Whole-Blood Hypercholinemia and Coronary Instability and Thrombosis

Whole-blood choline (WBCHO) and plasma choline (PLCHO) have been reported to be predictive for cardiac events in patients with suspected acute coronary syndromes (1)(2). The differential information of whole-blood vs plasma choline offers insights into the biochemistry and pathophysiology of acute coronary syndromes. A previous study has shown that mean (SD) WBCHO concentrations are significantly increased in patients with non-ST-elevation myocardial infarction [31.1 (18.8) μmol/L] and high-risk unstable angina [47.4 (22.8) μmol/L] compared with patients with noncardiac chest pain [19.4 (6.8) μmol/L] (1) or healthy volunteers [15.8 (9.5) μmol/L]. For interpretation of WBCHO, a cutoff of 28.2 μmol/L has been proposed (1), which also represents the 90th percentile of a reference population. For PLCHO, the optimum cutoff has not been determined, and 25 μmol/L (99th percentile of a reference population) and lower cutoffs (18.5 μmol/L) have been used for risk stratification. We have selected 3 cases with the constellation of increased WBCHO in combination with low PLCHO to discuss potential pathophysiologic implications. All choline analyses were performed with HPLC–mass spectrometry (1), and choline concentrations were not available for clinical decision-making.