Factor In Acute Myocardial Infarction Research Articles

Post-load hyperglycemia as an important predictor of long-term adverse cardiac events after acute myocardial infarction: a scientific study

BackgroundDiabetes mellitus (DM) and impaired glucose tolerance (IGT) are risk factors for acute myocardial infarction (AMI). However, it is unknown whether hyperglycemic state is associated with increased major adverse cardiovascular events (MACE) after AMI. In this study, we evaluated the relationship between glucometabolic status and MACE in patients after AMI, and determined the critical level of 2 h post-load plasma glucose that may be used to predict MACE.MethodsAMI patients (n = 422) were divided into 4 groups as follows: normal glucose tolerance (NGT) group, IGT group, newly diagnosed DM (NDM) group, and previously known DM (PDM) group. MACE of the 4 groups were compared for 2 years from AMI onset.ResultsThe NDM group had a significantly higher event rate than the IGT and NGT groups and had a similar event rate curve to PDM group. The logistic models analyses revealed that 2 h post-load plasma glucose values of ≥160 mg/dL was the only independent predictor of long-term MACE after AMI (p = 0.028, OR: 1.85, 95% CI: 1.07-3.21). The 2-year cardiac event rate of patients with a 2 h post-load hyperglycemia of ≥160 mg/dL was significantly higher than that of patients with 2 h post-load glucose of <160 mg/dL (32.2% vs. 19.8%, p < 0.05) and was similar to that of PDM group (37.4%, p = 0.513).ConclusionsNDM increases the risk of MACE after AMI as does PDM. Particularly, post-AMI patients with a 2 h post-load hyperglycemia ≥160 mg/dL may need adjunctive therapy after AMI.

Angiotensinogen gene polymorphism in acute myocardial infarction patients

The objective of the study was to explore the role of a genetic variant of angiotensinogen (AGT), M235T, as an independent risk factor for acute myocardial infarction (AMI) and to investigate the possible association with the severity of coronary artery disease (CAD), estimated on the basis of the number of coronary stenoses and critical arterial occlusions. 123 AMI patients were compared to 144 healthy controls. AGT genotypes were determined by PCR. A significant association was found between AGT M235T polymorphism and AMI (p = .021). By logistic regression, the TT genotype appeared to confer 1.9-fold increased risk for AMI in both the univariate and the multivariate model. The frequencies of the TT genotype and T allele increased with the number of stenoses in coronary vessels. Moreover, the TT genotype and the T allele were more frequent in the subgroup of patients with stenoses in at least four coronary vessels than in other patients, including subjects with one- to three-vessel disease. Furthermore, the TT genotype and the T allele were significantly more frequent in patients with critical arterial occlusions (> 90%) than in subjects without critical stenoses. The AGT M235T polymorphism associates with AMI risk and influences CAD severity.

Perturbation of lipids and glucose metabolism associated with previous 2,4-D exposure: a cross-sectional study of NHANES III data, 1988-1994.

BackgroundResults from previous population studies showed that mortality rates from acute myocardial infarction and type-2 diabetes during the 1980s and 1990s in rural, agricultural counties of Minnesota, Montana, North and South Dakota, were higher in counties with a higher level of spring wheat farming than in counties with lower levels of this crop. Spring wheat, one of the major field crops in these four states, was treated for 85% or more of its acreage with chlorophenoxy herbicides. In the current study NHANES III data were reviewed for associations of 2,4-dichlorophenoxy acetic acid (2,4-D) exposure, one of the most frequently used chlorophenoxy herbicides, with risk factors that are linked to the pathogenesis of acute myocardial infarction and type-2 diabetes, such as dyslipidemia and impaired glucose metabolism.MethodsTo investigate the toxicity pattern of chlorophenoxy herbicides, effects of a previous 2,4-D exposure were assessed by comparing levels of lipids, glucose metabolism, and thyroid stimulating hormone in healthy adult NHANES III subjects with urinary 2,4-D above and below the level of detection, using linear regression analysis. The analyses were conducted for all available subjects and for two susceptible subpopulations characterized by high glycosylated hemoglobin (upper 50th percentile) and low thyroxine (lower 50th percentile).ResultsPresence of urinary 2,4-D was associated with a decrease of HDL levels: 8.6% in the unadjusted data (p-value = 0.006), 4.8% in the adjusted data (p-value = 0.08), and 9% in the adjusted data for the susceptible subpopulation with low thyroxine (p-value = 0.02). An effect modification of the inverse triglycerides-HDL relation was observed in association with 2,4-D. Among subjects with low HDL, urinary 2,4-D was associated with increased levels of triglycerides, insulin, C-peptide, and thyroid stimulating hormone, especially in the susceptible subpopulations. In contrast, subjects with high HDL did not experience adverse 2,4-D associated effects.ConclusionsThe results indicate that exposure to 2,4-D was associated with changes in biomarkers that, based on the published literature, have been linked to risk factors for acute myocardial infarction and type-2 diabetes.

Acute Myocardial Infarction in the Evening Has a Worse Prognosis. Circadian Rhythm, Does It Matter?

Refer to the page 616-624 Recently Bae et al.1) reported that hospital presentation of patients with acute myocardial infarction (AMI) in the evening was linked to a higher rate of mortality for twelve months. In addition, congestive heart failure (CHF) was more prevalent in the evening onset of AMI. Therefore, it was concluded that the evening onset of AMI was indirectly related to a worse prognosis due to poor baseline left ventricular (LV) function. A finding consistent with previous reports was that the proportion of diabetes patients was higher in the evening onset of ST segment elevation myocardial infarction (STEMI).2) Since the mode of onset as the dependent variable in the baseline data was not considered, statistical analyses on factors related to evening onsets similar to the previous study were not available.2-4) LV function is the strongest prognostic factor in AMI. It is critical to ascertain the factors which are associated with depressed LV function at the time of hospital presentation.5) Consequently, symptom to door (STD) time or door to balloon time (DBT) should be the first theoretical reference for AMI. However, it is very difficult to define the real onset of AMI using chest pain as an indicator because the elderly, patients with diabetes and females have blunted or atypical symptoms. In this study, an important finding on the quality of care was addressed. DBT was longer in the evening or during off-duty hours. A worse outcome of pre-hospital delay or longer DBT was not observed, even with a higher proportion of STEMI in this study. This is because the effect can be diluted by patients with a very long STD time. STD time, which is pre-hospital time delay in STEMI was 419±573 minutes, which is better compared to the previous result of 699±144 minutes.4) However the large standard deviation is still challenging and the factors related to the pre-hospital time delay in Korea need to be further investigated. The natural course of AMI is inevitably followed by LV failure within a couple of days. As with the progression of infarction, increased wall tension and ischemia may allow the provocation of angina by a vulnerable myocardium resulting in a delayed presentation in the evening. Asymptomatic or neglected onset of AMI in the morning can present as CHF in the evening. Recurrent and gradual or slowly progressive ischemia in the morning may also result in AMI with CHF in the evening. As a pathophysiological perspective, Tanaka et al.6) suggested patients with non-plaque rupture are more likely to present in the evening. Nonetheless, an evening onset of AMI is not necessarily a delayed manifestation by a new onset of LV dysfunction from the morning since pre-existing LV dysfunction or ischemia could provoke ischemic symptoms in the evening. With overtime work, mental stress may aggravate pre-existing CHF in patients who have critical stenosis in the coronary vessel. Consequently, they would suffer from chest pain with a recumbent position in the evening. Other factors associated with an evening onset of AMI such as the reluctance to visit the hospital, poor social or familial support and behavioral factors such as smoking and drinking may be associated with CHF.7) History of CHF and Non-Q wave MI are well known factors linked to the evening onset of AMI.2) In the early 1990s, Kim et al.8) also reported that history of CHF is more frequently noted in the evening onset of AMI in Korean patients. In patients with pre-existing heart failure, limited duration of heart failure medications could also unveil ischemic symptoms in the evening. On the other hand, aspirin or beta-blockers may blunt the symptoms in the morning, potentially leading to pre-hospital delay.2) Hence, from the clinical viewpoint, AMI in the evening warrants a more sophisticated strategy to cope with all of these associated clinical problems. CHF was present in 20-40% of AMI patients on admission and pre-existing heart failure was present in approximately 10% of patients.5) Considering the mechanism of CHF at the onset of AMI and the prognosis, multi-vessel disease with single culprit lesion causing AMI is of particular interest. The net results of revascularization treatment are decided by the summation of the infarcted myocardium and the saved ischemic myocardium. Therefore, not only the quality of care for the culprit lesion but also the results of revascularization on non-culprit vessels may be important for long-term prognosis. As the optimal revascularization strategy for the non-culprit lesions in AMI patients with depressed LV function, outcome of percutaneous coronary intervention versus coronary artery bypass graft needs further study. Unlike previous studies in Western countries, a majority of Asian studies showed a clear double peak circadian rhythm in AMI.3),7),9),10) It is important to investigate whether this difference is due to racial/biologic factors or to socioeconomic factors in order to provide appropriate interventions.

Small Birth Size, Adult Overweight, and Risk of Acute Myocardial Infraction

The association between small size at birth and increased risk of cardiovascular disease in adulthood is well established. This relationship is commonly interpreted according to the "thrifty phenotype hypothesis," which states that the association is generated by a mismatch between fetal and postnatal nutrition. Empirical support for an interaction between impaired fetal growth and later overnutrition is, however, sparse and partly conflicting. The Stockholm Heart Epidemiology Program is a population-based case-control study of risk factors for acute myocardial infarction (MI); data were available for 1058 cases and 1478 controls. Using logistic regression, we studied the effect of size at birth, and its interactive effect with body mass index (BMI), at 3 occasions in adulthood, on the risk of MI. Biologic interaction was estimated with the synergy index. Very low birth weight for gestational age was associated with increased risk of MI (odds ratio [OR] = 2.0; 95% confidence interval [CI] = 1.4-2.9; attributable fraction = 5%). In nonfatal cases, adjustment for waist-hip ratio, insulin resistance, blood pressure, and lipids reduced the point estimate somewhat. Low birth weight for gestational age in combination with high BMI at the time of the MI produced an OR of 10.8 (3.6-31.8) for MI compared with normal birth weight and normal BMI; the synergy index was 6.5 (95% CI = 1.8-24.0). The synergism between small size at birth and high adult BMI supports the thrifty phenotype hypothesis. However, this mechanism seems to pertain to only a small fraction of the acute MI cases, implying minor public health importance.

The Polymorphism in Aldehyde Dehydrogenase-2 Gene Is Associated with Elevated Plasma Levels of High-Sensitivity C-Reactive Protein in the Early Phase of Myocardial Infarction

Aldehyde dehydrogenase-2 (ALDH2) is a key enzyme of alcohol metabolism, catalyzing the conversion of aldehyde to acetic acid. The G-to-A polymorphism in exon 12 of the ALDH2 gene, which causes Glu-to-Lys substitution at codon 504, has been shown to be an independent risk factor for acute myocardial infarction (AMI). We investigated the possible role of the G-to-A polymorphism in the severity of the myocardial damage in the early phase of AMI by measuring plasma levels of inflammatory markers, including high-sensitivity C-reactive protein (hs-CRP). A total of 226 Han Chinese patients with AMI were divided into two groups: subjects without A allele (GG, n = 144) and subjects with A allele (GA and AA, n = 82), and the blood samples were collected within 12 hours after the onset of AMI. The results displayed that high-density lipoprotein cholesterol (HDL-C) was higher in GG group than that in GA and AA group (p < 0.05). The body mass index (BMI) and the concentration of hs-CRP were lower in GG group than that in GA and AA group (p < 0.05). Multivariate logistic regression analysis showed that subjects with the A allele were at an increased risk for the high level of hs-CRP (> 3 mg/L) compared with those with GG genotype (OR = 4.908, 95% CI = 1.57 approximately 20.98). Thus, the A allele in ALDH2 gene is associated with the elevated plasma levels of hs-CRP after the onset of AMI, suggesting a higher susceptibility of the myocardium to ischemic injuries.

Relationship Between Obesity and N-Terminal Brain Natriuretic Peptide Level as a Prognostic Value After Acute Myocardial Infarction

Background and ObjectivesRecently, the prognostic value of N-terminal brain natriuretic peptide (NT-proBNP) in acute coronary syndrome has been demonstrated in many studies. However, NT-proBNP levels are influenced by various factors such as sex, age, renal function, heart failure severity, and obesity. NT-proBNP concentrations tend to decrease with higher body mass index (BMI). The aim of this study was to examine the influence of obesity on NT-proBNP as a predictive prognostic factor in acute myocardial infarction (AMI) patients.Subjects and MethodsUsing data from the Korea Acute Myocardial Infarction Registry (January 2005 to September 2008), 2,736 AMI patients were included in this study. These patients were divided into men (n=1,972, 70%) and women (n=764, 30%), and were grouped according to their BMIs. Major adverse cardiac events (MACE) during 1 year clinical follow-up were evaluated.ResultsNT-proBNP was significantly higher in lower BMI (p<0.001). Mean NT-proBNP levels of each obesity group were 2,393±4,022 pg/mL in the lean group (n=875), 1,506±3,074 pg/mL in the overweight group (n=724) and 1,100±1,137 pg/mL in the obese group (n=1,137) (p<0.01). NT-proBNP was an independent prognostic factor of AMI in obese patients by multivariative analysis of independent risk factors of MACE (p=0.01).ConclusionNT-proBNP is lower in obese AMI patients than in non-obese AMI patients, but NT-proBNP is still of independent prognostic value in obese AMI patients.

Plasma thrombomodulin activity, tissue factor activity and high levels of circulating procoagulant phospholipid as prognostic factors for acute myocardial infarction

Several studies have indicated an association between haemostatic markers and acute myocardial infarction, but few or no studies refer to their activity. We studied plasma levels of 10 coagulation factors (fibrinogen, protein C, protein S, von Willebrand factor, D-dimers, factor VIIa, free tissue factor pathway inhibitor, tissue-type plasminogen activator, plasminogen activator inhibitor-1, thrombomodulin) and using new specific assays analysed the activity of plasma tissue factor (TFa), thrombomodulin (TMa), and procoagulant phospholipid in 46 consecutive patients with acute myocardial infarction at the time of hospital admission, and compared them with 34 healthy normal volunteers. Plasma levels of TFa, TMa, and procoagulant phospholipid were significantly higher in cases than in control patients (P < 0.001). In addition the ratio of TFa/free tissue factor pathway inhibitor was higher in patients than in controls, whereas the tissue-type plasminogen activator (t-PA)/plasminogen activator inhibitor-1 ratio was lower in patients. Interestingly, patients with an unfavourable outcome during a 2-month follow-up had higher levels of TFa, TMa, procoagulant phospholipid, a higher ratio of TFa/free tissue factor pathway inhibitor and a lower ratio of t-PA/plasminogen activator inhibitor-1 than patients who recovered. The combination of these different parameters reveals an increase in procoagulant activity as well as impaired fibrinolytic activity during the acute phase of an acute myocardial infarction. The association of the level of the activity of these three factors may provide a new tool to assess the prognosis of acute myocardial infarction. Further studies are needed to support our findings and to elucidate the clinical interest of measuring these factors.

Gouty Arthritis in Acute Cerebrovascular Disease

Background: Gouty arthritis is a metabolic disorder associated with several medical diseases and is considered as a high-risk factor of acute myocardial infarction and cardiovascular mortality. Since no study has assessed the frequency of gout attack in acute-stroke patients, a retrospective analysis of gouty arthritis in stroke patients was performed to identify the frequency and characteristics of gouty arthritis in hospitalized stroke patients. Methods: We reviewed the data of 920 patients admitted to the neurology ward of the Chiayi Chang Gung Memorial Hospital between 2002 and 2005 with ischemic stroke. The frequency of gouty arthritis in these patients was evaluated. The severity of the risk factors was compared between the patients with gout and those without. Results: The frequency of gouty arthritis in the stroke patients was 6.5%. Most patients had an attack of gout within 9 days of admission. History of gout, uric acid level and hypercholesterolemia were independent risk factors of gout attack during acute stroke. The duration of acute-ward stay was longer in patients with gout than in those without (17.17 vs. 14.01 days, p = 0.016). Conclusions: Our retrospective study demonstrated that gout attack is not uncommon in acute-stroke patients and may result in longer duration of acute-ward stay.

Consumption of filtered and boiled coffee and the risk of first acute myocardial infarction; a nested case/referent study

Background and aim In northern Sweden, consumption of both filtered and boiled coffee is common. Boiled coffee, especially popular in rural areas, is known to raise blood lipids, a risk factor for acute myocardial infarction (MI). To our knowledge, only one epidemiological study, a case-control study from Sweden, has investigated boiled coffee in MI, noting an increased risk at high consumption levels in men, and no association in women. The aim of the present nested case-referent study was to relate consumption of filtered and boiled coffee to the risk of first MI. Methods and results The study subjects were 375 cases (303 men, 72 women) and 1293 matched referents from the population-based Northern Sweden Health and Disease Study. Coffee consumption was assessed by food frequency questionnaire. Risk estimates were calculated by conditional logistic regression. A statistically significant positive association was found between consumption of filtered coffee and MI risk in men [odds ratio for consumption ≥4 times/day versus ≤1 time/day 1.73 (95% CI 1.05–2.84)]. In women, a similar association was observed, but for boiled coffee [odds ratio 2.51 (95% CI 1.08–5.86)]. After adjustment for current smoking, postsecondary education, hypertension, and sedentary lifestyle, the results for women were no longer statistically significant. Conclusion Consumption of filtered coffee was positively associated with the risk of a first MI in men. A similar tendency was observed for boiled coffee in women, but the result was not statistically significant in multivariate analysis. Further investigation in a larger study is warranted.

Serum electrolytes and parathyroid hormone concentrations in acute myocardial infarction.

Serum concentrations of calcium, magnesium, potassium and phosphate can be lowered experimentally by adrenaline, which also can stimulate the secretion of parathyroid hormone (PTH). In order to evaluate the possible clinical importance of these mechanisms serial blood samples were drawn during the first three hospital days in 26 patients with acute myocardial infarction (AMI), a condition known to increase plasma catecholamine levels. During the study period there were no consistent significant changes of the serum electrolytes. The serum PTH levels, however, were significantly raised in the AMI patients already on admission and did not normalize during the observation time. The PTH concentrations were unexplained by infarct size, concomitant diseases or medication. These findings suggest that PTH could be an independent risk factor for AMI.

Impact of risk factors for non-fatal acute myocardial infarction

The impact of risk factors for acute myocardial infarction (AMI) strongly differs across populations and most studies do not consider age as an effect modifier. This study aims to estimate the population attributable fractions (PAFs) of established risk factors for non-fatal AMI, considering age stratification, within a population-based case-control study of Portuguese men. Cases were male patients consecutively admitted with an incident AMI, during 1999-2003 (n = 638) and controls were a representative sample of the non-institutionalized Porto, Portugal inhabitants (n = 851). PAFs were derived by the equation: PAF = 1 - Sigma (rho/R), in which rho is the proportion of cases in each exposure stratum and R is the adjusted odds ratio. PAFs were obtained for the individual effect of each factor and for combinations of them, after allowance for confounding. High waist-to-hip ratio (> 0.90), smoking and lower education levels (0-4 years) had the highest PAFs among men aged < or = 45 years: 81.2% (95% CI: 71.2-88.2), 63.5% (95% CI: 42.0-80.6) and 53.8% (95% CI: 40.9-66.2), respectively. For the oldest men, high waist-to-hip ratio (PAF = 88.7%, 95% CI: 77.6-94.7) and lack of leisure-time physical activity (PAF = 44.8%, 95% CI: 32.0-58.2) were the risk factors with the highest impact. Lifestyles explained 77.2% (95% CI: 53.4-90.9) of young myocardial infarction cases and 77.6% (95% CI: 65.3-86.4) of the cases aged > 45 years. Preventive targeted interventions to decrease the prevalence of such modifiable risk factors would likely reduce morbidity and mortality of cardiovascular events and related conditions.

P-264 The Importance of Metabolic Syndrome as a Risk Factor for Acute Myocardial Infarction

P-264 The Importance of Metabolic Syndrome as a Risk Factor for Acute Myocardial Infarction

Kardiale MRT zur Quantifizierung der mikrovaskulären Obstruktion beim akuten Myokardinfarkt

Microvascular obstruction (MO) and the extent of infarction are important prognostic factors in acute myocardial infarction. Our study aimed to investigate the effect of the time interval between contrast administration and image acquisition on the quantification of microvascular obstruction and myocardial infarction. 50 consecutive patients with acute myocardial infarction (40 male, mean age 58.1 +/- 11.7 years) treated by percutaneous coronary revascularization resulting in a grade 3 flow according to the thrombolysis in myocardial infarction flow classification were examined on a 1.5 T MR scanner within the first 5 days after infarction. 2, 5, 10, and 20 minutes after I.V. administration of 0.2 mmol/kg per kg body weight of Gadodiamid (Omniscan), GE Healthcare Buchler, Germany), a single shot IR-SSFP sequence (TR 2.4 ms, TE 1.08 ms, TI 180 - 280 ms, FA 50 degrees) covering the entire left ventricle was acquired. Areas of MO and myocardial infarction were measured for all times after contrast injection (p. i.). MO was detected in 32 of 50 patients two minutes p. i., while 23 patients showed evidence of MO (p = 0.002) 20 min. p. i. In all patients with MO, the extent of MO decreased over time (7.4 +/- 9.0 % of the LV myocardium 2 min. p. i. vs. 2.4 +/- 4.6 % 20 min. p. i. p < 0.0001). The area of myocardial infarction increased from 13.9 +/- 13.5 % 2 min. p. i. to 18.6 +/- 14.2 % 10 min. p. i. (p < 0.0001), and then remained unchanged (18.7 +/- 14.3 % at 20 min. p = 0.57). Our study shows that the time delay between contrast media injection and image acquisition has a significant impact on the delimitable extent of MO and infarct size.

Oxidized LDL, Lipoprotein (a), and Other Emergent Risk Factors in Acute Myocardial Infarction (FORTIAM Study)

To determine the prevalence of acute myocardial infarction (AMI) without classical risk factors, and to ascertain whether affected patients exhibit a higher prevalence of emergent risk factors and whether the presence of specific emergent risk factors influence prognosis at 6 months. The FORTIAM (Factores Ocultos de Riesgo Tras un Infarto Agudo de Miocardio) study is a multicenter cohort study that includes 1371 AMI patients who were admitted within 24 hours of symptom onset. Strict definitions were used for classical risk factors and the concentrations of the following markers were determined: lipoprotein (a) [Lp(a)], oxidized low-density lipoprotein (oxLDL), high-sensitivity C-reactive protein, fibrinogen, homocysteine and antibody to Chlamydia. The end-points observed during the 6-month follow-up were death, angina and re-infarction. The prevalence of AMI without classical risk factors was 8.0%. The absence of classical risk factors did not affect the 6-month prognosis. The only emergent risk factors independently associated with a poorer prognosis were the Lp(a) and oxLDL concentrations. Cut-points were determined using smoothing splines: 60 mg/ dL for Lp(a) and 74 U/L for oxLDL. The associated hazard ratios, adjusted for age, sex and classical risk factors, were 1.40 (95% confidence interval, 1.06-1.84 ) and 1.48 (95% confidence interval, 1.06-2.06), respectively. The proportion of AMI patients without classical risk factors was low and their prognosis was similar to that in other AMI patients. Both oxLDL and Lp(a) concentrations were independently associated with a poorer 6-month prognosis, irrespective of the presence of classical risk factors.

Association of the Plasminogen Activator Inhibitor-1 Gene 4G/5G Polymorphism With ST Elevation Acute Myocardial Infarction in Young Patients

To investigate the role of the 4G/5G polymorphism in the plasminogen activator inhibitor-1 (PAI-1) gene in patients with ST-elevation myocardial infarction (STEMI) aged < or =45 years and its influence on regulation of the plasma PAI-1 concentration. This case-control study included 127 consecutive patients aged < or =45 years with a diagnosis of STEMI who were admitted to a cardiovascular intensive care unit and 127 controls recruited between January 2006 and March 2007. Participants were genotyped for the 4G/5G polymorphism using the polymerase chain reaction and restriction fragment length polymorphism analysis, and their plasma PAI-1 concentrations were measured. Informed consent was obtained from all participants. There was a significant difference in genotype distribution between the two groups (P< .002). The 4G allele occurred more frequently in the patient group (P=.032). In addition, there were significant independent associations between STEMI and the 4G allele (i.e., 4G/4G plus 4G/5G; odds ratio [OR]=2.29; 95% confidence interval [CI], 1.12-4.68; P=.022), smoking (OR=23.23; 95% CI, 8.92-60.47; P< .001), a family history of cardiovascular disease (OR=4.66; 95% CI, 2.06-10.52; P=.001) and hypertension (OR=5.42; 95% CI, 1.67-17.56; P=.005). The plasma PAI-1 concentration was higher in individuals who were homozygous for the 4G allele (P< .001). The study findings indicate that the 4G allele is an independent risk factor for acute myocardial infarction in young patients, as are smoking, hypertension and a family history of inherited cardiovascular disease.

Cardiopulmonary arrest due to persistent coronary spasm in a young woman: Are we properly diagnosing vasospastic angina?

Coronary spasm is a risk factor for acute myocardial infarction and sudden cardiac death. This is a case of a young female patient with cardiopulmonary arrest induced by coronary spasm on arrival at our hospital. There has been no case that prolonged spontaneous attack was confirmed in multi-vessels. This case demonstrates that persistent coronary spasm is lethal and an important cause of cardiopulmonary arrest even in young people. It is extremely important to detect patients with coronary spasm before the ischemic events associated with cardiopulmonary arrest occur.

Effect of Cardiac Nerve Growth Factor in Acute Myocardial Infarction in Human

Background and Objectives: It has been demonstrated that the concentration of plasma nerve growth factor (NGF) effects nerve sprouting. In addition, the relationship between plasma NGF concentration and the occurrence of ventricular tachyarrhythmia (VT) has been reported in animal models of myocardial infarction (MI). However, the causal relationship between NGF and VT remains unclear in humans. The aim of the current study was to determine whether NGF is increased in patients with MI. In addition, the relationship between the concentration of plasma NGF and the inducibility of VT was evaluated. Subjects and Methods: We studied 15 patients with stable angina pectoris (SA) and 30 patients with an acute MI (AMI). The patients in the AMI group were divided into VT occurrence (n=14) and non-VT occurrence groups (n=16). Thirty-four patients suspected to have VT underwent programmed electrical stimulation (PES) and were divided into an idiopathic VT group (n=24) and an induced VT with PES {healthy control (C) group; n=10}. Plasma NGF concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Results: The plasma concentrations of the AMI group were significantly increased compared to the C group {median (interquartile range), 18.9 (8.7) vs. 10.3 (12.5) pg/mL, p<0.05} and the patients with SA {18.9 (8.7) vs. 15.1 (6.7) pg/mL, p<0.05}, but not significantly different from those in the idiopathic VT group {median (interquartile range), 18.9 (8.7) vs. 18.7 (8.5) pg/mL, p=0.89}. There was no significant difference in the plasma NGF concentrations between the C and SA groups {10.3 (12.5) vs. 15.1 (6.7) pg/mL, p=0.18}. In the AMI patients, there was no significant difference in the plasma NGF concentrations between patients with VT and those without VT {18.5 (6.7) vs. 21.2 (10.2) pg/mL, p=0.25}. Conclusion: The plasma NGF concentrations were increased in patients with an AMI compared to patients with SA and Cs. (Korean Circ J 2009;39:16-20)

Haptoglobin and risk of myocardial infarction, stroke, and congestive heart failure in 342,125 men and women in the Apolipoprotein MOrtality RISk study (AMORIS)

Background. Few studies have analysed the importance of haptoglobin (Hp) as a risk factor for acute myocardial infarction (AMI), stroke, and heart failure (HF) in large healthy populations.Aims. We examined Hp as risk factor for AMI, stroke, and HF in the Apolipoprotein MOrtality RISk (AMORIS) Study and compared its predictive strength with that of total serum cholesterol (TC).Methods. Prospective study (11.8 years) of AMI, stroke, and HF through linkage with Swedish hospital discharge and mortality registers with measurements of Hp in 342,125 subjects.Results. Hp is a significant risk factor of AMI, stroke, and HF. Relationships were stronger for men than women with regard to stroke and HF, but not AMI. Hp was almost as predictive as TC for AMI and about equally predictive of stroke with a stronger relationship to ischaemic than haemorrhagic stroke. A 4.2-fold increase in risk of AMI was observed comparing subjects in the joint lower quartiles of TC and Hp to those in the upper. For stroke, the risk increase was 2-fold, and 1.5-fold for HF.Interpretation. The inflammation marker Hp carried as much additional predictive information value on AMI and stroke as TC. Hp was also a risk factor of HF.

Impact of statins on modulation by insulin of expression of plasminogen activator inhibitor type-1

Plasminogen activator inhibitor type-1 (PAI-1) is a physiologic inhibitor of fibrinolysis and a known determinant of cardiovascular risk. That its expression is stimulated by insulin in HepG2 human hepatoma cells has been shown earlier. Others have found that increased expression of PAI-1 is a risk factor for acute myocardial infarction. Pleiotropic (noncholesterol lowering) effects of statins seem to reduce cardiovascular risk. This study was designed to determine whether insulin stimulation of PAI-1 expression is attenuated by statins, and if so to explore mechanisms that are responsible for the attenuation. PAI-1 protein in the conditioned media was assayed by western blotting, and PAI-1 mRNA expression was measured by real-time reverse transcriptase polymerase chain reactions. Insulin (0.001-10 micromol/l) increased accumulation of PAI-1 protein in the conditioned media and PAI-1 mRNA expression in HepG2 cells. A transient transfection assay of the human PAI-1 promoter-luciferase construct demonstrated that insulin increased PAI-1 promoter activity. Increased PAI-1 mRNA was attenuated significantly by U0126 and PD98059, specific inhibitors of mitogen-activated protein kinase. In contrast, GF109203X, an inhibitor of the protein kinase C pathway, and LY294002, an inhibitor of phosphatidylinositol 3-kinase, exerted no effects. Simvastatin (10 micromol/l), known to translocate membrane-bound sterol regulatory element-binding protein to nuclei, attenuated PAI-1 mRNA expression induced by insulin. It did not affect baseline PAI-1 mRNA expression. Intraperitoneal injection of insulin (0.1 IU/kg) increased concentrations of PAI-1 antigen in plasma in mice within 3 h, correlating with hepatic PAI-1 mRNA expression. Insulin-mediated augmented expression of PAI-1 may be amenable to suppression attributable to pleiotropic effects of statins, potentially diminishing cardiovascular risk in patients with insulin resistance.