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Differences in lipoprotein (a) and apolipoprotein (a) levels in men and women with advanced coronary atherosclerosis
G M Stiel1, T Reblin, M Bührlen
1Division of Cardiology, University Hospital Eppendorf, Hamburg, Germany.
Insights
Women with advanced coronary artery disease have significantly higher lipoprotein (a) [Lp(a)] and apolipoprotein (a) [Apo(a)] levels than men. These findings suggest Lp(a) may be an independent risk factor for coronary artery disease in postmenopausal women.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Genetics
Background:
- Investigating sex-based differences in lipoprotein (a) [Lp(a)] and apolipoprotein (a) [Apo(a)] in advanced coronary artery disease (CAD).
- Understanding the role of Lp(a) and Apo(a) in CAD pathogenesis.
- Evaluating potential sex-specific risk factors in cardiovascular disease.
Purpose of the Study:
- To determine if significant sex-based disparities exist in serum Lp(a) and arterial wall Apo(a) levels among patients with severe CAD.
- To compare Lp(a) and Apo(a) levels between men and women with comparable CAD severity.
Main Methods:
- Serum Lp(a) and aortic biopsy Apo(a) concentrations were measured in 76 men and 20 women undergoing coronary artery bypass graft (CABG) surgery.
- Coronary artery disease severity was quantified using a coronary atherosclerosis score derived from quantitative coronary angiography.
Main Results:
- Serum Lp(a) and tissue Apo(a) did not correlate with coronary atherosclerosis score (r=0.09 and r=0.14).
- Women were older (65 vs 57 years) and exhibited higher mean serum Lp(a) (47 vs 32 mg/dl) and Apo(a) (33 vs 19 µg/g) levels than men (P<0.05).
- Despite similar CAD severity scores, women had 1.5x higher Lp(a) and 1.75x higher Apo(a) levels than men.
Conclusions:
- Men and women had comparable CAD severity, but women presented with significantly higher Lp(a) and Apo(a) levels.
- Higher serum Lp(a) levels (>25 mg/dl) were observed in 60% of women versus 39% of men.
- Elevated Lp(a) may represent an independent risk factor for CAD, particularly in postmenopausal women.
Background:
This study was designed to evaluate whether differences between sexes exist in serum-lipoprotein (a) [Lp(a)] and arterial-wall-apolipoprotein (a) [Apo(a)] levels in patients with advanced coronary artery disease.
Methods:
The concentrations of Lp(a) in serum and Apo(a) in aortic biopsies were studied in 76 men and 20 women undergoing coronary artery bypass graft surgery. The severity of coronary artery disease was determined by a coronary atherosclerosis score that used quantitative coronary angiography.
Results:
Serum-Lp(a) and tissue-Apo(a) do not correlate with the severity of coronary artery disease as expressed by the coronary atherosclerosis score (r = 0.09 and r = 0.14, respectively). Women were older (65 +/- 8 versus 57 +/- 8 years, P < 0.001) and had higher mean Lp(a) and higher mean Apo(a) levels (47 +/- 41 versus 32 +/- 40 mg/dl and 33 +/- 34 versus 19 +/- 24 micrograms/g wet weight, P < 0.05) than men with identical coronary atherosclerosis score (35 +/- 8 versus 33 +/- 8, P > 0.05). The serum levels of cholesterol, triglycerides, and high-density lipoprotein were similar in both groups.
Conclusions:
Men and women undergoing coronary artery bypass graft surgery had very similar severity of coronary artery disease as expressed by the coronary atherosclerosis score. Women were 8 years older and had 1.5 times higher mean serum-Lp(a) levels and 1.75 times higher mean tissue Apo(a) levels higher than the men. Sixty per cent of the women but only 39% of the men had serum Lp(a) levels higher than 25 mg/dl. Lp(a) level seems to be an additional risk factor for coronary artery disease confined to postmenopausal women.