Aasvee K, Jauhiainen M, Kurvinen E, Tur I, Sundvall J, Roovere T, Baburin A
Department of Molecular Medicine, National Public Health Institute, Biomedicum, Helsinki, Finland.
Scand J Clin Lab Invest. 2006;66(3):191-9. doi: 10.1080/00365510600564881.
Environmental as well as genetic factors are involved in the pathogenesis of myocardial infarction. The disease is a frequent cause of mortality in the middle-aged male population of Estonia. The high prevalence of premature myocardial infarction (PMI) in this country is not fully understood. The association of atherogenic and thrombogenetic risk factors with lifestyle was evaluated in men who had suffered myocardial infarction at 55 years of age (n = 71) and in randomly selected corresponding controls (n = 85). Serum routine lipids, apolipoprotein (apo)A-I, apoB, apoE polymorphism, lipoprotein(a) and fibrinogen levels were determined. Behavioural risk factors, indices of obesity, blood pressure and pedigree data were registered. In 80.6 % of PMI subjects some type of hyperlipidaemia was observed (European Atherosclerosis Society Classification) and lipid-lowering drugs were taken by 13.9 % of patients. In PMI patients the most common positive determinants of atherogenic lipoprotein indices were waist-to-hip ratio and physical inactivity, and in controls, waist-to-hip ratio and apoE phenotype. The odds ratio (OR) of PMI was 8.9-fold greater in the highest tertile of apoB/apoA-I distribution compared with the lowest tertile. The OR of PMI in the highest tertile of fibrinogen distribution versus the lowest tertile was 6.2 (95 % CI 2.46-15.44), and OR of PMI in the highest Lp(a) tertile versus the lowest was 3.1 (95 % CI 1.31-7.40). Thus, atherogenic dyslipidaemia was the most serious cardiovascular risk factor among PMI patients. From two thrombogenesis-related markers, the levels of fibrinogen and Lp(a), the first one was more strongly associated with PMI status.
环境因素以及遗传因素都参与了心肌梗死的发病过程。该疾病是爱沙尼亚中年男性人群中常见的死亡原因。该国早发性心肌梗死（PMI）的高患病率尚未完全明确。对55岁时发生心肌梗死的男性（n = 71）和随机选取的相应对照组（n = 85），评估了致动脉粥样硬化和血栓形成风险因素与生活方式之间的关联。测定了血清常规脂质、载脂蛋白（apo）A-I、apoB、apoE多态性、脂蛋白（a）和纤维蛋白原水平。记录了行为风险因素、肥胖指标、血压和家系数据。在80.6%的PMI受试者中观察到某种类型的高脂血症（欧洲动脉粥样硬化学会分类），13.9%的患者服用了降脂药物。在PMI患者中，致动脉粥样硬化脂蛋白指标最常见的阳性决定因素是腰臀比和身体活动不足，而在对照组中是腰臀比和apoE表型。与最低三分位数相比，apoB/apoA-I分布最高三分位数的PMI比值比（OR）高8.9倍。纤维蛋白原分布最高三分位数与最低三分位数相比，PMI的OR为6.2（95%CI 2.46 - 15.44），Lp（a）最高三分位数与最低三分位数相比，PMI的OR为3.1（95%CI 1.31 - 7.40）。因此，致动脉粥样硬化性血脂异常是PMI患者中最严重的心血管危险因素。在两个与血栓形成相关的标志物纤维蛋白原和Lp（a）水平中，第一个与PMI状态的关联更强。
