APOLIPOPROTEIN(A) PHENOTYPES AS GENETIC-MARKERS OF CORONARY ATHEROSCLEROSIS SEVERITY

We investigated Lp(a) levels and apo(a) polymorphism in relation to th e severity of coronary artery disease, expressed both by the number of coronary arteries stenosed and three different coronary scoring syste ms. In a sample of 267 patients with coronary artery disease, a Mono-, Bi- or Multi-vessel coronary stenosis was documented by angiography. Twenty-five apo(a) isoforms were detected by a high resolution phenoty ping method. Lp(a) levels did not show any differences among subgroups of patients. Both the percentage of apo(a) isoforms of low molecular weight (<655 kDa) (P=0.00015) and the percentage of subjects with at l east one apo(a) isoform of low molecular weight (P=0.00027) were signi ficantly correlated with increasing number of coronary vessels stenose d. In multivariate analysis, only apo(a) isoforms of low molecular wei ght were predictors of coronary atherosclerosis severity, when we used as the dependent variable both the '1-2-multi-vessels' categorization (P=0.000067) and the Gensini (P=0.008767), or Green Lane (P=0.000001) or Dahlen (P=0.000102) coronary scoring system. Our data show that ap o(a) isoforms of low molecular weight are associated with a greater se verity of coronary atherosclerosis. If these data are confirmed by pro spective studies, apo(a) phenotypes might be used as genetic markers o f a greater severity of coronary atherosclerotic lesions. (C) 1998 Els evier Science Ireland Ltd.