RELATION OF ANTIOXIDANT STATUS AND LIPOPROTEIN (a) LEVEL IN MYOCARDIAL INFARCTION PATIENTS : A CLINICAL STUDY TO EVALUATE THE ANTIOXIDANT/ LIPOPROTEIN (a) RATIO AS A NOVEL PARAMETER TO INDICATE CARDIOVASCULAR ACCIDENT

Abstract

Lipoprotein (a), a prominent marker of cardiovascular accident, was first described by Berg in 1963(3). Lipoprotein (a) [Lp(a)] has been considered as one of the distinguished signature in myocardial infarction and  for many years.^1. Owing to incomplete scientific evidence in clinical practice, screening for and treatment of high Lp(a) levels is primarily essential . On the other hand free radicals, now shown to be one of the underlying causes in neurological and immunological diseases, possess tremendous affinity to pair with electrons to form couples. These high velocity reactions have been shown to be the major mechanism behind the harmful effect of free radicals. The present study aims to correlate the antioxidant status ,which has been shown to be associated with kidney, heart and lung diseases, with  lipoprotein (a) or Lp (a),  The free radicals, basically species with unpaired electrons have been found to be of the causative agents for shifting of equilibrium of pro-oxidant antioxidant balance. Aims  and  Objectives: Aim of our study is 1.To determine the level of Lp (a) and antioxidant status  of  patients viz. the antioxidant  in vivo  parameters like catalase [CAT], superoxide dismutase[SOD] and reduced sulfhydryl group[GSH]   2. To find out the significance of relation between parameters of antioxidant and Lipoprotein (a) level among the patients of cardiovascular accident 3. To compare the Lipoprotein (a) and antioxidant status 4. To find out the significance of Lipoprotein (a) level antioxidant status and correlate the two parameters in  acute myocardial infarction [AMI] patients. Materials and Methods: Fourty one (41) patients with acute myocardial infarction were selected from a series of consecutive patients admitted in the coronary care unit (CCU) of different medical colleges and /or hospitals or Nursing Homes or health care centres.  Lp(a) was  quantified by immunoturbidiometric method and other antioxidant parameters by spectrophotometric /enzymatic assays. Results: Serum  LP(a)  concentration  in  control  group  is  30.50 ± 25 mg/dl with  maximum 134mg/dl .  In  the  case  group AMI patient group in  both male &  female  patients with  average  mean  LP(a) concentration   is 78.95±45 mg/dl, the   maximum  value is 485 mg/ dl. There is direct correlation between antioxidant enzyme catalase and inverse relationship between superoxide dismutase and reduced sulfhydryl group [Equivalent to reduced glutathione][GSH] Discussion: There  is significant difference  between  the  two  groups. ( p< 0.05). Lp-(a)  concentration  level  in  patients with  AMI  is  higher  than  the  control group. An  elevated  Lp(a)  concentration  is associated  AMI  and   a  risk  factor  for  AMI ., suggesting  that  Lp(a)  may  play an  important  role in  the  genesis  of thrombotic coronary  occlusion and  the  occurance  of AMI. The relationship of antioxidant enzymes  proves that the underlying causative agent of pathogenesis of cardiovascular accident is due to ROS[Reactive oxygen species]Conclusion: It  is  suggested to  make  Lp(a) serum level determination   test  as  a  routine  laboratory  test for  identification of  risk factor for  AMI .The antioxidant parameters can also be taken as accessory parameters in the detection of CAD.

Keywords: LP(a), AMI ,  catalase, SOD, GSH