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Prevalence of lipoprotein (a) [Lp(a)] excess in coronary artery disease
J Genest1, J L Jenner, J R McNamara
1Lipid Metabolism Laboratory, U.S.D.A. Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts 02111.
Insights
Elevated Lipoprotein (a) [Lp(a)] levels are common in patients with coronary artery disease (CAD) and are strongly heritable. This study found familial Lp(a) excess in 17% of CAD patients, highlighting its genetic role in cardiovascular risk.
Area of Science:
- Cardiovascular Medicine
- Genetics
- Lipidology
Background:
- Lipoprotein (a) [Lp(a)] is a lipoprotein particle linked to increased risk of coronary artery disease (CAD).
- Elevated Lp(a) levels are highly heritable, suggesting a significant genetic component in cardiovascular disease predisposition.
- The prevalence of familial Lp(a) excess in patients with established CAD requires further investigation.
Purpose of the Study:
- To determine the prevalence of familial excess of Lipoprotein (a) [Lp(a)] in patients diagnosed with coronary artery disease (CAD).
- To investigate the association between Lp(a) levels and cardiovascular risk factors in CAD patients and control subjects.
- To confirm the genetic determination of Lp(a) levels through family studies.
Main Methods:
- Plasma Lp(a) levels were measured in 180 patients with documented CAD (under age 60) and 459 disease-free control subjects.
- Lp(a) excess was defined as levels above the 90th percentile of control subjects.
- Family members of 102 CAD probands also underwent Lp(a) level assessment to evaluate heritability.
Main Results:
- Patients with CAD exhibited significantly higher Lp(a) levels compared to control subjects (19 ± 21 vs 13 ± 15 mg/dl, p < 0.001).
- A significant prevalence of Lp(a) excess (17%) was observed in the CAD patient group (p < 0.05).
- Lp(a) was identified as an independent risk factor for CAD in men, irrespective of traditional risk factors; family studies confirmed strong genetic determination of Lp(a) levels.
Conclusions:
- Familial excess of Lipoprotein (a) [Lp(a)] is prevalent in patients with coronary artery disease (CAD).
- Elevated Lp(a) levels represent a significant, genetically determined risk factor for CAD.
- These findings underscore the importance of assessing Lp(a) in the context of cardiovascular risk assessment and management.
Abstract:
Lipoprotein (a) [Lp(a)] is composed of 1 low-density lipoprotein (LDL) particle, to which 1 molecule of apolipoprotein (a) is covalently linked. Elevated levels of Lp(a) have been associated with coronary artery disease (CAD) and Lp(a) has been shown to be highly heritable. Our purpose was to determine the prevalence of familial Lp(a) excess in patients with CAD. We determined plasma levels of Lp(a) in 180 patients (150 men and 30 women) with angiographically documented CAD before age 60 years, and in 459 control subjects (276 men and 183 women) clinically free of cardiovascular disease. In addition, Lp(a) levels were determined in families of 102 of the CAD probands (87 men and 15 women). No gender differences in Lp(a) levels were observed between men and women (patients or control subjects). Patients with CAD had higher Lp(a) levels than did control subjects (19 +/- 21 vs 13 +/- 15 mg/dl, p less than 0.001). The prevalence of Lp(a) excess (defined as greater than 90th percentile of controls) was 17% in patients with CAD (p less than 0.05). Lp(a) levels were not correlated with cholesterol, LDL cholesterol, high-density lipoprotein (HDL) cholesterol or apolipoproteins A-I or B. There was a weak correlation between Lp(a) and triglycerides (r = 0.166, p less than 0.05) in patients and control subjects. Stepwise discriminant analysis revealed that Lp(a) was a risk factor for the presence of CAD in men, independent of smoking, hypertension, diabetes, LDL and HDL cholesterol, or apolipoprotein A-I and B levels. Family studies revealed that Lp(a) levels are strongly genetically determined.(ABSTRACT TRUNCATED AT 250 WORDS)