Serum total homocysteine and lipoprotein [a] levels in acute myocardial infarction and their response to treatment with vitamins

ABSTRACT

To assess the relationship of serum total homocysteine [tHcy] and lipoprotein [a] [Lp[a]] levels with systemic hypertension, Diabetes mellitus and smoking as risk factors in patients with acute myocardial infarction [AMI] and changes in the former levels with vitamins supplementation. An interventional study. Medical College for Women and Hospital [MCW and H], Dhaka, Bangladesh, from July 2008 to December 2009. Consecutive AMI patients were recruited from the Coronary Care Unit [CCU] and MCW and H, Dhaka. Blood samples were collected at inclusion [Patient-I[0]]. They were given conventional treatments and prescribed vitamins [vitamins B[6]=25 mg, B[12]=2 mg and folic acid=2.5 mg] daily for 2 months. After follow-up, blood samples were taken again [Patient II[0]]. A group of 25 normal subjects were also included as controls. Serum tHcy and Lp[a] were measured by kinetic method and nephelometric method respectively. serum tHcy [micro mol/L] and Lp[a] [mg/dl] levels were elevated in Patient -I[0] that reduced in Patient-II[0] after vitamins supplementation, but not to the normal control level. tHcy of Patient-I[0] was 25.1 +/- 4.7 micro mol/L, of Patient-II[0] was 20.1 +/- 4.5 micro mol/L and of controls 12.1 +/- 3.3, p < 0.001. Lp[a] of Patient-I[0] was 43.1 +/- 15.2 mg/dL, of Patient-II[0] was 35.6 +/- 10.2 mg/dL, Control 22.3 +/- 5.2 mg/dL, p<0.001. Elevated tHcy and Lp[a] levels were independent of the traditional risk factors [p> 0.1]. However, in a significant proportion of patients tHcy and Lp[a] levels were reduced to control levels [tHcy p<0.001, Lp[a] p<0.01]. These results indicated that tHcy and Lp[a] levels were possibly atherogenic risk factors independent of conventional risk factors. Since both tHcy and Lp[a] levels responded in a similar fashion, a common point of the metabolic and pathogenetic pathways of tHcy and Lp[a] may be influenced by the vitamins supplementation