Abstract
Background: Lp(a) is a highly atherogenic particle with a prothrombotic effect. Until now its relation to the extent and severity of the atheromatic lesions had not been established by standard procedures.
Hypothesis: This study examined the correlation of Lp(a) to the extent and severity of coronary artery disease (CAD) and its relation to unstable clinical events (not including sudden death).
Methods: In 202 patients undergoing coronary angiography, plasma lipids were measured with the usual procedures and Lp(a) with the enzyme‐linked immunosorbent assay. The extent of CAD was expressed in the number of diseased vessels and its severity in terms of the severity coefficient and the obstruction coefficient.
Results: A very strong relationship between LP(a) and the number of diseased vessels (p = 0.0007) signifying diffuse atherosclerosis, but no relation with the severity of the lesions, was found. However, it was the only lipid that correlated significantly with the number of totally occluded vessels (p = 0.0003). The thrombogenic ability of Lp(a) was manifested by increased incidence of myocardial infarction and unstable angina episodes in patients with elevated Lp(a) (p = 0.0157).
Conclusion: Elevated Lp(a) predisposes to the extent of CAD and total occlusions but not to the severity of lesions. Patients with increased Lp(a) levels and unstable angina are at increased danger of suffering myocardial infarction. Thus, Lp(a) may predispose to plaque destabilization and thrombosis of noncritical lesions.
Keywords: lipoprotein(a), lipids, coronary artery disease, atherosclerosis, thrombosis, unstable angina, myocardial infarction
Full Text
The Full Text of this article is available as a PDF (610.4 KB).
References
- 1. Berg K: Lp(a) lipoprotein: An overview. Chem Phys Lipids 1994; 67–68: 9–16 [DOI] [PubMed] [Google Scholar]
- 2. Dahlen G, Berg K, Frick MH: Lp(a) lipoprotein/pre‐B 1‐lipoprotein, serum lipids and atherosclerotic disease. Clin Genet 1976; 9: 558–566 [DOI] [PubMed] [Google Scholar]
- 3. Hearn JA, De Mauio SJ Jr, Roubin GS, Hammarstrom M, Sgoutas D: Predictive value of lipoprotein(a) and other serum lipoproteins in the angiographic diagnosis of coronary artery disease. Am J Cardiol 1990; 66: 1176–1180 [DOI] [PubMed] [Google Scholar]
- 4. Mbewn AD, Durrington PN: Lipoprotein(a): structure, properties and possible involvement in thrombogenesis and atherogenesis. Atherosclerosis 1990; 85: 1–14 [DOI] [PubMed] [Google Scholar]
- 5. Scanu AM: Lp(a): A genetic risk factor for premature coronary artery disease. J Am Med Assoc 1992; 267: 1709–1717 [Google Scholar]
- 6. Ornish D, Brown S, Scherwitz L, Billings J, Armstrong W, Ports T: Can life style changes reverse coronary heart disease? Lancet 1990; 336: 129–133 [DOI] [PubMed] [Google Scholar]
- 7. Schuler G, Hambrecht R, Schlierf G, Niebauer J, Hauer K, Newmann J, Hoberg E: Regular physical exercise and low fat diet: Effects on progression of coronary heart disease. Circulation 1992; 86: 1–11 [DOI] [PubMed] [Google Scholar]
- 8. Betteridge DJ, Durrington PN, Fairhurst GJ, Jackson G, McEwan MS, McInnes GT: Comparison of lipid lowering effects of low dose fluvastatin and conventional dose gemfibrosil in patients with primary hypercholesterolemia. Am J Med 1994; 96: 45S–54S [DOI] [PubMed] [Google Scholar]
- 9. O'Brien T, Nguyen TT, Harrison JM, Bailey KR, Dyck PJ, Kottke BA: Lipids and LP(a) levels and coronary artery disease in subjects with non‐insulin dependent diabetes mellitus. Mayo Clin Proc 1994; 69: 430–435 [DOI] [PubMed] [Google Scholar]
- 10. Hiraga T, Kobayashi T, Okubo M, Nakanishi K, Sugimoto T, Ohashi Y: Prospective study of lipoprotein(a) as a risk factor for atherosclerotic cardiovascular disease in patients with diabetes. Diabetes Care 1995; 18: 241–244 [DOI] [PubMed] [Google Scholar]
- 11. Braunwald E: Unstable angina: A classification. Circulation 1989; 80: 410–416 [DOI] [PubMed] [Google Scholar]
- 12. Reardon MF, Nestel JP, Craig IH, Harper RW: Lipoprotein predictors of the severity of coronary artery disease in men and women. Circulation 1985; 71: 881–888 [DOI] [PubMed] [Google Scholar]
- 13. Dahlen GH, Guyton JR, Attar M, Farmer JA, Kautz JA, Gotto AM: Association of levels of lipoprotein(a), plasma lipids and other lipoproteins with coronary artery disease documented by angiography. Circulation 1986; 74: 758–765 [DOI] [PubMed] [Google Scholar]
- 14. Mancini JGB, Simon SB, McGillem MJ, LeFree MT, Friedman HZ, Vogel RA: Automated quantitative coronary arteriography: Morphologic and physiologic validation in vivo of a rapid digital angiographic method. Circulation 1987; 75: 452–460 [DOI] [PubMed] [Google Scholar]
- 15. Yeung AC, Vekshtein VI, Krantz DS: The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress. N Engl J Med 1991; 325: 1551–1556 [DOI] [PubMed] [Google Scholar]
- 16. Cox DA, Vita JA, Treasure CB: Atherosclerosis impairs flow mediated dilation of coronary arteries in humans. Circulation 1989; 80: 458–465 [DOI] [PubMed] [Google Scholar]
- 17. Statistica: General Conventions and Statistics. Vol. 1, p. 1417–1593. New York: Statsoft, 1995. [Google Scholar]
- 18. Van Wersch JW: The behaviour of lipoprotein(a) in patients with various diseases. Scand J Clin Lab Invest 1994; 54: 559–562 [DOI] [PubMed] [Google Scholar]
- 19. Valentine RJ, Grayburn PA, Vega GL, Grundy SM: Lp(a) is an independent, discriminating risk factor for premature peripheral atherosclerosis among white men. Arch Intern Med 1994; 154: 801–806 [PubMed] [Google Scholar]
- 20. Romn PA, Green CE, Reagan K, Rackley CE: Relation of serum lipoprotein cholesterol levels to presence and severity of angiographic coronary artery disease. Am J Cardiol 1991; 67: 479–483 [DOI] [PubMed] [Google Scholar]
- 21. Albers J, Marcovina SM, Lodge MS: The unique lipoprotein(a): Properties and immunochemical measurement. Clin Chem 1990; 36/ 12: 2019–2026 [PubMed] [Google Scholar]
- 22. Plow EF, Herren T, Redlitz A, Miles LA, Hoover Plow JL: The cell biology of the plasminogen system. FASEB J 1995; 9: 939–945 [DOI] [PubMed] [Google Scholar]
- 23. Miles LA, Flesst GM, Levin EG, Scanut AM, Plow EF: A potential basis for the thrombotic risks associated with Lp(a). Nature 1989; 339: 301–305 [DOI] [PubMed] [Google Scholar]
- 24. Hajjar CA, Gavish D, Breslow JL, Nachman RL: Lipoprotein(a) modulation of endothelial cell surface fibrinolysis and its potential role in atherosclerosis. Nature 1989; 339: 303–305 [DOI] [PubMed] [Google Scholar]
- 25. Swahn E, von Schenck H: Prognostic importance of plasma lipoprotein analyses in patients with unstable coronary artery disease. Scand J Clin Lab Invest 1993; 53: 289–295 [DOI] [PubMed] [Google Scholar]
- 26. Sandkamp M, Funke H, Schulte H, Kohler E, Assmann G: Lipoprotein(a) is an independent risk factor for myocardial infarction at a young age. Clin Chem 1996; 36/l: 20–23 [PubMed] [Google Scholar]
- 27. Dangas G, Ambrose JA, D'Agate DJ, Shao JH, Chockalingham S, Levine D, Smith DA: Correlation of serum Lp(a) with the angiographic and clinical presentation of coronary artery disease. Am J Cardiol 1999; 83: 583–585 [DOI] [PubMed] [Google Scholar]
- 28. Franceschini G, Cofrancesco E, Safa O, Boschetti C, Tremoli E, Mussoni L: Association of lipoprotein(a) with atherothrombotic events and fibrinolytic variables. A case control study. Thromb Res 1996; 78: 227–238 [DOI] [PubMed] [Google Scholar]
- 29. Brunelli C, Spallarossa P, Bertolini S, Balbi M, Barbara C, Masturzo P, Lantieri PB, Pastorini C, Caponnetto S: Lipoprotein(a) is increased in acute coronary syndromes but it is not predictive of the severity of coronary lesions. Clin Cardiol 1995; 18: 526–529 [DOI] [PubMed] [Google Scholar]
- 30. Marburger C, Hambrecht R, Niebauer J, Schoeppenthau M, Scheffler E, Hawer K: Association between Lp(a) and progression of coronary artery disease in middle‐aged men. Am J Cardiol 1994; 73: 742–746 [DOI] [PubMed] [Google Scholar]
- 31. Cooke T, Sheahan R, Foley D, Reilly M, D'Arcy G, Jauch W: Lipoprotein(a) in restenosis after percutaneous angioplasty and coronary artery disease. Circulation 1994; 89: 1593–1598 [DOI] [PubMed] [Google Scholar]