2005 American College of Physicians Poster Competition Winners
Each year, the state chapters of the American College of Physicians (ACP) invite medical students, residents, and fellows to participate in a scientific poster competition.
The Minnesota chapter received more than 125 submissions in the clinical vignette and research categories from students, residents, and fellows from the University of Minnesota, Mayo Clinic, Abbott Northwestern Hospital, and Hennepin County Medical Center. The abstracts were reviewed and presented in poster form at the Minnesota Chapter of the ACP’s Scientific Meeting held at the Minneapolis Convention Center on Nov. 4 and 5, 2005.
Kevin Larsen, M.D., and Susan M. Simmons, administrative coordinator for the Minnesota ACP chapter, coordinated the competition. Judges included teaching faculty and community physicians. Judging was double-blinded, and research was assessed for originality, significance, and presentation. Winners received prizes, and the winners of the clinical vignette and research categories are guaranteed entry in the national competition, which will be held in Philadelphia in April.
Congratulations to the winners and everyone who participated in the poster competition.
Research Winner
PAPP-A Levels are Elevated in Patients with Acute Myocardial Infarction and are Proportionally Decreased by Treatment with Atorvastatin
Results of a Dual-Dose, Double-Blind, Randomized Study
By Michael D. Miedema, M.D., Cheryl A. Conover, Ph.D., Sean C. Harrington, Diedra Oberg, Holly Macdonald, Daniel Wilson, M.D., Giuseppe Sangiorgi, M.D., Timothy D. Henry, M.D., and Robert S. Schwartz, M.D., Abbott Northwestern Hospital
Background: Pregnancy-associated plasma protein-A (PAPP-A) is a novel metalloproteinase of the insulin-like growth factor system. It is associated with vascular inflammation, plaque vulnerability, and extent of coronary artery disease. Given increased PAPP-A levels are a marker of plaque instability, we hypothesized that PAPP-A levels would be increased in patients presenting with chest pain who subsequently were found to have myocardial infarction. Since statins reduce vascular inflammation, we also hypothesized that statin therapy would reduce PAPP-A levels in patients with coronary disease. We thus measured PAPP-A, hs-CRP, and lipid levels in patients randomized to low- or high-dose atorvastatin treatment.
Methods: Seventy-seven patients who presented with coronary angiography with anginal symptoms were grouped by troponin status. Patients with angiographically verified coronary artery disease were then randomized in a double-blind study to receive either 10 mg or 80 mg of oral atorvastatin daily. PAPP-A, hs-CRP, and lipid profiles were measured at baseline, 1 month, and 6 months.
Results: PAPP-A levels were significantly increased in 16 patients with troponin-positive anginal symptoms versus 61 patients with troponin-negative disease (2.99 mIU/L vs 1.36 mIU/L, P<0.05). In the 51 patients who completed follow-up, atorvastatin significantly reduced PAPP-A levels in both the 10 mg and 80 mg treatment groups. Patients randomized to 10 mg had a 37% reduction (1.69 1.48 mIU/L at baseline to 1.06 0.79 mIU/L at 1 month, P<0.05). The 80 mg group showed a 60% reduction (1.89 2.30 mIU/L at baseline to 0.75 0.61 mIU/L at 1 month, P<0.05). A 13-patient subset with PAPP-A levels greater than 2.0 mIU/L showed a 67% reduction, and 8 patients with levels greater than 3.0 mIU/L had a 73% reduction in PAPP-A. Hs-CRP levels were reduced by 63% and 77% in the groups receiving 10 mg and 80 mg, respectively. LDL decreased by 37% and 52%.
Conclusions: 1) PAPP-A levels are more than double in patients presenting with acute myocardial infarction. 2) Atorvastatin reduces PAPP-A levels proportionally to initial elevation and in a dose-dependent fashion. This suggests moderation of coronary inflammation and enhanced plaque stability.