F. Kronenberg et al., The low molecular weight apo(a) phenotype is an independent predictor for coronary artery disease in hemodialysis patients: A prospective follow-up, J AM S NEPH, 10(5), 1999, pp. 1027-1036
Patients with end-stage renal disease treated by hemodialysis have a tremen
dous risk for cardiovascular complications that cannot be explained by trad
itional atherosclerosis risk factors. Lipoprotein(a) (Lp(a)), a risk factor
for these complications in the general population, is significantly elevat
ed in these patients. In this study, it was determined whether Lp(a) and/or
the genetically determined apo(a) phenotype are risk predictors for the de
velopment of coronary artery disease in these patients. A cohort of 440 uns
elected hemodialysis patients were followed for a period of 5 yr independen
t of the cause of renal disease, duration of preceding treatment, and the p
reexistence of coronary artery disease at study entry. Coronary events defi
ned as definite myocardial infarction, percutaneous transluminal coronary a
ngioplasty, aortocoronary bypass, or a stenosis >50% in the coronary angiog
raphy were the main outcome measure. Sixty-six (15%) of the 440 patients su
ffered a coronary event during follow-up. In univariate analysis, patients
with events were significantly older and showed a trend to lower HDL choles
terol concentrations, and higher apolipoprotein B and Lp(a) concentrations
without reaching significance. Apo(a) phenotypes of low molecular weight, h
owever, were significantly more frequent in patients with compared to those
without events (43.9% versus 21.9%, P < 0.001). The other lipids, lipoprot
eins, and apolipoproteins were similar in both groups. Multiple Cox proport
ional hazards regression analysis found age and the apo(a) phenotype to be
the best predictors for coronary events during the observation period, inde
pendent of whether patients with a preexisting coronary artery disease or a
n age >65 yr at the study entry or both were excluded from the analysis. Di
abetes mellitus was a risk factor only in presence of a low molecular weigh
t apo(a) phenotype. The genetically determined apo(a) phenotype is a strong
and independent predictor for coronary events in hemodialysis patients. Ap
o(a) phenotyping might be helpful to identify hemodialysis patients at high
risk for coronary artery disease.