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Increased homocysteine and lipoprotein(a) levels highlight systemic atherosclerotic burden in patients with a history of acute coronary syndromes.
J Vasc Surg. 2016 Jul; 64(1):163-70.JV

Abstract

BACKGROUND

Strong evidence supports an association between high levels of homocysteine (Hcy) and lipoprotein(a) [Lp(a)] and an increased rate of ischemic vascular events.

METHODS

The study population comprised 162 patients (50 women [30.9%]; age, 66.71 ± 12.76 years) having a history of acute coronary syndrome within 1 year who underwent fasting blood sampling, measurement of intima-media thickness and pulse wave velocity at the common carotid and femoral arteries by Doppler ultrasound, and ankle-brachial index measurement. Cutoff values were considered 0.9 mm and 1.2 mm for carotid and femoral intima-media thickness, respectively; 12 m/s for pulse wave velocity; and <0.9 for ankle-brachial index. We included hypertension, dyslipidemia, diabetes, overweight/obesity, smoking, and family history of cardiovascular disease in the count of traditional risk factors (CRFs). Adding Hcy ≥15 μmol/L and Lp(a) ≥500 mg/L to CRFs, we obtained a new score, named TOTAL.

RESULTS

On univariate analysis, Hcy and Lp(a) were significantly associated with presence of atherosclerotic extracoronary lesions (for Hcy: β = .934; standard error = 0.178; P < .0001; for Lp(a): β = .961; standard error = 0.177; P < .0001) and compliance alterations (for Hcy: odds ratio, 13.3; 95% confidence interval, 3.9-45.3; P < .0001; for Lp(a): odds ratio, 14.6; 95% confidence interval, 5.69-37.62; P < .0001). On multivariate analysis, Lp(a) and Hcy were significantly associated with extracoronary atherosclerosis, even after correction for CRFs. The area under the curve of the TOTAL score for both atherosclerosis and vascular compliance alterations was significantly higher than the area under the curve of traditional CRFs plus only Hcy ≥15 μmol/L or plus Lp(a) ≥500 mg/L, separately added.

CONCLUSIONS

The addition of evaluation of Hcy ≥15 μmol/L and Lp(a) ≥500 mg/L to the traditional CRF count does improve detection of systemic atherosclerotic burden of patients with acute coronary syndrome and can offer a new opportunity to optimize secondary prevention.

Authors+Show Affiliations

Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy. Electronic address: gabriele.cioni@unifi.it.Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy.Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy.Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy.Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy.Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy; Don Carlo Gnocchi Foundation, IRCCS, Florence, Italy.Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy.Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

27139787

Citation

Cioni, Gabriele, et al. "Increased Homocysteine and Lipoprotein(a) Levels Highlight Systemic Atherosclerotic Burden in Patients With a History of Acute Coronary Syndromes." Journal of Vascular Surgery, vol. 64, no. 1, 2016, pp. 163-70.
Cioni G, Marcucci R, Gori AM, et al. Increased homocysteine and lipoprotein(a) levels highlight systemic atherosclerotic burden in patients with a history of acute coronary syndromes. J Vasc Surg. 2016;64(1):163-70.
Cioni, G., Marcucci, R., Gori, A. M., Valente, S., Giglioli, C., Gensini, G. F., Abbate, R., & Boddi, M. (2016). Increased homocysteine and lipoprotein(a) levels highlight systemic atherosclerotic burden in patients with a history of acute coronary syndromes. Journal of Vascular Surgery, 64(1), 163-70. https://doi.org/10.1016/j.jvs.2016.01.056
Cioni G, et al. Increased Homocysteine and Lipoprotein(a) Levels Highlight Systemic Atherosclerotic Burden in Patients With a History of Acute Coronary Syndromes. J Vasc Surg. 2016;64(1):163-70. PubMed PMID: 27139787.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased homocysteine and lipoprotein(a) levels highlight systemic atherosclerotic burden in patients with a history of acute coronary syndromes. AU - Cioni,Gabriele, AU - Marcucci,Rossella, AU - Gori,Anna Maria, AU - Valente,Serafina, AU - Giglioli,Cristina, AU - Gensini,Gian Franco, AU - Abbate,Rosanna, AU - Boddi,Maria, Y1 - 2016/04/29/ PY - 2015/07/27/received PY - 2016/01/31/accepted PY - 2016/5/4/entrez PY - 2016/5/4/pubmed PY - 2017/5/27/medline SP - 163 EP - 70 JF - Journal of vascular surgery JO - J Vasc Surg VL - 64 IS - 1 N2 - BACKGROUND: Strong evidence supports an association between high levels of homocysteine (Hcy) and lipoprotein(a) [Lp(a)] and an increased rate of ischemic vascular events. METHODS: The study population comprised 162 patients (50 women [30.9%]; age, 66.71 ± 12.76 years) having a history of acute coronary syndrome within 1 year who underwent fasting blood sampling, measurement of intima-media thickness and pulse wave velocity at the common carotid and femoral arteries by Doppler ultrasound, and ankle-brachial index measurement. Cutoff values were considered 0.9 mm and 1.2 mm for carotid and femoral intima-media thickness, respectively; 12 m/s for pulse wave velocity; and <0.9 for ankle-brachial index. We included hypertension, dyslipidemia, diabetes, overweight/obesity, smoking, and family history of cardiovascular disease in the count of traditional risk factors (CRFs). Adding Hcy ≥15 μmol/L and Lp(a) ≥500 mg/L to CRFs, we obtained a new score, named TOTAL. RESULTS: On univariate analysis, Hcy and Lp(a) were significantly associated with presence of atherosclerotic extracoronary lesions (for Hcy: β = .934; standard error = 0.178; P < .0001; for Lp(a): β = .961; standard error = 0.177; P < .0001) and compliance alterations (for Hcy: odds ratio, 13.3; 95% confidence interval, 3.9-45.3; P < .0001; for Lp(a): odds ratio, 14.6; 95% confidence interval, 5.69-37.62; P < .0001). On multivariate analysis, Lp(a) and Hcy were significantly associated with extracoronary atherosclerosis, even after correction for CRFs. The area under the curve of the TOTAL score for both atherosclerosis and vascular compliance alterations was significantly higher than the area under the curve of traditional CRFs plus only Hcy ≥15 μmol/L or plus Lp(a) ≥500 mg/L, separately added. CONCLUSIONS: The addition of evaluation of Hcy ≥15 μmol/L and Lp(a) ≥500 mg/L to the traditional CRF count does improve detection of systemic atherosclerotic burden of patients with acute coronary syndrome and can offer a new opportunity to optimize secondary prevention. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/27139787/Increased_homocysteine_and_lipoprotein_a__levels_highlight_systemic_atherosclerotic_burden_in_patients_with_a_history_of_acute_coronary_syndromes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(16)00219-6 DB - PRIME DP - Unbound Medicine ER -