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[Lipoprotein (a), apolipoproteins and the lipid profile late after heart transplantation]
R Maranhão1, R D Santos, C Furlaneto
1Instituto do Coração do Hospital das Clínicas, FMUSP.
Insights
Lipoprotein (a) [Lp(a)] levels are elevated in heart transplant (HT) patients and may indicate graft vascular disease (GVD). Lipid profiles did not differentiate GVD patients from non-GVD patients after HT.
Area of Science:
- Cardiology
- Transplantation Medicine
- Vascular Biology
Background:
- Heart transplantation (HT) is a life-saving procedure, but graft vascular disease (GVD) remains a significant complication.
- Lipid profiles, including lipoprotein (a) [Lp(a)] and apolipoproteins (apo) A1 and B, are crucial markers in cardiovascular health.
- Understanding lipid alterations post-HT is vital for managing GVD risk.
Purpose of the Study:
- To investigate differences in Lp(a), apo A1, apo B, and overall lipid profiles (LP) between heart transplant (HT) patients with and without coronary artery disease (CAD).
- To determine if LP can discriminate between HT patients with and without graft vascular disease (GVD).
Main Methods:
- A comparative study involving 170 patients divided into three groups: HT patients (n=43), patients with established CAD (n=72), and a normal (NL) control group (n=45).
- HT patients were further analyzed for GVD (n=9) versus non-GVD (NGVD) (n=19) based on serial angiography.
- Levels of Lp(a), apo A1, apo B, and comprehensive lipid profiles were measured and compared across groups.
Main Results:
- Heart transplant patients exhibited significantly higher apo A1 levels compared to both CAD and NL groups.
- Coronary artery disease patients showed higher apo B levels than HT and NL groups.
- A significant trend towards higher Lp(a) levels was observed in HT and CAD groups compared to the NL group, with HT and CAD individually showing higher Lp(a) than NL.
- Lipid profiles did not differ significantly between HT patients with GVD and those without GVD.
Conclusions:
- Elevated Lp(a) levels post-heart transplantation may be associated with the high incidence of GVD.
- The overall lipid profile was not effective in distinguishing between patients with and without GVD after heart transplantation.
Abstract:
PURPOSE--To evaluate if the levels of lipoprotein (a) [Lp(a)], apolipoproteins (apo) A1, B and the lipid profile (LP) differ among heart transplantation (HT) patients, with coronary artery disease (CAD) and patients without CAD (NL) and if LP discriminates patients with graft vascular disease (GVD). METHODS--A hundred and seventy patients separated in 3 groups: I) HT [n = 43 46 +/- 15 years, 24 months (median) after transplantation], of these 28 were submitted to serial angiography after the first year of transplantation subgroups with GVD (n = 9) and without GVD (NGVD) (n = 19); II) CAD (n = 72, 48 +/- 6 years); III) NL (n = 45, 50 +/- 6 years). RESULTS--HT presented higher apo A1 levels than CAD and NL (1.5 +/- 0.5 vs 1.2 +/- 0.05 vs 1.1 +/- 0.06 g/l p < 0.05 respectively). Apo B was higher on CAD than in HT and NL (1.5 +/- 0.05 vs 1.2 +/- 0.07 vs 1.3 +/- 0.09 g/l p < 0.05). Lp (a) presented a trend to higher levels in HT and CAD than in NL [25(2-97), 24(1-130) and 15 (1-100) mg/dl, p = 0.05)]. However, when individually evaluated against NL Lp(a) levels were higher in HT and CAD (p = 0.019 and 0.03 respectively). LP did not differ between GVD and NGVD. CONCLUSION--Increased Lp(a) levels after transplantation might be related to the high prevalence of GVD. The LP did not discriminate GVD.