© Borgis - New Medicine 2/2004, s. 48-51
Zygmunt Chodorowski1, Jacek Sein Anand1, Jerzy Foerster2, Marcin Gruchała3, Krzysztof Chlebus3
Differences in lipid profile in patients with first myocardial infarction occurring at different ages
1 First Clinic of Internal Diseases and Acute Poisoning, Institute of Internal Medicine, Gdańsk Medical University, Gdańsk, Poland
2 Voivodeship Outpatient Gerontology Clinic, Gdańsk, Poland
3 First Clinic of Cardiac Diseases, Institute of Internal Medicine, Gdańsk Medical University, Gdańsk, Poland
Aim. Disorders of lipid metabolism occupy a prominent place among the numerous well-known risk factors for ischemic heart disease. Relatively little attention has been paid, however, to the behavior of the basic lipid metabolism parameters in particular age groups of patients with ischemic heart disease. The goal of our study was to trace the mutual relations between disorders of lipid metabolism and the patient´s age at the time of first myocardial infarction.
Method. Plasma lipid levels were examined in 1567 patients with first acute myocardial infarction, 944 men and 623 women, ranging in age from 26 to 100 years (mean 63.1±11.9). Six lipid parameters were analyzed: Total cholesterol (Tch), LDL-cholesterol (LDLch), HDL-cholesterol (HDLch), triglycerides (TG), atherogenic index (Tch/HDLch) and Gubner´s index (Tch/HDLch × TG). The patients were divided into four age groups: <40 years, 40-59 years, 60-79 years, and 80.
Results. Of the 6 lipid metabolism parameters, 4 (Tch, TG, atherogenic index, Gubner´s index) demonstrated a significant downward trend in the whole study population from 52 to 85 years, while LDL cholesterol declined only until age 68. Among men, all of the lipid indicators except for HDLch decreased significantly from 51 to 85 years. Among women, the downward tendency was similar; however, LDL-cholesterol values did not decline significantly.
Conclusion. Among all studied indicators of lipid metabolism, only HDL-cholesterol levels remained stable and did not change significantly with age in any of the study groups.
Among the numerous risk factors known to be of etiopathogenic significance for ischemic heart disease, a particularly prominent place is occupied by disorders of lipid metabolism. This topic has been the subject of considerable research (1-10). Somewhat less interest has been shown, however, in the behavior of the basic parameters of lipid metabolism in various age groups among patients with ischemic heart disease (5, 10, 11, 15). The purpose of the present study, then, was to trace the mutual relations between disorders of lipid metabolism and the age of patients experiencing a first-time myocardial infarction (MI).
MATERIAL AND METHOD
Lipidograms were performed on 1567 patients with a first-time recent MI, including 944 men and 623 women ranging in age from 26 to 100 years (mean 63.1±11.9). The women in this study population were significantly older than the men (66.0±12.0 vs 61.2±11.5, p <0.001). All these patients were hospitalized at the First Clinic of Heart Diseases or the First Clinic of Internal Diseases at the Gdańsk Medical University from 1994 to 2002.
The study population was divided into four age groups:
– Group 1: <40 years, mean age 36.1±3.3;
– Group 2: 40-59 years, mean age 51.7±5.3;
– Group 3: 60-79 years, mean age 68.3±5.3;
– Group 4: 80 years, mean age 85.1±3.9.
The diagnosis of MI was made on the basis of the clinical picture, the classic ECG criteria, and elevated serum levels of troponine, creatine kinase, CK-MB cardiac fraction, and the aminotransferases AspAT and AlAT. The diagnosis of MI without Q fraction was based on the finding of increased serum activity of creatine kinase and its isoenzyme MB, and/or a concentration of troponine exceeding two times the upper limit of the norm. Only those patients were included in the study in whom blood was drawn for a lipid profile within the first 24 hours of an acute MI episode and centrifuged within 2 hours of collection (1). If necessary, the plasma was preserved at a temperature of –20°C until the chemical analyses were performed. The lipids – total cholesterol (Tch), triglycerides (TG), and the HDL fraction of total cholesterol (HDLch) – were assayed in serum by the generally accepted methods routinely used in the Department of Clinical Biochemistry at the Gdańsk Medical University. The LDL fraction of total cholesterol was established indirectly by using Friedewald´s equation (12):
LDL ch = Tch – HDLch – TG/5
This equation was used to calculate the concentration of LDLch only when the plasma level of TG did not exceed 400 mg/dl.
In addition to Tch, HDLch, LDLch, and TG, we calculated the atherogenic index:
and the Gubner index:
The exclusion criteria included the following:
– cirrhosis of the liver or other liver diseases with features of active hepatocyte damage;
– nephrotic syndrome;
– chronic kidney failure;
– use by the patients of thiazide diuretics, non-selective-blockers, estrogens and progestagens, anticonceptive drugs, statins, fibrates, nicotinic acid, anion-exchange resins, phenytoines, benzodiazepines, prebucol, or anabolic and parasympatholytic compounds;
– coronary angioplasty performed in the acute phase of MI (14).
For purposes of statistical analysis we used the test of significance for two factors of structure and the U-Mann-Whitney test.
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