SYMPOSIUM Monday June 25 1990

87 Impaired fibrinolytic function in coronary heart disease WIMANB,iUMSTENA Departments of Clinical Chem&y and Internal Medicine, Karolinska Hospital, Stockholm, Sweden

molipoproteinemic patients an impaired fibrinolytic func- tion due to decreased ability to release t-PA was more common. Increased PAI- levels was an independent risk- factor for early reinfarction (within 3 years). At a cut-off level of 25 U/ml (reference limit ~25 U/ml) both the diag- nostic sensitivity and specificity for reinfarction were about

An impaired fibrinolytic function is commonly observed in 80%. Patients above this limit had a 45% risk of recurrence

patients with coronary artery disease. In a case control study as compared to only 4% for those with PAI- levels below

we have investigated the fibrinolytic function, glucose and this limit.

lipid metabolic factors, left ventricular function and coro- nary atheromatosis in patients with myocardial infarction before the age of 45. Furthermore, about 200 such patients have been followed clinically for recurrences allowing a prospective evaluation of the different parameters studied. A decreased fibrinolytic potential was a common finding in these patients, especially due to increased plasma levels of PAI- in patients with hypertriglyceridemia or a decreased glucose tolerance. In a subpopulation consisting of nor-

88 Effects of diet and eating habits on the fibrinolytic system ~NDELLIB,D~LI~NGH,&NBYM Depanments of Pathology, Clinical Chemby and Medical Biochemistry and Biophysics, Urned University, Umed, Sweden

Introduction. Eating habits and metabolic status are known to influence fibrinolysis. In the present studywe investigated if diet induced changes in hormones, glucose and lipid levels also effect fibrinolytic factors such as PAI- activity and t-PA antigen levels. Experimental design. 24 healthy females (in the same menstrual phase throughout the study) on a 60 hour high fat/low carbohydrate diet followed by a 36 hour low fat/high carbohydrate diet or vice versa were studied in a cross-over design. At the end of each diet period, urine was collected for 12 hours after which a blood sample was drawn. Plasma insulin, glucose, triglycerides, total cholesterol, Lp(a), PAI- activity and t-PA antigen were determined.

Urine adrenalin, noradrenalin, dopamine and cortisol levels were determined and excretion rates calculated. Results. Changes in PAI- activity correlated positively with changes in triglycerides and glucose but not with changes in insulin, in a bivariate regression analysis. In multivariate regression analysis, changes in PAI- activity were well explained by cwges in glucose (p=O.O57) and triglycerides (p=O.O51), R 0.42. Addition of change in insulin as independent vari- able did not improve the model (R2 was 0.45) whereas elimination offhange in glucose resulted in a considerable reduction of R to 0.28. Conclusion. This study indicates that triglycerides and glucose play a role in the regulation of PAI-1. In this relatively limited diet study, there was a ten- dency towards lower PAI- following the high carbohy- drate/low fat diet (6.Ok3.5 (SD) as compared to 7.1k3.9 U/ml). Eating habits or diet appears to have an influence on the fibrinolytic system which is also supported by a popula- tion study where high consumers of fruit and vegetables had significantly lower PAL1 levels (Nilsson et al. in press).