A Systematic Review on the Risk Modulators of Myocardial Infarction in the “Young”—Implications of Lipoprotein (a)
Abstract
:1. Introduction
2. Methods
3. Results and Discussion
3.1. Myocardial Infarction Related to Traditional Cardiovascular Risk Factors in Young Patients
3.1.1. Arterial Hypertension
3.1.2. Smoking
3.1.3. Diabetes Mellitus
3.1.4. Obesity
3.1.5. Dyslipidaemia
3.1.6. Gender
3.1.7. Family History
3.1.8. Psychosocial and Environmental Factors
3.2. Lipoprotein (a)
3.2.1. How, When, and What to Look For?
3.2.2. Implications of Lp(a) in Young Patients
3.2.3. Therapeutic Approaches
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Traditional Cardiovascular Risk Factor | “Young” Patients | “Old” Patients |
---|---|---|
Arterial hypertension |
| |
Smoking | ||
Diabetes mellitus |
|
|
Obesity |
|
|
Dyslipidaemia |
|
|
Gender |
| |
Family history |
|
Guidelines | Recommendation |
---|---|
ESC/EAS (European Society of Cardiology/European Atherosclerosis Society) for the management of dyslipidemias [76] |
|
HEART UK (Hyperlipidaemia Education and Atherosclerosis Research Trust UK) [77] |
|
AHA/ACC (American Heart Association/American College of Cardiology) Guideline of the Management of Blood Cholesterol [78] |
|
NLA (National Lipid Association) [79] |
|
CCS (Canadian Cardiovascular Society) [80] |
|
Study | Country | Population | Measurement | High Lp(a) Threshold | Methodology | Results |
---|---|---|---|---|---|---|
Afshar et al. [8] | USA | 2606 participants from the Framingham Offspring Cohort (median age of 54, 45% men) | ELISA | ≥100 nmol/L | Prospective cohort study with a median follow-up of 15 years | Elevated levels of Lp(a) were associated with a high incidence of cardiovascular disease |
Rallidis et al. [82] | Greece | 382 participants ≤ 40 years who suffered an AMI | High sensitivity particle-enhanced immunonephelometry | apoB > 120 mg/dL | Retrospective cohort study | Lp(a) levels were higher in patients with combined hyperlipidaemia phenotype |
Hanif et al. [83] | Pakistan | 180 participants with ACS (70% male) subdivided into 45 cases aged ≤ 45 years (considered “young”), respectively, 45 aged > 45 years, each group with age-matched healthy controls | Lp(a) assay on Abbott Architect platform ci8200 using a Latex enhanced technique | High risk for ACS: 31–50 mg/dL, very high risk for ACS: >50 mg/dL | Case control study | In young patients, Lp(a) levels were strongly associated with coronary vascular disease, even with comparative values of LDL and HDL between cases and controls |
Jubran [84] | Israel | 134 patients ≤ 65 years, with a mean age of 52 ± 8 years, 83% male, presenting with ACS | Particle enhanced trubidimetric immunoassay | >30 mg/dL | Retrospective observational cohort analysis | Elevated Lp(a) levels were independently associated with CAD in young and middle-aged patients |
Luna et al. [85] | Spain | 159 patients (men under 65 years and women under 70 years), who suffered a STEMI or NSTEMI | ELISA | >60 mg/dL | Descriptive and observational study | Mean Lp(a) levels were 41.08 mg/dL, and 24.5% of patients had values greater than 60 mg/dL |
Rallidis et al. [86] | Greece | 1457 patients with a history of ACS (median age 54.8 ± 13 years, 86% male) and 2090 age- and sex-matched controls with no CAD | High sensitivity particle-enhanced immunonephelometry | >30 mg/dL | Case-control study | In young patients (<45 years), Lp(a) is an independent risk factor for ACS and elevated Lp(a) levels increase this risk threefold; the correlation was not as strong in the 45–60 years category and was not observed at all >60 years |
Schatz et al. [87] | Germany | 130 patients with a history of cardiovascular events, aged ≤ 50 years | Immune nephelometry | Three groups: <18 mg/dL, 18–50 mg/dL, >50 mg/dL | Prospective observational study | Lp(a) levels >50 mg/dL were associated with premature CAD |
Finneran et al. [59] | UK | 153 228 patients without prevalent CAD and no family history of heart disease, with a mean age of 58.4 years, of which 52.2% were female with follow-up time of <9 years | Immunoturbidimetric assay | >150 nmol/L | Prospective, observational cohort study | In patients with no personal or familial (first degree) history of CAD, high Lp(a) levels were associated with an increased risk of incident CAD |
Korneva et al. [67] | Karelia Republic | 81 patients (middle age was 39.1 ± 0.4 years, 33 males, 48 females), with familial hypercholesterolaemia | Immunoturbidimetry | >30 mg/dL | Prospective observational study | Elevated Lp(a) levels were associated with an increased risk of CAD in patients with familial hypercholesterolaemia |
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Stătescu, C.; Anghel, L.; Benchea, L.-C.; Tudurachi, B.-S.; Leonte, A.; Zăvoi, A.; Zota, I.M.; Prisacariu, C.; Radu, R.; Șerban, I.-L.; et al. A Systematic Review on the Risk Modulators of Myocardial Infarction in the “Young”—Implications of Lipoprotein (a). Int. J. Mol. Sci. 2023, 24, 5927. https://doi.org/10.3390/ijms24065927
Stătescu C, Anghel L, Benchea L-C, Tudurachi B-S, Leonte A, Zăvoi A, Zota IM, Prisacariu C, Radu R, Șerban I-L, et al. A Systematic Review on the Risk Modulators of Myocardial Infarction in the “Young”—Implications of Lipoprotein (a). International Journal of Molecular Sciences. 2023; 24(6):5927. https://doi.org/10.3390/ijms24065927
Chicago/Turabian StyleStătescu, Cristian, Larisa Anghel, Laura-Cătălina Benchea, Bogdan-Sorin Tudurachi, Andreea Leonte, Alexandra Zăvoi, Ioana Mădălina Zota, Cristina Prisacariu, Rodica Radu, Ionela-Lăcrămioara Șerban, and et al. 2023. "A Systematic Review on the Risk Modulators of Myocardial Infarction in the “Young”—Implications of Lipoprotein (a)" International Journal of Molecular Sciences 24, no. 6: 5927. https://doi.org/10.3390/ijms24065927