Lipoprotein(a), fibrinogen and vascular mortality in an elderly northern Italian population
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Published on: October 12, 2017
Armando D'Angelo1, Giacomo Ruotolo, Paola Garancini
1Servizio di Coagulazione ed Unità Ricerca Trombosi, IRCCS H S. Raffaele, Via Olgettina 60, 20132 Milano, Italy. armando.dangelo@hsr.it
Insights
High levels of lipoprotein a [Lp(a)] and fibrinogen together significantly increase the risk of death from coronary heart disease (CHD) and stroke in older adults. This combined effect, not seen with either factor alone, highlights a critical cardiovascular risk.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Epidemiology
Background:
- High lipoprotein a [Lp(a)] and fibrinogen are implicated as risk factors for coronary heart disease (CHD) and stroke.
- Experimental data suggest a synergistic interaction between Lp(a) and fibrinogen in atherothrombosis.
- Clinical evidence for this synergism, however, remains limited.
Purpose of the Study:
- To investigate the combined clinical impact of elevated Lp(a) and fibrinogen levels on cardiovascular mortality.
- To assess whether a synergistic effect exists between Lp(a) and fibrinogen in predicting CHD and stroke mortality in an elderly population.
Main Methods:
- Prospective population study in Cremona, Italy, involving 559 adults aged 65+.
- Evaluation of cardiovascular risk factors, including Lp(a) and fibrinogen levels.
- Median follow-up of 6.3 years to record deaths, specifically those due to CHD or ischemic stroke.
Main Results:
- The combined incidence rate of CHD and stroke mortality was significantly higher in subjects with both elevated Lp(a) and high fibrinogen (38.4 per 1000 person-years).
- The combination of high Lp(a) and fibrinogen was an independent predictor of mortality (hazard ratio=3.11, p=0.014).
- Neither Lp(a) nor fibrinogen levels in isolation, nor C-reactive protein (CRP), predicted combined CHD and stroke mortality.
Conclusions:
- The co-occurrence of high lipoprotein a [Lp(a)] and fibrinogen levels is associated with an increased risk of death from coronary heart disease and stroke.
- This finding, observed in an elderly cohort, supports the hypothesis of a synergistic atherothrombotic mechanism involving both factors.
- Further research is warranted to explore this combined risk in larger and more diverse populations.
Background And Objectives:
High lipoprotein a [Lp(a)] and fibrinogen levels are suggested risk factors for coronary heart disease (CHD) and stroke morbidity and mortality. Experimental data strongly suggest that the mechanisms of atherothrombosis include an interaction between fibrinogen and Lp(a), but little clinical evidence of a synergism between these two parameters has been reported.
Design And Methods:
Within the frame of a prospective population study conducted in the area of Cremona (Lombardy, Italy), 343 women and 216 men aged > or =65 years were evaluated for clinical and biochemical cardiovascular risk factors. Lp(a) levels > or =30 mg/dL were observed in 22.7% and 23.9% of men and women, respectively. Fibrinogen levels were higher in women (p<0.0001). After a median follow-up of 6.3 years 107 deaths were recorded, of which 33 were due to CHD or ischemic stroke.
Results:
The combined incidence rate of CHD and stroke mortality increased from 10.8 (per 1000 person-years) for subjects with either Lp(a) > or =30 mg/dL or fibrinogen within the 5th quintile of the gender-specific distribution to 38.4 for subjects with both Lp(a) > or =30 mg/dL and fibrinogen within the 5th quintile. Age (p<0.0001), insulin (p<0.0002) and the combination of high Lp(a) and fibrinogen (hazard ratio=3.11, p=0.014), but not fibrinogen or Lp(a) levels in isolation, were independent predictors of CHD and stroke mortality. In a subgroup of 447 subjects in whom C-reactive protein (CRP) was measured, CRP levels were not predictive of combined CHD and stroke mortality.
Interpretations And Conclusions:
Based on these results obtained in a relatively small population of elderly subjects, the association of high Lp(a) and fibrinogen levels appears to carry an increased risk of pooled CHD and stroke mortality.
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