F. Kronenberg et al., Role of lipoprotein(a) and apolipoprotein(a) phenotype in atherogenesis - Prospective results from the Bruneck study, CIRCULATION, 100(11), 1999, pp. 1154-1160
Citations number
42
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-Experimental studies have suggested both atherogenic and thrombo
genic properties of lipoprotein(a) [Lp(a)], depending on Lp(a) plasma conce
ntrations and varying antifibrinolytic capacity of apolipoprotein(a) [apo(a
)] isoforms. Epidemiological studies may contribute to assessment of the re
levance of these findings in the general population.
Methods and Results-This study prospectively investigated the association b
etween Lp(a) plasma concentrations, apo(a) phenotypes, and the 5-year progr
ession of carotid atherosclerosis assessed by high-resolution duplex ultras
ound in a random sample population of 826 individuals. We differentiated ea
rly atherogenesis (incident nonstenotic atherosclerosis) from advanced (ste
notic) stages in atherosclerosis that originate mainly from atherothromboti
c mechanisms. Lp(a) plasma concentrations predicted the risk of early ather
ogenesis in a dose-dependent fashion, with this association being confined
to subjects with LDL cholesterol levels above the population median (3.3 mm
ol/L). po(a) phenotypes were distributed similarly in subjects with and wit
hout early carotid atherosclerosis. In contrast, apo(a) phenotypes of low m
olecular weight emerged as one of the strongest risk predictors of advanced
stenotic atherosclerosis, especially when associated with high Lp(a) plasm
a concentrations (odds ratio, 6.4; 95% CI, 2.8 to 14.9)
Conclusions-Lp(a) is one of the few risk factors capable of promoting both
early and advanced stages of atherogenesis, Lp(a) plasma concentrations pre
dicted the risk of early atherogenesis synergistically with high LDL choles
terol. Low-molecular-weight apo(a) phenotypes with a putatively high antifi
brinolytic capacity in turn emerged as one of the leading risk conditions o
f advanced stenotic stages of atherosclerosis.