Increased homocysteine and lipoprotein(a) levels highlight systemic atherosclerotic burden in patients with a history of acute coronary syndromes
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 corona...
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| Veröffentlicht in: | Journal of vascular surgery 2016-07, Vol.64 (1), p.163-170 |
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| creator | Cioni, Gabriele, MD, PhD Marcucci, Rossella, MD, PhD Gori, Anna Maria, MSc Valente, Serafina, MD Giglioli, Cristina, MD Gensini, Gian Franco, MD Abbate, Rosanna, MD Boddi, Maria, MD, PhD |
| description | 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 |
| doi_str_mv | 10.1016/j.jvs.2016.01.056 |
| format | Article |
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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.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2016.01.056</identifier><identifier>PMID: 27139787</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute Coronary Syndrome - blood ; Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - epidemiology ; Aged ; Ankle Brachial Index ; Atherosclerosis - blood ; Atherosclerosis - diagnosis ; Atherosclerosis - epidemiology ; Biomarkers - blood ; Carotid Artery Diseases - blood ; Carotid Artery Diseases - diagnosis ; Carotid Artery Diseases - epidemiology ; Carotid Intima-Media Thickness ; Chi-Square Distribution ; Coronary Artery Disease - blood ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - epidemiology ; Female ; Homocysteine - blood ; Humans ; Hyperhomocysteinemia - blood ; Hyperhomocysteinemia - diagnosis ; Hyperhomocysteinemia - epidemiology ; Italy - epidemiology ; Lipoprotein(a) - blood ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Predictive Value of Tests ; Prognosis ; Pulse Wave Analysis ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Surgery ; Time Factors ; Ultrasonography, Doppler ; Up-Regulation</subject><ispartof>Journal of vascular surgery, 2016-07, Vol.64 (1), p.163-170</ispartof><rights>Society for Vascular Surgery</rights><rights>2016 Society for Vascular Surgery</rights><rights>Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-b12c5295b23b4a5501b92a543e0ad4e4c928896f3c1629e79398c5585897daf33</citedby><cites>FETCH-LOGICAL-c451t-b12c5295b23b4a5501b92a543e0ad4e4c928896f3c1629e79398c5585897daf33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521416002196$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27139787$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cioni, Gabriele, MD, PhD</creatorcontrib><creatorcontrib>Marcucci, Rossella, MD, PhD</creatorcontrib><creatorcontrib>Gori, Anna Maria, MSc</creatorcontrib><creatorcontrib>Valente, Serafina, MD</creatorcontrib><creatorcontrib>Giglioli, Cristina, MD</creatorcontrib><creatorcontrib>Gensini, Gian Franco, MD</creatorcontrib><creatorcontrib>Abbate, Rosanna, MD</creatorcontrib><creatorcontrib>Boddi, Maria, MD, PhD</creatorcontrib><title>Increased homocysteine and lipoprotein(a) levels highlight systemic atherosclerotic burden in patients with a history of acute coronary syndromes</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>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.</description><subject>Acute Coronary Syndrome - blood</subject><subject>Acute Coronary Syndrome - diagnosis</subject><subject>Acute Coronary Syndrome - epidemiology</subject><subject>Aged</subject><subject>Ankle Brachial Index</subject><subject>Atherosclerosis - blood</subject><subject>Atherosclerosis - diagnosis</subject><subject>Atherosclerosis - epidemiology</subject><subject>Biomarkers - blood</subject><subject>Carotid Artery Diseases - blood</subject><subject>Carotid Artery Diseases - diagnosis</subject><subject>Carotid Artery Diseases - epidemiology</subject><subject>Carotid Intima-Media Thickness</subject><subject>Chi-Square Distribution</subject><subject>Coronary Artery Disease - blood</subject><subject>Coronary Artery Disease - diagnosis</subject><subject>Coronary Artery Disease - epidemiology</subject><subject>Female</subject><subject>Homocysteine - blood</subject><subject>Humans</subject><subject>Hyperhomocysteinemia - blood</subject><subject>Hyperhomocysteinemia - diagnosis</subject><subject>Hyperhomocysteinemia - epidemiology</subject><subject>Italy - epidemiology</subject><subject>Lipoprotein(a) - blood</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Pulse Wave Analysis</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Ultrasonography, Doppler</subject><subject>Up-Regulation</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UsuO1DAQjBCInV34AC7Ix-WQwe3ESSwkJLSCZaWVOABny3E6xMGxB9sZNJ_BH-NoFg4cOPjVqiq5q7ooXgDdA4Xm9byfj3HP8nVPYU9586jYARVt2XRUPC52tK2h5Azqi-IyxplSAN61T4sL1kIl2q7dFb_unA6oIg5k8ovXp5jQOCTKDcSagz8EvxWu1Sti8Yg2ksl8m2xeicQNvBhNVJow-Kht3lN-92sY0BHjyEElgy5F8tOkiahMjsmHE_EjUXpNSLQP3qlciSc3BL9gfFY8GZWN-PzhvCq-fnj_5eZjef_p9u7m3X2paw6p7IFpzgTvWdXXinMKvWCK1xVSNdRYa8G6TjRjpaFhAltRiU5z3vFOtIMaq-qquD7r5hZ_rBiTXEzUaK1y6Ncooct-sa6mkKFwhurcZQw4ykMwS_61BCq3JOQscxJyS0JSkDmJzHn5IL_2Cw5_GX-sz4A3Z0A2FY8Gg4w6e6VxMAF1koM3_5V_-w9bW-OMVvY7njDOfg0uuydBRiap_LyNwjYJ0FDKQDTVb0gPsUU</recordid><startdate>20160701</startdate><enddate>20160701</enddate><creator>Cioni, Gabriele, MD, PhD</creator><creator>Marcucci, Rossella, MD, PhD</creator><creator>Gori, Anna Maria, MSc</creator><creator>Valente, Serafina, MD</creator><creator>Giglioli, Cristina, MD</creator><creator>Gensini, Gian Franco, MD</creator><creator>Abbate, Rosanna, MD</creator><creator>Boddi, Maria, MD, PhD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160701</creationdate><title>Increased homocysteine and lipoprotein(a) levels highlight systemic atherosclerotic burden in patients with a history of acute coronary syndromes</title><author>Cioni, Gabriele, MD, PhD ; Marcucci, Rossella, MD, PhD ; Gori, Anna Maria, MSc ; Valente, Serafina, MD ; Giglioli, Cristina, MD ; Gensini, Gian Franco, MD ; Abbate, Rosanna, MD ; Boddi, Maria, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-b12c5295b23b4a5501b92a543e0ad4e4c928896f3c1629e79398c5585897daf33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Acute Coronary Syndrome - blood</topic><topic>Acute Coronary Syndrome - diagnosis</topic><topic>Acute Coronary Syndrome - epidemiology</topic><topic>Aged</topic><topic>Ankle Brachial Index</topic><topic>Atherosclerosis - blood</topic><topic>Atherosclerosis - diagnosis</topic><topic>Atherosclerosis - epidemiology</topic><topic>Biomarkers - blood</topic><topic>Carotid Artery Diseases - blood</topic><topic>Carotid Artery Diseases - diagnosis</topic><topic>Carotid Artery Diseases - epidemiology</topic><topic>Carotid Intima-Media Thickness</topic><topic>Chi-Square Distribution</topic><topic>Coronary Artery Disease - blood</topic><topic>Coronary Artery Disease - diagnosis</topic><topic>Coronary Artery Disease - epidemiology</topic><topic>Female</topic><topic>Homocysteine - blood</topic><topic>Humans</topic><topic>Hyperhomocysteinemia - blood</topic><topic>Hyperhomocysteinemia - diagnosis</topic><topic>Hyperhomocysteinemia - epidemiology</topic><topic>Italy - epidemiology</topic><topic>Lipoprotein(a) - blood</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Pulse Wave Analysis</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Ultrasonography, Doppler</topic><topic>Up-Regulation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cioni, Gabriele, MD, PhD</creatorcontrib><creatorcontrib>Marcucci, Rossella, MD, PhD</creatorcontrib><creatorcontrib>Gori, Anna Maria, MSc</creatorcontrib><creatorcontrib>Valente, Serafina, MD</creatorcontrib><creatorcontrib>Giglioli, Cristina, MD</creatorcontrib><creatorcontrib>Gensini, Gian Franco, MD</creatorcontrib><creatorcontrib>Abbate, Rosanna, MD</creatorcontrib><creatorcontrib>Boddi, Maria, MD, PhD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cioni, Gabriele, MD, PhD</au><au>Marcucci, Rossella, MD, PhD</au><au>Gori, Anna Maria, MSc</au><au>Valente, Serafina, MD</au><au>Giglioli, Cristina, MD</au><au>Gensini, Gian Franco, MD</au><au>Abbate, Rosanna, MD</au><au>Boddi, Maria, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increased homocysteine and lipoprotein(a) levels highlight systemic atherosclerotic burden in patients with a history of acute coronary syndromes</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2016-07-01</date><risdate>2016</risdate><volume>64</volume><issue>1</issue><spage>163</spage><epage>170</epage><pages>163-170</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27139787</pmid><doi>10.1016/j.jvs.2016.01.056</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of vascular surgery, 2016-07, Vol.64 (1), p.163-170 |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present); Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Acute Coronary Syndrome - blood Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - epidemiology Aged Ankle Brachial Index Atherosclerosis - blood Atherosclerosis - diagnosis Atherosclerosis - epidemiology Biomarkers - blood Carotid Artery Diseases - blood Carotid Artery Diseases - diagnosis Carotid Artery Diseases - epidemiology Carotid Intima-Media Thickness Chi-Square Distribution Coronary Artery Disease - blood Coronary Artery Disease - diagnosis Coronary Artery Disease - epidemiology Female Homocysteine - blood Humans Hyperhomocysteinemia - blood Hyperhomocysteinemia - diagnosis Hyperhomocysteinemia - epidemiology Italy - epidemiology Lipoprotein(a) - blood Logistic Models Male Middle Aged Multivariate Analysis Odds Ratio Predictive Value of Tests Prognosis Pulse Wave Analysis Risk Assessment Risk Factors Severity of Illness Index Surgery Time Factors Ultrasonography, Doppler Up-Regulation |
| title | Increased homocysteine and lipoprotein(a) levels highlight systemic atherosclerotic burden in patients with a history of acute coronary syndromes |
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