ELEVATED PLASMA LIPOPROTEIN(A) IS ASSOCIATED WITH CORONARY-ARTERY DISEASE IN PATIENTS WITH CHRONIC STABLE ANGINA-PECTORIS

Objectives. We sought to assess the relation between plasma lipoprotei n(a) [Lp(a)] levels, clinical variables and angiographic coronary arte ry disease (CAD) in patients with chronic stable angina. Background. T he relation between plasma Lp(a) levels and the severity and extent of angiographic CAD has not been studied in well characterized patients with stable angina pectoris, Methods. We investigated clinical variabl es, lipid variables and angiographic scores in 129 consecutive white p atients (43 women) undergoing coronary angiography for chronic stable angina. Results. Plasma Lp(a) levels were significantly higher in pati ents with than in those without significant angiographic stenoses (gre ater than or equal to 70%) (372 mg/liter [interquartile range 87 to 88 4] vs. 105 mg/liter [interquartile range 56 to 366], respectively, p = 0.002), This difference remained significant when patients with mild or severe angiographic disease were compared with those with completel y normal coronary arteries (312 mg/liter [interquartile range 64 to 86 4] vs. 116 mg/liter [interquartile range 63 to 366], respectively, p = 0.02), However, subset analysis indicated that this difference achiev ed statistical significance only in women. Multiple logistic regressio n analysis indicated that Lp(a) concentration was independently predic tive of significant angiographic stenoses (adjusted odds ratio [OR] 9. 1, 95% confidence interval [CI] 2.0 to 42.1, p = 0.006) and remained t rue even after exclusion of patients receiving lipid-lowering treatmen t (n = 27) (OR 10.4, 95% CI 1.1 to 102.9, p = 0.05), Lp(a) also had in dependent predictive value in a similar analysis using mild or severe angiographic disease as the outcome variable (OR 11.8, 95% CI 1.5 to 9 0.8, p = 0.02), Conclusions. Our results indicate that elevated plasma Lp(a) is an independent risk factor for angiographic CAD in chronic s table angina and may have particular significance in women.