Lipoprotein(a) as a Risk Factor for Coronary Heart Disease in Hypercholeterolemic Men

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Abstract

Lipoprotein(a)[Lp(a)]is a blood lipoprotein that has recently raised major interest because its proposed involvement in both atherogenic and thrombogenic phenomena. Lp(a) has been implicated with contradictory results as an independent coronary heart disease (CHD) risk factor.ObjectiveTo assess the predictive value of Lp(a) as a risk factor for CHD in male patients with severe hypercholesterolemia or combined hyperlipidemia.

Material and method

121 men with primary hyperlipidemia and total cholesterol (TC) > 300 mg/dl were recruited from our Lipid Clinic. TC, tryglicerides (TG), HDL-cho-esterol (HDL-C), apolipoprotein B (apoB), Lp(a)and uric acid (UA) were measured in the absence of any hypolipidemic drug therapy. Lp(a) was semiquantified by a counter inmune electrophoresis method that accurately discriminates serum Lp(a) levels lower or higher than 30 mg/dl. CHD was defined by a previous acute myocardial infarction or revascularisation procedure (coronary by-pass orPTCA). No-CHD was determined by the abscence of symptoms and/or negative functional tests for ischemic heart disease. The predictive value for CHD of age, smoking(SM), sedentarism (SED),arterial hypertension (HTA), type II diabetes (DBT),body mass index(BMI),TC, TG, HDL-C, apoB, [Lp(a)]and UA were investigated using univariate regression analysis. A multiple logistic regression analysis included in the model: age HTA, TC, HDL-C, TG, DBT, SM and [Lp(a)].

Results

Population data (mean ± SD). Sixty-six out of the121 subjects had CHD. Age = 51,9 ± 11 years; TC =334 ± 38 mg/dl, TG = 317 ± 242 mg/dl, HDL-C = 38,5± 1 mg/dl, apoB = 151 ± 53 mg/dl, blood glucose =109 ± 32 mg/dl, UA = 6,5 ± 2,1 mg/dl, BMI = 27 ±4,3.Age, SM, HDL-C, DBT, and Lp(a) were significant risk factors (p < 0.05) by univariate analysis. In multivariate analysis only age and[Lp(a)]remained significantly and positively associated with CHD [odds ratio 1.05 (IC95% 1.01-1.09) p = 0.01 and odds ratio 2.62 (IC95% 1.15-5.99) p = 0.02, respectively].

Conclusion

Our findings suggest that Lp(a) is an independent risk factor for CHD in primary hyperlipidemia. Therefore, the measurement of Lp(a) might be considered as a further parameter in the evaluation of the global coronary risk in hyperlipidemic patients.