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Lipoprotein(a) as a determinant of the severity of angiographically defined carotid atherosclerosis
G F Watts1, J C Mazurkiewicz, K Tonge
1University Department of Medicine, University of Western Australia, Royal Perth Hospital.
Insights
Elevated lipoprotein(a) [Lp(a)] levels are linked to more severe carotid artery disease in patients experiencing transient ischemic attacks. This finding suggests Lp(a) may help identify individuals at higher stroke risk.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Biochemistry
Background:
- Transient ischemic attacks (TIAs) are often linked to atherosclerosis.
- Cerebrovascular disease severity assessment is crucial for stroke risk stratification.
- Lipid profiles are known risk factors for cardiovascular events.
Purpose of the Study:
- To investigate the relationship between serum lipids, lipoproteins, apolipoproteins, and lipoprotein(a) [Lp(a)] with the severity of extracranial cerebrovascular disease in TIA patients.
- To determine if Lp(a) is an independent predictor of carotid artery disease severity.
Main Methods:
- Fasting serum lipids, lipoproteins, apolipoproteins, and Lp(a) were measured in 49 Caucasian patients with TIAs.
- Carotid angiography was performed to assess extracranial cerebrovascular disease severity using a validated grading system.
- Regression analysis was used to identify associations between lipoprotein-related variables and disease severity, adjusting for confounding factors.
Main Results:
- Patients with TIAs had significantly higher total cholesterol, apolipoprotein B, triglycerides, and Lp(a) compared to a healthy reference group.
- Serum Lp(a) concentration was the only lipoprotein-related variable significantly associated with carotid artery disease severity.
- This association remained significant after adjusting for age, sex, blood pressure, and stroke history. Patients with higher Lp(a) had more severe carotid atherosclerosis.
Conclusions:
- Elevated serum Lp(a) is a significant determinant of the extent of carotid atherosclerosis.
- Lp(a) may serve as a valuable biomarker for identifying patients at increased risk of stroke.
- Further research into the role of Lp(a) in cerebrovascular disease is warranted.
Abstract:
We measured fasting serum lipids, lipoproteins, apolipoproteins and lipoprotein(a) [Lp(a)] in 49 Caucasian patients with transient ischaemic attacks undergoing carotid angiography. The severity of extracranial cerebrovascular disease was assessed visually by a highly reproducible grading system that focused on the internal carotid artery and carotid bifurcation. Compared with a healthy reference group, patients had significantly higher serum concentrations of: total cholesterol (mean +/- SD), 6.2 +/- 1.6 vs. 5.6 +/- 1.0 mmol/l, p = 0.02; apolipoprotein B, 1.4 +/- 0.5 vs. 1.2 +/- 0.3 g/l, p = 0.03; triglyceride [geometric mean(95% CI)], 2.02(1.75-2.32) vs. 1.66(0.67-4.06) mmol/l, p = 0.03; and Lp(a), 0.33(0.26-0.42) vs. 0.17(0.40-0.76) g/l, p < 0.001. Regression analysis showed that of the lipoprotein-related variables, only Lp(a) was significantly related to the severity of carotid artery disease (p = 0.04) in the patients; this association remained significant after adjusting for age, sex, blood pressure, and a history of stroke. Serum Lp(a) concentration was significantly higher in patients with carotid artery disease severity score above the median value of the sample population compared with those below the median: 0.45 vs. 0.24 g/l (95% CI for difference 0.35-0.88), p = 0.01. Elevated serum Lp(a) is a significant determinant of the extent of carotid atherosclerosis and may be useful in identifying patients most at risk of stroke.