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Is MDA-Modified LDL a Marker for Acute Coronary Syndromes?

Coronary endothelial injury is associated with platelet adhesion, aggregation synthesis of prostaglandins, and the release of aldehydes that bind to low-density lipoprotein (LDL) to create malondialdehyde (MDA)-modified LDL. Belgian investigators compared MDA-modified LDL, troponin I, and C-reactive protein as markers for stable coronary disease (n=64), unstable angina (n=42), and acute MI (n=62).

Univariate analysis revealed an association of acute coronary syndromes with elevated levels of C-reactive protein, troponin I, and MDA-modified LDL. On multivariate analysis, elevated levels of MDA-modified LDL correlated with unstable coronary syndromes, but troponin I most strongly correlated with acute MI. With cutoff values exceeding the 95th percentile of patients with stable angina, the sensitivity of MDA-modified LDL was 95 percent for unstable angina and 95 percent for acute MI, with a specificity of 95 percent. The combined sensitivity of MDA-modified LDL plus troponin I was 98 percent for unstable angina and 100 percent for acute MI, with a combined specificity of 99 percent. By combining assays, physicians may be able to identify the presence of coronary plaque instability and myocardial cell injury, thus improving the ability to diagnose and stratify patients with acute coronary syndromes.

Comment: This small, interesting study of patients with acute coronary syndromes indicates that biochemical assays may help identify patients with unstable coronary plaques even without myocardial cell injury. (The authors of this paper created the MDA-modified LDL assay.) More studies are needed to verify these results in larger groups of patients at other centers.

— KA Eagle

Published in Journal Watch Cardiology July 16, 1999

Citation(s):

Holvoet P et al. Malondialdehyde-modified LDL as a marker of acute coronary syndromes. JAMA 1999 May 12 281 1718-1721.

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