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Association of lipoprotein(a) with atherothrombotic events and fibrinolytic variables. A case-control study
G Franceschini1, E Cofrancesco, O Safa
1E. Grossi Paoletti Center, Institute of Pharmacological Sciences, University of Milan, Italy.
Insights
Elevated lipoprotein(a) [Lp(a)] levels did not predict future ischemic events in patients with established atherosclerosis. However, Lp(a) correlated with fibrinolytic activity, suggesting a role in the coagulation process.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Clinical Research
Background:
- Elevated lipoprotein(a) [Lp(a)] is linked to increased cardiovascular disease risk.
- The predictive value of Lp(a) for ischemic events in established atherosclerosis requires further investigation.
Purpose of the Study:
- To examine the association between Lp(a) levels and subsequent ischemic events.
- To investigate the relationship between Lp(a) and fibrinolytic variables in patients with established atherosclerotic disease.
Main Methods:
- Prospective study (PLAT study) comparing 37 patients with subsequent atherothrombotic events (cases) to matched controls.
- Analysis of plasma Lp(a) levels and fibrinolytic variables, including tissue plasminogen activator (t-PA) antigen and activity, before and after venous stasis.
Main Results:
- Median and mean Lp(a) levels were similar between cases and controls.
- Plasma Lp(a) levels showed a significant correlation with increased t-PA antigen and fibrinolytic activity induced by venous stasis.
- No significant correlation was found between Lp(a) and baseline fibrinolytic variables.
Conclusions:
- Lipoprotein(a) may influence the in vivo fibrinolytic process in patients with established atherosclerotic disease.
- Plasma Lp(a) levels are not predictive of subsequent ischemic events in this patient population.
Abstract:
Elevated plasma levels of lipoprotein(a) [Lp(a)] have been associated with an increased risk of cardiovascular disease. The aim of the present study was to investigate whether Lp(a) plasma levels were associated with subsequent ischemic events and with fibrinolytic variables in patients with established atherosclerotic disease enrolled in the prospective PLAT study. Lp(a) levels and fibrinolytic variables in 37 atherosclerotic patients who subsequently developed an atherothrombotic event during the first year of follow-up (cases) were compared with those in paired controls, matched for age, sex, diagnosis at enrollment and lipid pattern, who remained free from vascular events during the same time frame. Median and mean Lp(a) levels were similar in cases (6.05 mg/dl; 13.8 +/- 19.4 mg/dl) and controls (6.05 mg/dl; 17.1 +/- 21.6 mg/dl). In the whole group plasma Lp(a) levels correlated significantly with the increase of t-PA antigen (r = 0.368; p = 0.002) and fibrinolytic activity (r = 0.410; p = 0.001) induced by venous stasis but not with baseline fibrinolytic variables. These findings indicate that in patients with established atherosclerotic disease Lp(a) may interfere in vivo with the fibrinolytic process but is not predictive of subsequent ischemic events.
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