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Published on: August 23, 2011
Relationship of lipoprotein(a) to variables of coagulation in hypertensive subjects
1Hypertension Unit, Department of Experimental and Clinical Pathology and Medicine, Internal Medicine, University of Udine, Italy. Sechi@uniud.it
Insights
In hypertensive individuals, lipoprotein(a) (Lp(a)) shows a stronger association with clotting factors like fibrinogen and D-dimer compared to normotensive individuals. This suggests an accelerated risk of atherothrombosis in hypertension patients.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Genetics
Background:
- Coagulation factors are established predictors of cardiovascular damage in the general population.
- Lipoprotein(a) (Lp(a)) and apolipoprotein(a) (apo(a)) isoforms are implicated in cardiovascular risk.
- Hypertension is a significant risk factor for cardiovascular disease.
Purpose of the Study:
- To investigate the relationships between cardiovascular risk factors, Lp(a), and hemostatic variables in hypertensive subjects.
- To characterize apo(a) isoforms in hypertensive individuals.
- To compare these relationships in hypertensive versus normotensive subjects.
Main Methods:
- Measured plasma lipids, apolipoproteins, Lp(a), apo(a) isoforms, fibrinogen, and coagulation activation markers in 389 untreated essential hypertensive patients and 323 normotensive controls.
- Analyzed correlations between Lp(a), cardiovascular risk factors, and hemostatic variables.
- Investigated apo(a) phenotypes to understand the genetic basis of observed relationships.
Main Results:
- In hypertensive subjects, Lp(a) correlated significantly with age, apo-B, fibrinogen, and D-dimer, but not with other traditional risk factors.
- The association between Lp(a) and fibrinogen/D-dimer was stronger in hypertensive individuals than in normotensive controls.
- Elevated fibrinogen, D-dimer, and Lp(a) were independently associated with atherosclerotic disease; Lp(a) levels inversely correlated with apo(a) isoform size.
Conclusions:
- The relationship between Lp(a) and clotting variables is significantly stronger in hypertensive subjects.
- This enhanced association suggests accelerated atherothrombosis progression in hypertensive patients.
- Lp(a) and specific clotting factors represent key targets for managing cardiovascular risk in hypertension.
Background:
Coagulation factors are independent predictors of cardiovascular damage in the general population. The purpose of this study was to investigate the relationships between general cardiovascular risk factors, lipoprotein(a) (Lp(a)), and some hemostatic variables, and to characterize the isoforms of apolipoprotein(a) (apo(a)) in hypertensive subjects.
Methods:
Plasma lipids, apolipoproteins, Lp(a), apo(a) isoforms, fibrinogen, and parameters that directly reflect the coagulation activation were measured in 389 untreated essential hypertensive patients recruited at a hypertension clinic. Hypertensive patients were compared with 323 normotensive controls.
Results:
In normotensive subjects, Lp(a) concentrations were significantly correlated with fibrinogen (r = 0.138; P < 0.02) but not D-dimer (r = 0.074; not significant). In hypertensive subjects, log Lp(a) concentrations were significantly correlated with age (r = 0.127; P < 0.02), apo-B (r = 0.128; P < 0.02), plasma fibrinogen (r = 0.193; P < 0.001), and fibrin D-dimer (r = 0.200; P < 0.001) levels, but not with body mass index, blood pressure, cholesterol, triglycerides, apo-AI, prothrombin fragment 1 + 2, and antithrombin III. The relationship of Lp(a) with fibrinogen (male: r = 0.198, P < 0.002; female: r = 0.177, P < 0.01) and D-dimer (male: r = 0.211, P < 0.002; female: r = 0.188, P < 0.01) was significant in both sexes, whereas the relationship of Lp(a) with age and apo-B was found only in males. Multivariate analysis showed that both fibrinogen and D-dimer were independently related with Lp(a). Elevated fibrinogen, D-dimer, and Lp(a) levels were significantly and independently associated with clinical evidence of atherosclerotic disease. Apo(a) phenotypes were analyzed to investigate the genetic background of the relationships between Lp(a) and coagulation parameters. In both hypertensive and normotensive subjects, Lp(a) levels were inversely correlated with apo(a) isoform protein size, whereas fibrinogen and D-dimer concentrations were comparable in patients with apo(a) isoforms of different size.
Conclusions:
The relationship between Lp(a) and clotting variables is significantly stronger in hypertensive than in normotensive subjects, providing a compelling argument for accelerated progression of atherothrombosis in these patients.
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