SERUM LIPOPROTEIN(A) AND CORONARY-ARTERY DISEASE IN UREMIC PATIENTS ON CHRONIC-HEMODIALYSIS

There is convincing clinical and experimental evidence to support the notion that lipoprotein(a) [Lp(a)] is atherogenic. Patients undergoing chronic hemodialysis have an increased risk of atherosclerotic cardio vascular complications. In the present study, we investigated the poss ible relation between the alteration, if any, in serum Lp(a) and coron ary artery disease in such patients. The mean serum concentration of L p(a) tended to be higher in the 64 hemodialysis patients than in the 3 0 normal controls (15.1 +/- 15.2 vs. 9.7 +/- 10.4 mg/dl). However the difference did not reach statistical significance. The prevalence of l evels above 30 mg/dl was 14% (9/64) and 10% (3/10), respectively, and the difference was also not statistically significant. Eleven hemodial ysis patients with coronary artery disease had a significantly higher mean serum concentration of Lp(a) than the unaffected 53 (33.7 +/- 18. 4 vs. 11.1 +/- 11.2 mg/dl, p < 0.001). Elevated levels were present in 63.6% (7111) and 3.8% (2/53), respectively (p < 0.01). Other paramete rs of lipid metabolism were not different between the two groups. We o bserved statistically significant positive correlations of Lp(a) to to tal cholesterol, LDL cholesterol and apolipoprotein B in controls, in hemodialysis patients as a whole and in those without coronary artery disease. No such correlations were obtained when hemodialysis patients with coronary artery disease were analysed separately. It is conclude d that firstly, high serum levels of Lp(a) in hemodialysis patients ar e strongly associated with coronary artery disease, as well as in the general population; and secondly, abnormalities in the metabolism of L p(a) may underlie atherogenesis in these patients, independently of al terations in other lipid constituents