Copyright © 1998 by the European Society of Cardiology.
Progression of coronary artery disease in young male post-infarction patients is linked to disturbances of carbohydrate and lipoprotein metabolism and to impaired fibrinolytic function
a Departments of Emergency and Cardiovascular Medicine, Karolinska Hospital, Stockholm
b Department of Thoracic Radiology, Karolinska Hospital, Stockholm
c Department of Endocrinology, Karolinska Hospital, Stockholm
e Departments of Clinical Chemistry and Blood Coagulation, Karolinska Hospital, Stockholm
d Atherosclerosis Research Unit, King Gustaf V Research Institute, Karolinska Institute, Stockholm, Sweden
accepted July 26, 1997
Aims
To assess determinants of coronary artery disease progression in men with previous myocardial infarction.
Methods and Results
A total of 102 unselected non-diabetic Swedish men (age 40·4±3·6, range 23–44 years) entered the study 3–6 months after a first myocardial infarction. The programme included metabolic and haemostatic investigations and routine coronary angiography at baseline, followed by re-angiography 5 years later. Of the original cohort, 76 patients underwent a second angiogram. Separate semiquantitative scoring systems were used for diffuse coronary atherosclerosis and distinct stenoses in 15 proximal coronary segments. Smoking, global severity of coronary atherosclerosis and presence of multi-vessel disease at baseline (P<0·001) characterized patients with severe progression of both diffuse and focal lesions. Higher plasma levels of low density lipoprotein cholesterol (P<0·01) and low density lipoprotein triglycerides (P<0·05), a lower plasma high density lipoprotein2cholesterol level (P<0·05) and higher plasma plasminogen activator inhibitor-1 activity (P<0·05), together with a high baseline stenosis score (P<0·001) characterized patients with severe progression of coronary atherosclerosis. On the other hand, more pronounced fasting and post-prandial glycaemia (P<0·05), together with higher plasma plasminogen activator inhibitor-1 activity (P<0·01) characterized severe progressors with respect to coronary stenosis. Multi-variate analysis identified the presence of multi-vessel disease as an independent predictor of progression of both coronary atherosclerosis (P=0·008) and stenoses (P=0·007), whereas a high low density lipoprotein tri-glyceride level (P<0·01) was independently related to progression of coronary atherosclerosis and a high fasting glucose level (P=0·02) to progression of coronary stenoses.
Conclusion
Disturbances in carbohydrate and lipoprotein metabolism and impaired fibrinolytic function are associated with progression of coronary artery disease in young male post-infarction patients.
Key Words: Lipoproteins • plamsinogen activator inhibitor-1 • glucose • insulin • myocardial infarction • coronary angiography.
Correspondence: Dr Peter B
venholm, Division of Internal Medicine, Department of Emergency and Cardiovascular Medicine, Karolinska Hospital, S-171 76 Stockholm, Sweden.
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