Is Lipoprotein (a) a Risk Factor for Coronary Artery Ectasia?

Abstract

Background:The pathophysiology of coronary artery ectasia (CAE) is under investigated and not well understood. Atherosclerosis is considered as the main etiologic factor for CAE in adults where more than 50% of CAE patients have atherosclerosis. Recently, lipoprotein (a) (Lp(a)) has emerged as a powerful risk factor for atherosclerosis and coronary artery disease (CAD). Serum levels of Lp(a) in patients with CAE have not been investigated. We assumed that Lp(a) may play a role in the pathogenesis of CAE. Principally, our study aims to identify whether Lp(a) is an independent risk factor for CAE. Methods:Our study is a prospective pilot study. Study population was collected prospectively from pool of patients referred for elective cardiac catheterization at Jordan University Hospital (JUH) in the period extending from February 17, 2018 to June 31, 2018. Patients were referred for elective coronary angiography after being interviewed and physically examined by a cardiologist (HA). Patients with known history of CAD or who are already on anti-lipidemic drugs either documented in the medical records or by interviewing patients for history of revascularization were excluded from the study. Results:Regarding the primary outcome, there was no significant difference in Lp(a) concentrations between normal and ectasia groups in the general sample (median: 17.5mg/dL vs. 20.4 mg/dL, P value = 0.38). Conclusions:Our study concludes that there is no detected relationship between elevated Lp(a) levels and developing CAE. CAE was more common in patients with low high-density lipoprotein (HDL) level (compared with patients with normal coronaries), higher total cholesterol level (compared with patients with non-obstructive stenosis) and higher hemoglobin A1c (HbA1c).

Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma

“…Moreover, given atherosclerosis as the most prevalent underlying condition, it is unknown whether aggressive lipid lowering therapies with PCSK-9 inhibitors might provide a prognostic benefit in CAE patients with ACS. Lipoprotein (a) [Lp(a)], despite being associated with aortic and cerebral aneurysms, has an unclear role in the pathogenesis of CAE (117)(118)(119). In consideration of the association between high Lp(a) levels and adverse cardiac events in patients with CAD, Lp(a) might be a useful predictor for the prognostic stratification of CAE (120)(121)(122).…”

A Jordanian Multidisciplinary Consensus Statement on the Management of Dyslipidemia

“…The calculation using the Friedewald formula is valid in cases where the TG concentration is below 400 mg/dL, and it becomes less precise when LDL-C levels are very low (below 50 mg/dL) [ 31 ]. Therefore, in patients with low LDL-C levels and/or hypertriglyceridemia (≤800 mg/dL), alternative formulas can be used or LDL-C levels can be directly measured [ 45 ].…”