RELATION OF LIPOPROTEIN(A) TO CORONARY HEART-DISEASE AND DUPLEX SONOGRAPHIC FINDINGS OF THE CAROTID ARTERIES IN HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA

In familial hypercholesterolemia (FH) elevated Lp(a) concentrations ar e more frequent than in the general Caucasian population, but the clin ical relevance of Lp(a) as a risk-factor in this group of patients is controversial. In 91 adult patients with heterozygous FH due to LDL-re ceptor defect we analyzed the correlation between Lp(a) concentrations , presence of coronary heart disease (CHD) and degree of atheroscleros is of the carotid arteries assessed by duplex scan. Coronary heart dis ease was present in 32 patients (24 males, 8 females). In the group wi thout CHD the median of the Lp(a) distribution was 23 mg/dl, in the gr oup with CHD 43 mg/dl (P < 0.05). The median of Lp(a) was 8 mg/dl in p atients without pathological changes in the duplex scan of the carotid s, 13 mg/dl in the group with intimal thickening, 25 mg/dl in patients with non-obstructing plaques, and 45 mg/dl in presence of >30% lumina l obstruction (P < 0.01). The role of Lp(a) as an independent risk fac tor was analyzed by stepwise logistic regression together with age, se x, LDL-, HDL-cholesterol, serum triglycerides, smoking status and pres ence of hypertension. For the prediction of CHD only age, HDL choleste rol and gender reached statistical significance. Lp(a) was, however, t he lipoprotein parameter with the highest discriminative strength for the presence of a pathological duplex scan (P = 0.016), followed by LD L- (P = 0.03), and HDL-cholesterol (P = 0.03). These results provide d irect evidence for a close correlation between Lp(a) and the rate of p rogression of atherosclerosis in FH, already at early, asymtomatic sta ges.