BACKGROUND: Inflammation and lipid metabolism play a central role in pathogenesis of atherosclerosis. High sensitivity C-reactive protein (hsCRP), Lipoprotein(a) [Lp(a)] and other inflammation markers are well-established markers of cardiovascular (CV) diseases and are associated with adverse CV outcome after acute coronary syndrome (ACS).
METHODS: The study enrolled patients ≤ 55 years of age referred to Cardiology Department of Policlinico Casilino with ACS. In order to evaluate inflammation and lipid metabolism in young patients presenting with ACS, we design an acronym to describe biochemical tests measured: ACS-Lip. Biochemical tests include:
A – Apolipoprotein A (ApoA),
A – Apolipoprotein B (ApoB),
C – hsCRP,
C – Cystatin C,
S – Suppression of tumourigenicity 2 (ST2).
Lip
– low-density lipoprotein cholesterol (LDL), high-density lipoprotein (HDL) cholesterol and triglycerides (TG),
– Lp(a),
Interleukin 6 (IL-6), plasma glucose, glycosylated hemoglobin Type A1c (HbA1c) levels were also determined.
RESULTS: A total of 20 patients (85% males, mean age 45.5 ± 7.7 years old) were enrolled from July 2020 to March 2022.
Hs-CRP was ≥3 mg/L in 100 % of patients.
Mean LDL cholesterol level at admission was 117 ± 56 mg/dL, while mean HDL cholesterol was 38 ± 11 mg/dL. Mean Lp(a) level was 42.9 ± 36.1 mg/dL. Elevated Lp(a)>30 mg/dL was documented in 55% of patients. Lp(a) level distribution in the study population is reported in Figure 1. Additional parameters are reported in Table 1.
CONCLUSION: In our experience, elevated levels of Lp(a) and of markers inflammation display a detailed profile of patients presenting with ACS at a relatively young age, identifying patients with high risk of recurrence of cardiovascular events. This result focus on the potential use in clinical practice of efficacious Lp(a)-lowering drugs and on the role on inflammatory mediators both as indicator and therapeutic target.