Progression of coronary artery disease in young male post-infarction patients is linked to disturbances of carbohydrate and lipoprotein metabolism and to impaired fibrinolytic function

Aims To assess determinants of coronary artery disease progression in men with previous myocardial infarction. Methods and Results A total of 102 unselected nondiabetic Swedish men (age 40.4+/-3.6, range 23-44 years) entered the study 3-6 months after a first myocardial infarction. The programme included metabolic and haemostatic investigations and routine coronary angiography at baseline, followed by re-angiography 5 years later. Of the original cohort, 76 patients underwent a second angiogram. Separate semiquantitative scoring systems were used for diffuse coronary atherosclerosis and distinct stenoses in 15 proximal coronary segments. Smoking, global severity of coronary atherosclerosis and presence of multi-vessel disease at baseline (P<0.001) characterized patients with severe progression of both diffuse and focal lesions. Higher plasma levels of low density lipoprotein cholesterol (P<0.01) and low density lipoprotein triglycerides (P<0.05), a lower plasma high density lipoprotein, cholesterol level (P<0.05) and higher plasma plasminogen activator inhibitor-1 activity (P<0.05), together with a high baseline stenosis score (P<0.001) characterized patients with severe progression of coronary atherosclerosis. On the other hand, more pronounced fasting and post-prandial glycaemia (P<0.05), together with higher plasma plasminogen activator inhibitor-1 activity (P<0.01) characterized severe progressors with respect to coronary stenosis. Multivariate analysis identified the presence of multi-vessel disease as an independent predictor of progression of both coronary atherosclerosis (P=0.008) and stenoses (P=0.007), whereas a high low density lipoprotein triglyceride level (P<0.01) was independently related to progression of coronary atherosclerosis and a high fasting glucose level (P=0.02) to progression of coronary stenoses. Conclusion Disturbances in carbohydrate and lipoprotein metabolism and impaired fibrinolytic function are associated with progression of coronary artery disease in young male post-infarction patients.