LIPOPROTEIN(A), TISSUE-PLASMINOGEN ACTIVATOR AND PLASMINOGEN-ACTIVATOR INHIBITOR-1 LEVELS IN HYPERLIPIDEMIC PATIENTS IN KUWAIT

Plasma levels of lipoprotein(a) [Lp(a)], tissue plasminogen activator (tPA) and plasminogen activator inhibitor type 1 (PAT-1) were assessed in addition to anthropometry and levels of glucose, total cholesterol , triglycerides, high-density Lipoprotein (HDL), low-density lipoprote in (LDL) and apo A1 and B in 73 patients (36 men and 37 women) with pr imary hyperlipidaemia (group NDHL) in Kuwait. Lp(a) levels (212 mg L-1 , 8-600 mg L-1 median and range) were similar to those obtained in a m atched group of 32 non-insulin-dependent diabetes mellitus (NIDDM) pat ients with hyperlipidaemia (218 mg L-1, 50-610 mg L-1) and slightly hi gher, although not significantly so (P=0.06), than levels seen in 68 h ealthy normolipidaemic control subjects (182 mg L-1, 70-488 mg L-1). t PA levels (84 ng mL(-1), 3.8-18.4 ng mL(-1) median and range) in group NDHL were lower than In the diabetic group (11.4 ng mL(-1), 5.2-14.2 ng mL(-1)) but higher than in the healthy control subjects (7.4 ng mL( -1), 2.8-12.6 ng mL(-1)). PAI-1 levels in group NDHL (40.4 ng mL(-1), 8.6-55 ng mL(-1), median and range) were higher than in the control su bjects (32.5 ng mL(-1), 14.6-46.4 ng mL(-1)) but lower than in diabeti c patients (43.8 ng mL(-1), 15.6-55 ng mL(-1)). Hyperlipidaemia phenot ype (hypercholesterolaemia or hypertriglyceridaemia) did not influence tPA and PAI-1 levels, but Lp(a) levels were significantly lower with hypertriglyceridaemia. Gender, cigarette smoking and racial origin (Ku waitis, other Arabs or South Asians) did not affect Lp(a), tPA and PAT -1 levels, but tPA levels were higher in postmenopausal subjects. Low- density lipoprotein (LDL) levels (whether in total cholesterol or as a po B) correlated significantly (P < 0.05) with Lp(a) levels. tPA level s were correlated with age and the plasma levels of glucose and uric a cid (P < 0.05); this correlation with glucose may explain the high lev els associated with diabetes, whereas the age association might accoun t not only for the differences observed between group NDHL and the you nger control group but also for the higher levels in the postmenopausa l women. PAT-1 levels correlated with tPA and triglyceride (TG) levels in the groups of subjects (normo- and hyperlipidaemic). In the normol ipidaemic control group, the significant associations of tPA and PAI-1 were with body mass, expressed as the body mass index or the waist-hi p ratio. These results suggest that different factors influence the pl asma levels of the prothrombotic factors Lp(a), tPA and PAI-1 in healt hy control subjects and in patients with hyperlipidaemia. In the latte r, hyperlipidaemia phenotype, age, glycaemic status and uric acid leve ls are important determinants of the levels of these prothrombotic var iables, whereas in the healthy, young control population, body mass wa s the single important association with tPA and PAI-1.