Free fatty acids and acute coronary syndromes--the history

Abstract

While it has been known for >40 years that elevation of plasma-free fatty acids (FFAs or non-esterified fatty acids, NEFA) occurs within 1 or 2 h of the onset of an acute coronary syndrome (ACS) and that the greater the increase in plasma FFA the greater the incidence of serious ventricular arrhythmias, no account exists as to how this was discovered and developed. It was derived from analysis of serum lipoproteins. In 1949, Cohn and colleagues, using elaborate low temperature fractionation, reported that almost all the plasma lipids circulate in combination with proteins, particularly the α- and β-globulin fractions1; these were therefore termed α- and β-lipoproteins.2 A more simple method of analysis is zone electrophoresis of serum lipoproteins in a starch block.3 Using lipid stains, it was possible to identify cholesterol-carrying β-lipoproteins [low-density lipoproteins (LDL)] and α-lipoproteins [or high-density lipoproteins (HDL)]. But these methods required many milliliters of serum, so we developed a micro method applying 0.15 ml of serum to Whatman filter paper using sudan IV or oil red O as the lipid stain. The precise analytical method based on cholesterol elution from the electrophoretic bands reacting to protein staining with bromophenol blue was described in detail in 1954.4 It provided the basis of our report in 1955 that, compared with age-matched …