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.