Serum Lipoprotein (a) Düzeyleri ile İlk Akut Koroner Sendromun Klinik Prezentasyonu Arasındaki İlişki

Yıl 2023, , 15 - 20, 31.03.2023

Nurullah Çetin , İbrahim Halil Özdemır , Eren Ozan Bakır , Bekir Serhat Yildiz , Yeşim Güvenç Demirağcı , Özgür Bayturan

https://doi.org/10.34087/cbusbed.1214478

Öz

Giriş ve Amaç: Yüksek Lipoprotien (a) [Lp (a)] düzeylerinin artmış koroner arter hastalığı riski ile ilişkili olduğu bilinmektedir. Çalışmamızda ilk kez akut koroner sendrom tanısı ile başvuran hastalarda, serum Lp (a) seviyesi ile klinik prezentasyon arasındaki ilişkiyi araştırmayı planladık.
Gereç ve Yöntem: İlk kez akut koroner sendrom tablosu ile başvuran hastalar prospektif olarak çalışmamaıza dahil edildi. Hastalara ait demografik veriler dosya kayıtlarından toplandı. Lp (a) ve diğer lipid parametrelerinin ölçümü başvuru sonrası en az sekiz saatlik açlığı takiben alınan venöz kandan yapıldı.
Bulgular: 105 ST segment elevasyonlu miyokard infarktüsü (STEMI), 132 ST segment elevasyonu olmayan miyokard infarktüsü (NSTEMI) hastası olmak üzere toplam 237 hasta çalışmaya dahil edildi. Yaş ve cinsiyet açısından gruplar arasında anlamlı bir fark yoktu. Serum Lp (a) seviyeleri STEMI hastalarında daha yüksek saptansa da iki grup arasında anlamlı bir fark yoktu [10.2 (19.7) mg/dl vs. 8.5 (12.7) mg/dl, p: 0.393]. Lp (a) ≥ 30 mg/dl olup, LDL ≥ 100 mg/dl olanlar, LDL < 100 mg/dl olanlara göre 4.95 kat daha fazla STEMI kliniği ile prezente olmakta idiler (odds oranı:4.95, % 95 güven aralığı:1.31-16.5, p:0.027). Diğer taraftan LDL ≥ 100 mg/dl olup, Lp (a) ≥ 30 mg/dl olanların, Lp (a) < 30 mg/dl olanlara göre 2.45 kat daha fazla STEMI kliniği ile prezente olduklarını saptadık (odds oranı:2.45, % 95 güven aralığı:1.04-5.6, p:0.039).
Sonuç: Lp (a) ≥ 30 mg/dl ve LDL ≥ 100 mg/dl olan hastaların akut koroner sendrom klinik prezentasyonlarının STEMI lehine olduğunu saptadık. Bu hasta grubunda daha erken ve etkin yaşam tarzı değişikliklerine ihtiyaç gözükmektedir.

Anahtar Kelimeler

Lipoprotein (a), Akut koroner sendrom, ST segment elevasyonlu miyokard infarktüsü, ST segment elevasyonu olmayan miyokard infarktüsü

Destekleyen Kurum

Manisa Celal Bayar Üniversitesi Bilimsel Araştırma Projeleri Koordinasyon Birimi

Proje Numarası

2020-024.

The Relationship Between Serum Lipoprotein (a) Levels and the Clinical Presentation of the First Acute Coronary Syndrome

Öz

Objective: It is known that high Lipoprotien (a) [Lp (a)] levels are associated with an increased risk of coronary artery disease. In our study, we planned to investigate the relationship between serum Lp (a) level and clinical presentation in patients admitted for the first time with the diagnosis of acute coronary syndrome.
Materials and Methods: Patients presenting with acute coronary syndrome for the first time were included in our study prospectively. Demographic data of the patients were collected from file records. Measurement of Lp (a) and other lipid parameters was made from venous blood taken after at least eight hours of fasting after hospitalization.
Results: A total of 237 patients, including 105 patients with ST-segment elevation myocardial infarction (STEMI) and 132 patients with non-ST-segment elevation myocardial infarction (NSTEMI), were included in the study. There was no significant difference between the groups in terms of age and gender. Although serum Lp (a) levels were found to be higher in STEMI patients, there was no significant difference between the two groups [10.2 (19.7) mg/dl vs. 8.5 (12.7) mg/dl, p: 0.393]. Patients with Lp(a) ≥ 30 mg/dl and LDL ≥ 100 mg/dl are 4.95 times more likely to present to a STEMI clinic than those with LDL < 100 mg/dl (odds ratio: 4.95, 95% confidence interval: 1.31- 16.5, p:0.027). On the other hand, we found that patients with LDL ≥ 100 mg/dl and Lp(a) ≥ 30 mg/dl presented with STEMI clinics 2.45 times more than those with Lp(a) < 30 mg/dl (odds ratio: 2.45, 95% confidence interval: 1.04-5.6, p:0.039).
Conclusion: We found that the clinical presentations of acute coronary syndrome in patients with Lp (a) ≥ 30 mg/dl and LDL ≥ 100 mg/dl were in favor of STEMI. Earlier and more effective lifestyle changes seem to be needed in this patient group.

Anahtar Kelimeler

Lipoprotein (a), Acute coronary syndrome, ST segment elevation myocardial infarction, non-ST segment elevation myocardial infarction

Proje Numarası

2020-024.

Kaynakça

• Ozkan, A.A, Acute coronary syndromes: epidemiology. Turk Kardiyoloji Dernegi Arsivi, 2013, 41, 1-3.
• Onat, A, Yüksel, M, et al., Turkish Adult Risk Factor Study survey 2012: overall and coronary mortality and trends in the prevalence of metabolic syndrome. Turk Kardiyoloji Dernegi Arsivi, 2013, 41, 373-378.
• Nordestgaard, B.G. , Langsted, A, Lipoprotein (a) as a cause of cardiovascular disease: insights from epidemiology, genetics, and biology, Journal of Lipid Research, 2016, 57, 1953-1975.
• Tsimikas, S, A Test in Context: Lipoprotein(a): Diagnosis, Prognosis, Controversies, and Emerging Therapies, Journal of the American Collage of Cardiology, 2017, 69, 692-711.
• Seed, M, Ayres, K.L, et al., Lipoprotein (a) as a predictor of myocardial infarction in middle-aged men, The American Journal of Medicine, 2001, 110, 22-27.
• Willeit, P, Kiechl, S. et al., Discrimination and net reclassification of cardiovascular risk with lipoprotein(a): prospective 15-year outcomes in the Bruneck Study, Journal of the American Collage of Cardiology, 2014, 64, 851-860.
• O'Donoghue, M.L, D.A. Morrow, et al., Lipoprotein(a) for risk assessment in patients with established coronary artery disease, Journal of the American Collage of Cardiology, 2014, 63, 520-527.
• Jubran, A, Zetser, A, Zafrir, B, Lipoprotein(a) screening in young and middle-aged patients presenting with acute coronary syndrome. Cardiology Journal, 2019, 26, 511-518.
• Kamstrup, P.R, Tybjaerg-Hansen, A, et al., Genetically elevated lipoprotein(a) and increased risk of myocardial infarction, Journal of the American Medical Association, 2009, 301, 2331-2339.
• Pearson, G.J, Thanassoulis, G, et al., 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults, The Canadian Journal of Cardiology, 2021, 37, 1129-1150.
• Rawther, T. Tabet, F, Biology, pathophysiology and current therapies that affect lipoprotein (a) levels. Journal of Molecular and Cellular Cardiology, 2019, 131, 1-11.
• Hajjar, K.A, Gavish, D, et al., Lipoprotein(a) modulation of endothelial cell surface fibrinolysis and its potential role in atherosclerosis, Nature, 1989, 339(6222), 303-305.
• Sangrar, W., Bajzar, L, et al., Antifibrinolytic effect of recombinant apolipoprotein(a) in vitro is primarily due to attenuation of tPA-mediated Glu-plasminogen activation, Biochemistry, 1995, 34(15), 5151-5157.
• Daga, L.C, Kaul, U and Mansoor, A, Approach to STEMI and NSTEMI, The Journal of the Association of Physicians of India, 2011, 59, 19-25.
• Senoz, O, Yurdam, F, The effect of postdilatation on coronary blood flow and inhospital mortality after stent implantation in st-segment elevation myocardial infarction patients, International Journal of the Cardiovascular Academy, 2021, 7, 132-139.
• Zahn, R., Schweppe, F, et al., Reperfusion therapy for acute ST-elevation and non-ST-elevation myocardial infarction: what can be achieved in daily clinical practice in unselected patients at an interventional center? Acute Cardiac Care, 2009, 11, 92-98.
• Visseren, F.L.J, Mach, F, et al., 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies with the special contribution of the European Association of Preventive Cardiology (EAPC), Revista Espanola de Cardiologia (English edition), 2022, 75, 429.