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Elevated lipoprotein(a) and familial hypercholesterolemia in the coronary care unit: Between Scylla and Charybdis

Katrina L Ellis1,2, Jing Pang1, David Chieng3

  • 1School of Medicine, University of Western Australia, Perth, Australia.

Clinical Cardiology
|February 27, 2018
PubMed

Insights

Elevated lipoprotein(a) (Lp[a]) and familial hypercholesterolemia (FH) are common in coronary care unit patients and increase premature coronary artery disease (CAD) risk, especially when combined.

Area of Science:

  • Cardiology
  • Genetics
  • Lipidology

Background:

  • Familial hypercholesterolemia (FH) and elevated lipoprotein(a) (Lp[a]) are inherited lipid disorders.
  • Their prevalence, co-occurrence, and association with premature coronary artery disease (CAD) in coronary care unit (CCU) patients require definition.

Purpose of the Study:

  • To determine the frequencies of elevated Lp(a) and FH in CCU patients.
  • To investigate their independent and combined associations with premature CAD.

Main Methods:

  • Measured plasma Lp(a) and LDL-C in consecutive CCU patients with acute coronary syndrome or prior CAD.
  • Defined elevated Lp(a) as ≥0.5 g/L and FH phenotype as LDL-C ≥5 mmol/L.
  • Used logistic regression to assess the relationship with premature CAD (age <60 years).

Main Results:

  • Elevated Lp(a) and FH were found in 27.0% and 11.6% of 316 patients, respectively.
  • Both conditions were more frequent in patients with premature CAD (32.0% and 15.5%) compared to others.
  • Elevated Lp(a) alone, FH alone, and their combination increased premature CAD risk by 1.9, 3.2, and 5.3-fold, respectively.

Conclusions:

  • Elevated Lp(a) and FH are common in CCU patients and associated with premature CAD.
  • The combination of elevated Lp(a) and FH significantly elevates CAD risk.
  • Routine screening for elevated Lp(a) and FH is recommended for CCU patients.
Abstract

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