Markers of bone metabolism in premature myocardial infarction (≤ 40 years of age)

IntroductionAcute 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).Methods and resultsWe 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.ConclusionIn 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.

Research Highlights
► We investigated the role of markers of bone metabolism in premature coronary artery disease.
► We performed a multi-center case-control study on this subject.
► Elevated levels of 25 (OH) vitamin D3 and 1,25 (OH)2 vitamin D3 were associated with premature acute myocardial infarction.
► Ostecocalcin was inversely associated with premature myocardial infarction.