RESUMO
BACKGROUND: Monoclonal antibodies acting on the calcitonin gene-related peptide or its receptor (CGRP-mabs) are novel drugs for resistant migraine prophylaxis. As CGRP-mabs cause inhibition of vasodilatation, their use is reserved to patients with no recent history of cardiovascular diseases. We report a case of myocardial infarction associated with erenumab. CASE: A 57-year-old woman with a familial history of coronaropathy was first treated with erenumab 70 mg for 6 months and then increased to 140 mg. Almost 5 months after, the patient presented chest pain, increased troponin, and abnormal electrocardiogram. A myocardial infarction without coronarography abnormality was diagnosed through MRI. CONCLUSION: Further evidence is needed to assess the risk of myocardial infarction in patients treated with a CGRP-mab. In patients over 40 years of age, the risk of coronary or cardiovascular events should be assessed using risk tables or algorithms to take into account cardiovascular risk factors. This may be complemented by appropriate examinations to measure the burden of coronary atherosclerosis, if necessary.
Assuntos
Transtornos de Enxaqueca , Infarto do Miocárdio , Adulto , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados , Peptídeo Relacionado com Gene de Calcitonina/uso terapêutico , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/farmacologia , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/prevenção & controle , Infarto do Miocárdio/induzido quimicamente , Infarto do Miocárdio/tratamento farmacológico , Receptores de Peptídeo Relacionado com o Gene de Calcitonina/uso terapêuticoRESUMO
STUDY OBJECTIVE: Lipoprotein(a) (Lp[a]) level is a risk factor for ischemic heart disease, cerebrovascular disease, and peripheral vascular disease. However, few data are available concerning the relationship between Lp(a) level and severity of thoracic aortic atherosclerosis. We hypothesized in this transesophageal echocardiography (TEE) study that Lp(a) level is a marker of severity of thoracic aortic atherosclerosis. DESIGN: Cross-sectional study. SETTING: University hospital. PATIENTS: Risk factors, coronary angiographic features, and TEE findings were analyzed prospectively in 119 patients with valvular disease. MEASUREMENTS AND RESULTS: The following risk factors were recorded: age, gender, hypertension, smoking, lipid parameters, diabetes, body mass index, and family history of coronary artery disease. Serum levels of Lp(a) were measured for each patient. By univariate analysis, age, diabetes, hypertension, smoking, Lp(a), total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol levels were significant predictors of thoracic aortic atherosclerosis. There was a positive and significant correlation between the Lp(a) levels and the score of severity of thoracic aortic atherosclerosis (p = 0.0001). Multivariate regression analysis revealed that Lp(a) was an independent predictor of severity of thoracic aortic atherosclerosis (p = 0.0001). CONCLUSION: This prospective study indicates that serum Lp(a) level is an independent marker of severity of thoracic aortic atherosclerosis detected by multiplane TEE. These findings emphasize the role of Lp(a) as a marker of atherosclerotic lesions in the major arterial locations.