Lactate as a screening test for coronary artery disease
The association of increased lipid levels with abnormal lactate metabolism may provide a useful screening test for the detection of coronary artery disease (1). In fact it was demonstrated that plasma lipid abnormalities and myocardial lactate production at the time of the initial study were significantly associated with subsequent arteriographic progression (2).
In our opinion the raise in plasma lipids presented in these studies might be a response to injury of the arterial endothelium due to an increased release of lactate. The response to injury concept is supported by the acidity theory of atherosclerosis (4)
Lactate and severity of coronary artery disease
The amount of lactate released by the myocardium has been shown to be related to the severity of coronary artery disease (1,2,3). One of these studies (3) have shown heterogeneity of myocardial lactate metabolism at rest in patients with coronary-myocardial disease. Lactate was released or produced by the myocardium when there was no clinical evidence of ischemia and the chemical arterial-coronary sinus lactate difference showing net global lactate extraction (3).
Carlos Monteiro
1. G. Jackson, Lynne Atkinson, M. Clark, B. Crook, P. Armstrong, and S. Oram, Diagnosis of coronary artery disease by estimation of coronary sinus lactate. British Heart Journal, 1978, 40, 979-983 Full free text at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC483520/
2. Bemis CE, Gorlin R, et al. Progression of coronary artery disease: A clinical arteriographic study. Circulation, Vol XLVII, March 1973. Full free text at http://circ.ahajournals.org/content/47/3/455.full.pdf
3. Gertz EW, Wisneski JA, Neese R, Bristow JD, Searle GL, Hanlon JT: Myocardial lactate metabolism: evidence of lactate release during net chemical extraction in man. Circulation 1981, 63: 1273-1279. Full free text at http://circ.ahajournals.org/cgi/reprint/63/6/1273
4. Carlos ETB Monteiro, Acidic environment evoked by chronic stress: A novel mechanism to explain atherogenesis. Available from Infarct Combat Project, January 28, 2008 at http://www.infarctcombat.org/AcidityTheory.pdf
