LP(A) AND PREMATURE MORTALITY DURING CHRONIC-HEMODIALYSIS TREATMENT

Lipoprotein(a) levels are approximately three to four times higher in patients with end-stage renal disease (ESRD) when compared to controls with normal renal function (H.J. Parra, H. Mezdour, C. Cachera et al. , Clin. Chem. 33 (1987), 721). Hypertriglyceridemia occurs in approxim ately 50% of ESRD patients receiving chronic hemodialysis (HD) treatme nt and has been associated with an increased prevalence of cardiovascu lar disease (CVD) in cross-sectional studies of this subset of ESRD pa tients. We recently reported that HD patients with pre-existing ischem ic or atherosclerotic CVD and patients with elevated Lp(a) levels had an increased risk of fatal and non-fatal clinical events attributable to CVD during a 48-month period of maintenance HD treatment. The curre nt report describes a detailed analysis of study participants who did or did not have a history of ischemic CVD or angiographically document ed severe atherosclerotic lesions prior to entry into our prospective study. Although baseline total cholesterol (TC), triglyceride (TG) and apoprotein B (apoB) levels were higher in the 36 participants with pr evalent CVD than the remaining 93 study participants, total cholestero l levels were somewhat lower, while serum triglyceride levels were no different in patients who survived or experienced fatal CVD events dur ing the period of observation on HD treatment. In contrast, Lp(a) leve ls were no different in participants with or without evidence of pre-e xisting CVD. Lp(a) was, however, an independent predictor of fatal eve nts attributable to cardiovascular disease during the period of follow -up.