ASSOCIATION OF LIPOPROTEIN(A) LEVELS AND APOLIPOPROTEIN(A) PHENOTYPESWITH CORONARY HEART-DISEASE IN PATIENTS WITH ESSENTIAL-HYPERTENSION

Background Besides hypertension, several cardiovascular risk factors c an play a role in the development of coronary heart disease (CHD) in h ypertensive patients. Lipoprotein(a) [Lp(a)] is an important and indep endent cardiovascular risk factor, but its role in the development of CHD in hypertensives has not been studied. Objective To investigate wh ether or not Lp(a) levels and isoforms of apolipoprotein(a) [apo(a)] a re predictors of CHD in patients with essential hypertension. Methods Lp(a) levels and apo(a) polymorphism were evaluated in 249 patients wi th essential hypertension, in 142 non-hypertensive patients with CHD a nd in 264 healthy controls. Results Hypertensives with CHD (n = 61) ha d Lp(a) levels [19 (range 0.5-73.5) versus 7 mg/dl (range 0-83.5), P < 0.001] and a percentage of apo(a) isoforms of low (< 655 kDa) relativ e molecular mass (RMM, 59.2 versus 25.9%, P < 0.001) higher than did t hose without CHD (n = 188). Moreover, there were more subjects with at least one apo(a) isoform of low RMM in the subgroup of patients with CHD than there were in that of those without CHD (80.3 versus 30.8%, P < 0.001), Lp(a) levels and apo(a) polymorphism did not differ signifi cantly between hypertensive and non-hypertensive patients with CHD, St epwise regression analysis indicated that high Lp(a) levels (P = 0.002 073) and particularly the presence of at least one apo(a) isoform of l ow RMM (P < 0.000001) are strong predictors of CHD in hypertensive pat ients. Conclusions Our data show that high Lp(a) levels and the presen ce of at least one apo(a) isoform of low RMM are strong and independen t genetic risk factors for CHD in hypertensive patients. These finding s suggest that Lp(a) and apo(a) isoforms should be assessed together w ith other cardiovascular risk factors to establish the overall CHD ris k status of each hypertensive patient.