Low protein Z plasma levels are independently associated with acute coronary syndromes

Sandra Fedi; Francesco Sofi; Daria Brogi; Irene Tellini; Francesca Cesari; Ilaria Sestini; Alessandra Gazzini; Marco Comeglio; Rosanna Abbate; Gian Franco Gensini

doi:10.1160/TH03-04-0237

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2003; 90(06): 1173-1178
DOI: 10.1160/TH03-04-0237

Vascular Development and Vessel Remodelling

Schattauer GmbH

Low protein Z plasma levels are independently associated with acute coronary syndromes

Authors

Sandra Fedi

¹Department of Medical and Surgical Critical Care, Section of Clinical Medicine and Cardiology, University of Florence; Thrombosis Centre, Azienda Ospedaliera Careggi, Florence, Italy
Francesco Sofi

¹Department of Medical and Surgical Critical Care, Section of Clinical Medicine and Cardiology, University of Florence; Thrombosis Centre, Azienda Ospedaliera Careggi, Florence, Italy
Daria Brogi

¹Department of Medical and Surgical Critical Care, Section of Clinical Medicine and Cardiology, University of Florence; Thrombosis Centre, Azienda Ospedaliera Careggi, Florence, Italy
Irene Tellini

¹Department of Medical and Surgical Critical Care, Section of Clinical Medicine and Cardiology, University of Florence; Thrombosis Centre, Azienda Ospedaliera Careggi, Florence, Italy
Francesca Cesari

¹Department of Medical and Surgical Critical Care, Section of Clinical Medicine and Cardiology, University of Florence; Thrombosis Centre, Azienda Ospedaliera Careggi, Florence, Italy
Ilaria Sestini

¹Department of Medical and Surgical Critical Care, Section of Clinical Medicine and Cardiology, University of Florence; Thrombosis Centre, Azienda Ospedaliera Careggi, Florence, Italy
Alessandra Gazzini

¹Department of Medical and Surgical Critical Care, Section of Clinical Medicine and Cardiology, University of Florence; Thrombosis Centre, Azienda Ospedaliera Careggi, Florence, Italy
Marco Comeglio

¹Department of Medical and Surgical Critical Care, Section of Clinical Medicine and Cardiology, University of Florence; Thrombosis Centre, Azienda Ospedaliera Careggi, Florence, Italy
Rosanna Abbate

¹Department of Medical and Surgical Critical Care, Section of Clinical Medicine and Cardiology, University of Florence; Thrombosis Centre, Azienda Ospedaliera Careggi, Florence, Italy
Gian Franco Gensini

¹Department of Medical and Surgical Critical Care, Section of Clinical Medicine and Cardiology, University of Florence; Thrombosis Centre, Azienda Ospedaliera Careggi, Florence, Italy

Abstract

Summary

Protein Z (PZ) is a single chain vitamin-K-dependent glycoprotein synthesized by the liver. Studies in vivo and in vitro suggest that PZ plays an important role in inhibiting coagulation as it serves as cofactor for the inactivation of factor Xa by forming a complex with the plasma PZ-dependent protease inhibitor. Recently, conflicting findings on plasma PZ levels in patients with ischemic stroke have been published.

Aim of our study was to investigate the role of PZ in acute coronary syndromes (ACS). PZ plasma levels were determined in 223 (189 M; 34 F) patients with ACS referring to the Coronary Intensive Therapy Unit of University of Florence and in 265 (219 M; 46 F) healthy subjects. Patients under oral anticoagulation treatment as well as subjects with positivity for antiphospholipid antibodies were excluded. None had liver or kidney dysfunction. The mean PZ plasma level was lower in patients (1508 ± 730 ng/mL) than in controls (1728 ± 594 ng/mL) (p < 0.0001). PZ levels below the 5^th percentile (565 ng/mL) of normal values distribution in control subjects were found in 15.7% of patients and in 4.9% of controls (p <0 .0001). At multivariate analysis, PZ levels below 565 ng/mL were associated with ACS (OR=3.3; 99%CI 1.1-9.7; p = 0.004). The contemporary presence of low PZ levels and smoking habit leads to an increased risk of ACS (OR=9.5; 99%CI 2.4-37.2; p < 0.0001). In conclusion, our results suggest a possible role of PZ in the occurrence of arterial thrombosis.

Keywords

Protein Z (PZ) - Protein Z-dependent protease inhibitor - Factor Xa - Acute Myocardial Infarction - Unstable Angina

Full Text

References

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