Serum lipids, lipoprotein(a) level, and apolipoprotein(a) isoforms as prognostic markers in patients with coronary heart disease

Abstract

Abstract. Lundstam ULF, Herlitz J, Karlsson T, Linde Ân T, Wiklund O (Sahlgrenska University Hospital, Go Èteborg University, Go Èteborg; Sweden) Serum lipids, lipoprotein(a) level, and apolipoprotein(a) isoforms as prognostic markers in patients with coronary heart disease. J Intern Med 2002; 251: 111±118.Objective. Our objective was to study prognostic factors for death in patients with coronary heart disease (CHD), focusing on serum lipids and lipoproteins. Design and subjects. The study subjects were 964 patients with angina pectoris who underwent coronary angiography between 1985 and 1987. Follow-up, including survival and cause of death, was carried out in April 1998. Results. A total of 363 patients died. Increasing age, diabetes and low levels of HDL cholesterol and of apolipoprotein (apo) AI were associated with increased risk of total mortality and cardiac mortality. In men, low levels of LDL cholesterol and of apoB were associated with increased risk of death, but not of cardiac death only; high levels of lipoprotein(a) [Lp(a)] were not associated with increased risk. In women, however, there was a trend towards increased risk with increasing Lp(a) levels (P 0.054); the smallest isoform of apo(a) was associated with a twofold increase in risk. In women, but not in men, risk decreased with increasing molecular weight of the apo(a) isoforms. Conclusions. Amongst lipoprotein variables, low levels of HDL cholesterol and of apoAI and the presence of low-molecular weight isoforms of apo(a) are associated with increased risk of death in patients with CHD. Apo(a) isoforms and Lp(a) levels seem to be more important as risk factors amongst women. Low LDL cholesterol and apoB levels were associated with increased risk, but only in men. These ®ndings demonstrate the importance of a gender-speci®c analysis of risk factors for CHD.

Prognostic value of lipoproteins and their relation to inflammatory markers among patients with coronary artery disease

“…This is in accordance with data from the ECAT and other trials [40,[43][44][45][46][47]. However, other studies showed partly conflicting results [41,[48][49][50][51]. Our data support the concept that CAD risk management cannot simplified to LDL-C reduction [52].…”

Apolipoprotein(a) Size and Lipoprotein(a) Concentration and Future Risk of Angina Pectoris with Evidence of Severe Coronary Atherosclerosis in Men: The Physicians’ Health Study

“…However, for early stages of atherosclerosis, Lp(a) concentrations but not apo(a) isoforms were found to be predictive (4 ). Using multiple regression analysis, some studies found that apo(a) size was more important than Lp(a) concentrations (13 ), whereas others found that only Lp(a) concentrations were predictive (3, 11, 14 -18 ). We found that small apo(a) size is an independent predictor of angina regardless of Lp(a) concentration and that no additivity or synergism was present.…”

“…However, discordant results have been reported concerning the contribution of apo(a) size to CHD risk independent of Lp(a) concentrations (3,4,(11)(12)(13)(14)(15)(16)(17)(18). Substantial methodologic variation in determining Lp(a) concentrations and apo(a) size may explain the difference in findings.…”

Lipoprotein(a) levels, apo(a) isoform size, and coronary heart disease risk in the Framingham Offspring Study

“…Previous studies have examined the role of apo(a) isoform size on CHD prediction (24)(25)(26)(27)(28)(29)(30), and some of these studies have attempted to separate the prediction relative to isoform size from that of plasma levels of Lp(a). In a small case-control study, Kraft et al ( 26 ) have reported that both Lp(a) levels and isoform size were associated with CHD, but when both variables were entered in the multivariate model, the strength of the association was higher for apo(a) isoform size.…”