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Apolipoprotein(a) phenotypes as genetic markers of coronary atherosclerosis severity
C Gazzaruso1, D Geroldi, A Garzaniti
1Department of Internal Medicine and Medical Therapeutics, IRCCS Policlinico San Matteo, University of Pavia, Italy.
Insights
Low molecular weight apolipoprotein(a) isoforms are linked to more severe coronary artery disease. These findings suggest apolipoprotein(a) phenotypes may serve as genetic markers for coronary atherosclerosis severity.
Area of Science:
- Cardiovascular Medicine
- Genetics
- Biochemistry
Background:
- Coronary artery disease (CAD) severity is a critical factor in patient outcomes.
- Lp(a) levels and apolipoprotein(a) (apo(a)) polymorphism are implicated in atherosclerosis.
- Understanding genetic markers for CAD severity is crucial for risk stratification.
Purpose of the Study:
- To investigate the relationship between Lp(a) levels, apo(a) polymorphism, and the severity of coronary artery disease.
- To determine if specific apo(a) isoforms predict the extent of coronary atherosclerosis.
Main Methods:
- Analyzed Lp(a) levels and apo(a) isoforms in 267 CAD patients using high-resolution phenotyping.
- Assessed CAD severity by coronary angiography (number of stenosed vessels) and three scoring systems (Gensini, Green Lane, Dahlen).
- Utilized multivariate analysis to identify predictors of atherosclerosis severity.
Main Results:
- No significant differences in Lp(a) levels were observed among patient subgroups.
- A higher percentage of low molecular weight apo(a) isoforms (<655 kDa) strongly correlated with increased coronary vessel stenosis.
- Low molecular weight apo(a) isoforms were independent predictors of coronary atherosclerosis severity across different assessment methods.
Conclusions:
- Low molecular weight apo(a) isoforms are significantly associated with greater severity of coronary atherosclerosis.
- Apo(a) phenotypes, particularly low molecular weight isoforms, may serve as valuable genetic markers for predicting CAD severity.
- Prospective studies are warranted to confirm these findings and their clinical utility.
Abstract:
We investigated Lp(a) levels and apo(a) polymorphism in relation to the severity of coronary artery disease, expressed both by the number of coronary arteries stenosed and three different coronary scoring systems. In a sample of 267 patients with coronary artery disease, a Mono-, Bi- or Multi-vessel coronary stenosis was documented by angiography. Twenty-five apo(a) isoforms were detected by a high resolution phenotyping method. Lp(a) levels did not show any differences among subgroups of patients. Both the percentage of apo(a) isoforms of low molecular weight (<655 kDa) (P=0.00015) and the percentage of subjects with at least one apo(a) isoform of low molecular weight (P=0.00027) were significantly correlated with increasing number of coronary vessels stenosed. In multivariate analysis, only apo(a) isoforms of low molecular weight were predictors of coronary atherosclerosis severity, when we used as the dependent variable both the '1-2-multi-vessels' categorization (P=0.000067) and the Gensini (P=0.008767), or Green Lane (P= 0.000001) or Dahlen (P=0.000102) coronary scoring system. Our data show that apo(a) isoforms of low molecular weight are associated with a greater severity of coronary atherosclerosis. If these data are confirmed by prospective studies, apo(a) phenotypes might be used as genetic markers of a greater severity of coronary atherosclerotic lesions.