The association of lipoprotein(a) and apolipoprotein(a) phenotypes with peripheral artery disease


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Abstract

Aim. Lipoprotein(a) [Lp(a)] is an independent risk factor of coronary heart disease (CHD) and myocardial infarction. Data about the role of Lp(a) in the development of peripheral artery disease (PAD) is controversial and uncertain. The aim of the study was to evaluate the association between Lp(a), apolipoprotein(a) [apo(a)] phenotypes and PAD. Materials and methods. The study included 998 patients (707 male and 291 female, average age 60±12). The patients were divided into 4 groups depending on the presence or absence PAD and CHD: group I (n=188, PAD+CHD+), group II (n=78, PAD+CHD-), group III (n=407, PAD-CHD+), group IV (n=325, PAD-CHD-). Results. The level of Lp(a) was significantly higher in groups I, II, III in comparison with patients of control group (group IV): 34 [15; 80], 30 [10; 49], 22 [8; 60] mg/dl vs. 15 [6; 35] mg/dl respectively, p<0.01 in all cases. Lp(a) level was higher in the group I than in the other groups (p<0.05). The prevalence of elevated Lp(a) level (≥ 30 mg/dl) was significantly higher in groups I, II, III than in control group: 54%, 50%, 43% respectively vs. 30%, p<0.01 in all cases. The prevalence of Lp(a) ≥ 30 mg/dl was more frequent in the group with PAD and CHD than in the group with CHD and without PAD (p=0.02). The odds ratio (OR) of PAD in the presence of elevated Lp(a) level was 1.9 (95%CI, 1.4-2.5, p<0.01). Low molecular weight (LMW) apo(a) phenotype was met more frequently in groups I, II, III compared to group IV: 46%, 56%, 52% respectively vs. 28%, p<0.01. LMW apo(a) in the patients without CHD was associated with PAD (OR 3.3; 95% CI, 1.6-6.8, p<0.01), and there was no association with the patients with CHD. In logistic regression analysis adjusted for age, sex, hypertension, obesity, smoking, diabetes, LDL-C, Lp(a) and LMW apo(a) phenotype were independent predictors of PAD when included separately. Conclusions. Elevated level of Lp(a) and LMW apo(a) phenotype are independent risk factors of PAD. The level of Lp(a) in the patients with PAD and CHD was higher than in the case of isolated lesion of each vascular pool. Higher level of Lp(a) is associated with more severe atherosclerosis involving more than one vascular pools.

About the authors

N A Tmoyan

A.L. Myasnikov Institute of Clinical Cardiology FSBI "National Medical Research Center of Cardiology" of MoH of Russia

Email: ntmoyan@gmail.com
аспирант отд. проблем атеросклероза Moscow, Russia

M V Ezhov

A.L. Myasnikov Institute of Clinical Cardiology FSBI "National Medical Research Center of Cardiology" of MoH of Russia

д.м.н., в.н.с. отд. проблем атеросклероза Moscow, Russia

O I Afanasieva

Institute of Experimental Cardiology FSBI "National Medical Research Center of Cardiology" of MoH of Russia

д.м.н., в.н.с. лаб. проблем атеросклероза Moscow, Russia

E A Klesareva

Institute of Experimental Cardiology FSBI "National Medical Research Center of Cardiology" of MoH of Russia

к.т.н., н.с. лаб. проблем атеросклероза Moscow, Russia

O A Razova

Institute of Experimental Cardiology FSBI "National Medical Research Center of Cardiology" of MoH of Russia

н.с. лаб. проблем атеросклероза Moscow, Russia

V V Kukharchuk

A.L. Myasnikov Institute of Clinical Cardiology FSBI "National Medical Research Center of Cardiology" of MoH of Russia

д.м.н., проф., член-корр. РАН, руководитель отд. проблем атеросклероза Moscow, Russia

S N Pokrovsky

Institute of Experimental Cardiology FSBI "National Medical Research Center of Cardiology" of MoH of Russia

д.м.н., проф., руководитель лаб. проблем атеросклероза Moscow, Russia

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