interactive effect between these two factors and coronary disease (khi2 de Wald = 0.264, p > 0.05). No association was noted between Lp(a) and the others risk factors. Moreover, a positive correlation between the levels of homocysteine and those of Lp(a) was found (Spermann's rho = 0.54, p < 0.001). In contrast their effect on coronary heart disease seems to be independant (Wald khi2 = 2.957, p > 0.05). Thus, these two parameters appear as independant risk factors for coronary heart disease.