Serum total homocysteine and lipoprotein (a) levels in acute myocardial infarction and their response to treatment with vitamins.

Abstract

To assess the relationship of serum total homocysteine (tHcy) and lipoprotein (a) [Lp(a)] levels with systemic hypertension, Diabetes mellitus and smoking as risk factors in patients with acute myocardial infarction (AMI) and changes in the former levels with vitamins supplementation. An interventional study. Medical College for Women and Hospital (MCW & H), Dhaka, Bangladesh, from July 2008 to December 2009. Consecutive AMI patients were recruited from the Coronary Care Unit (CCU) at MCW &H, Dhaka. Blood samples were collected at inclusion (Patient-I0). They were given conventional treatments and prescribed vitamins (vitamins B6=25 mg, B12=2 mg and folic acid=2.5 mg) daily for 2 months. After follow-up, blood samples were taken again (Patient-II0). A group of 25 normal subjects were also included as controls. Serum tHcy and Lp(a) were measured by kinetic method and nephelometric method respectively. Serum tHcy (μmol/L) and Lp(a) (mg/dl) levels were elevated in Patient-I0 that reduced in Patient-II0 after vitamins supplementation, but not to the normal control level. tHcy of Patient-I0 was 25.1 ± 4.7 μmol/L, of Patient-II0 was 20.1 ± 4.5 μmol/L and of controls 12.1 ± 3.3, p < 0.001. Lp(a) of Patient-I0 was 43.1 ± 15.2 mg/dL, of Patient-II0 was 35.6 ± 10.2 mg/dL, Control: 22.3 ± 5.2 mg/dL, p < 0.001. Elevated tHcy and Lp(a) levels were independent of the traditional risk factors (p > 0.1). However, in a significant proportion of patients tHcy and Lp(a) levels were reduced to control levels (tHcy: p < 0.001, Lp(a): p < 0.01). These results indicated that tHcy and Lp(a) levels were possibly atherogenic risk factors independent of conventional risk factors. Since both tHcy and Lp(a) levels responded in a similar fashion, a common point of the metabolic and pathogenetic pathways of tHcy and Lp(a) may be influenced by the vitamins supplementation.