LIPOPROTEIN(A) AND PERIPHERAL ATHEROSCLEROSIS IN OLDER ADULTS

As part of an ancillary study to the Systolic Hypertension in the Elde rly Program, carotid and lower extremity arterial disease (LEAD) were evaluated in 369 subjects, 186 with a systolic blood pressure (SBP) gr eater than or equal to 160 mmHg, and 183 with SBP < 160 mmHg. Both gro ups had a diastolic blood pressure (DBP) < 90 mmHg. Internal carotid s tenosis was identified by Doppler and LEAD was assessed using the ankl e to arm systolic blood pressure ratio, commonly called the ankle/arm index (AAI). Lp(a) values were obtained from frozen sera and values gr eater than or equal to 20 mg/dl were considered elevated. Rates of car otid stenosis were 24% among those with an Lp(a) greater than or equal to 20 mg/dl and 14% among those with an Lp(a) level < 20 mg/dl (P = 0 .020). The relationship between Lp(a) and LEAD was even stronger. Thos e with an Lp(a) greater than or equal to 20 mg/dl had a 36% prevalence of a low AAI vs 14% among those with a Lp(a) level < 20 mg/dl (P < 0. 001). Lp(a) values were also associated with the severity of LEAD. Con trolling for other risk factors did not reduce the association between either LEAD or carotid stenosis and an Lp(a) greater than or equal to 20 mg/dl. Thus, Lp(a) appears to be independently associated with per ipheral atherosclerosis in older adults, both men and women. The relat ionship is particularly strong for atherosclerotic disease of the lowe r extremities.