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Columbia University Irving Medical Center

Below are story ideas from Columbia Presbyterian Medical Center (CPMC). To pursue any of these stories, call Carolyn Conway, Columbia University College of Physicians & Surgeons at CPMC, 212-305-3900 or Kathy Robinson Columbia Presbyterian Medical Center of New York Presbyterian Hospital, 212-305-5587. Contact the ACC news room at 714-765-2021.

LINK BETWEEN BLOOD-CLOTTING FACTORS, ESTROGEN LEVELS FOUND

Levels of two blood factors associated with heart disease risk vary during the course of a woman's menstrual cycle, according to new research to be presented at the American College of Cardiology's annual scientific session March 12. This finding could have ramifications for understanding heart disease risk in pre-menopausal women, as well as the cardiovascular effects of estrogen supplementation after menopause, according to lead researcher. Elsa-Grace Giardina, M.D., professor of clinical medicine at Columbia University College of Physicians & Surgeons and medical director of The Center for Women' s Health at the Columbia Presbyterian Medical Center of New York Presbyterian Hospital.

Dr. Giardina's research is the first to investigate levels of plasminogen activator inhibitor (PAI-1), fibrin D-dimer, and von Willebrand Factor (vWF) in pre-menopausal women. PAI-1 enhances the breakup of blood clots, while vWF promotes clotting. Clot formation in the blood vessels is can lead to heart attack or stroke.

Dr. Giardina and colleagues at the Columbia Presbyterian Center for Women's Health used a precise lab test called an enzyme-linked immunosorbent assay to check levels of the three factors in 19 women at days 2, 9, 16, and 23 of their menstrual cycles.

During a normal menstrual cycle, estrogen levels increase steadily. The Columbia team found that levels of PAI-1 decreased steadily as the cycle progressed, while levels of vWF peaked at days 2 and 23 of the cycle. Dr. Giardina observes that while the increase in vWF may not be good for premenstrual women, "it may be disastrous for postmenopausal women," who are at greater risk for heart-attacks.

Two inferences can be made from the research, according to Dr. Giardina: Young women who have heart attacks may have abnormal levels of PAI-1 and vWF, promoting blood clotting, and it may be helpful to monitor levels of these factors in postmenopausal women, just as estrogen levels are monitored, to gauge heart disease risk.

STUDY ADDS EVIDENCE FOR ADMA AS ATHEROSCLEROSIS RISK FACTOR

A newly discovered molecule found in blood plasma, asymmetric dimethylarginine (ADMA), is known to inhibit the ability of nitric oxide to expand the blood vessels. This response is crucial to normal blood-vessel function, and high levels of ADMA have been linked to atherosclerosis. Now Columbia Presbyterian researchers have found the first evidence for a link between ADMA and coronary artery disease.

Dr. Shunichi Homma M.D., assistant chief of cardiology at the Columbia Presbyterian Medical Center of New York Presbyterian Hospital, and colleagues checked ADMA levels in 53 volunteers who were undergoing coronary angiography, a test that evaluates blood flow in the heart. The patients were divided into two groups: 23 people with no coronary artery disease and 30 people with disease in two or three of their coronary arteries. Even after adjusting for cigarette smoking, diabetes, and other known heart-disease risk factors, the researchers found that people with multiple coronary artery disease had higher levels of ADMA. Also, none of the other risk factors had any significant association with ADMA levels.

Dr. Homma will present his findings at the American College of Cardiology's 49th annual scientific session March 12.

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