Department of Cardiology, Vienna General Hospital/Medical University of Vienna, Austria.
Bone. 2011 Mar 1;48(3):622-6. doi: 10.1016/j.bone.2010.11.005. Epub 2010 Nov 13.
Acute myocardial infarction (AMI) at young age is a rare disease with a poor prognosis. Bone metabolism parameters such as 1,25 (OH)₂ vitamin D₃, 25 (OH) vitamin D₃ and osteocalcin have been recently implicated in the development of coronary heart disease (CHD). We evaluated the role of these serum markers in a study population of very young AMI survivors (≤ 40 years).
We prospectively enrolled 302 subjects into our multi-center case control study, including 102 young myocardial infarction patients (≤ 40 years) and 200 control subjects who were frequency-matched on gender and age in an approximate 2:1 ratio per case patient. In the adjusted logistic regression analysis, we used baseline laboratory measurements for the first analysis (acute phase analysis) and measurements from one-year follow-up visits (stable phase analysis). In both, elevated levels of 25 (OH) vitamin D₃ (acute phase: OR per IQR 2.02, 95% CI 1.13-3.58, p = 0.017; stable phase: OR 4.07, 95% CI 1.8-9.21, p = 0.001) and 1,25 (OH)₂ vitamin D₃ (acute phase: OR 2.82, 95% CI 1.7-4.7, p < 0.001; stable phase: OR 4.57, 95% CI 2.31-9.05, p < 0.001) were associated with premature AMI. Conversely, osteocalcin was inversely associated with premature myocardial infarction (acute phase: OR 0.53, 95% CI 0.28-1.03, p = 0.059; stable phase: OR 0.26, 95% CI 0.12-0.6, p < 0.001). The observed associations were independent of the acute phase of myocardial infarction.
In our study, elevated levels of 25 (OH) vitamin D₃ and 1,25 (OH)₂ vitamin D₃, as well as decreased levels of osteocalcin were associated with myocardial infarction in very young patients. The precise mechanism and implications of these findings will have to be elucidated in future studies.
年轻人发生急性心肌梗死（AMI）是一种罕见疾病，预后较差。骨代谢参数如 1,25（OH）₂维生素 D₃、25（OH）维生素 D₃ 和骨钙素最近被认为与冠心病（CHD）的发生有关。我们评估了这些血清标志物在非常年轻的 AMI 幸存者（≤ 40 岁）的研究人群中的作用。
我们前瞻性地纳入了 302 名多中心病例对照研究的受试者，包括 102 名年轻心肌梗死患者（≤ 40 岁）和 200 名按性别和年龄以近似 2:1 比例匹配的对照组患者。在调整后的逻辑回归分析中，我们使用基线实验室测量值进行第一次分析（急性期分析）和一年随访时的测量值进行（稳定期分析）。在两种情况下，25（OH）维生素 D₃水平升高（急性期：每 IQR 的比值比为 2.02，95%置信区间为 1.13-3.58，p = 0.017；稳定期：比值比为 4.07，95%置信区间为 1.8-9.21，p = 0.001）和 1,25（OH）₂维生素 D₃（急性期：比值比为 2.82，95%置信区间为 1.7-4.7，p < 0.001；稳定期：比值比为 4.57，95%置信区间为 2.31-9.05，p < 0.001）与早发 AMI 相关。相反，骨钙素与早发心肌梗死呈负相关（急性期：比值比为 0.53，95%置信区间为 0.28-1.03，p = 0.059；稳定期：比值比为 0.26，95%置信区间为 0.12-0.6，p < 0.001）。这些观察到的关联独立于心肌梗死的急性期。
在我们的研究中，25（OH）维生素 D₃和 1,25（OH）₂维生素 D₃水平升高以及骨钙素水平降低与非常年轻的患者的心肌梗死有关。这些发现的确切机制和意义将需要在未来的研究中阐明。
