ASSOCIATION BETWEEN LIPOPROTEIN(A) AND PROGRESSION OF CORONARY-ARTERYDISEASE IN MIDDLE-AGED MEN

The association between lipoprotein(a) (Lp[a]) and progression of coro nary artery disease (CAD) compared with other serum lipids was evaluat ed in 104 patients with angiographically proven coronary atheroscleros is. Patients were randomized to either an intervention or a control gr oup. The 12-month intervention program consisted of a low fat diet and daily physical exercise. Patients in the control group received ''usu al care'' by their private physician. Eighty-three patients (36 in the intervention and 47 in the control group) underwent repeat angiograph y after 1 year. Angiographically documented net regression was seen in 13 patients (8 in the intervention and 5 in the control group), no ch ange was seen in 40 patients (21 in the intervention and 19 in the con trol group) and progression was noted in 30 patients (7 in the interve ntion and 23 in the control group). No correlation could be shown betw een Lp(a) and angiographically documented progression of the disease. In a multivariate analysis including metabolic variables, group assign ment, age and smoking habits, only assignment to the intervention grou p, (p = 0.0075) and a decrease in total cholesterol (p = 0.0167) were independently associated with the course of the disease. Patients with or without previous myocardial infarction (70 vs 34) did not differ i n Lp(a) levels (median 9.15 vs 14.25 mg/dl). Patients with Lp(a) >25 m g/dl were younger than patients with Lp(a) less than or equal to 25 mg /dl (52 vs 55 years; p <0.03), indicating a connection between Lp(a) a nd the development of premature CAD. It is concluded that Lp(a) levels in middle-aged Caucasian men with CAD but without prominent primary o r secondary hyperlipidemia due to other than alimentary causes have no association with progression of the disease, even though high Lp(a) l evels might have contributed to the early development of the disease.