Lp(a) and conventional risk profiles predict the severity of coronary stenosis in high-risk hospital-based patients

Aims: To explore predictive power of Lp(a), of conventional lipoprotein pro files and their carrier proteins, and of biometric measurements, for the pr esence and severity of angiographically documented coronary disease in high -risk patients, and to compare risk profiles in men and women. Methods: We determined coronary artery disease (CAD) risk factors in 1308 A ustralian Caucasian patients (313 women and 995 men) aged less than or equa l to 65 years who consecutively underwent coronary angiography. Results: In univariate analyses of the risk factors, lipid profiles, Lp(a), cigarette smoking, diabetes, hypertension and obesity were all higher in m en and women with CAD and changed significantly with the number of signific antly diseased vessels (greater than or equal to 50% luminal obstruction). When stepwise logistic regression analysis was applied, age (OR 1.06, 95% C I: 1.04-1.09), TC/HDL-C (OR 1.29, 95% CI: 1.15-1.45), male gender (OR 2.64, 95% CI: 1.67-4.16), hyperLp(a) (greater than or equal to 300 mg/L) (OR 2.0 9, 95% CI: 1.42-3.07), lifetime smoking dose (OR 1.02, 95% CI: 1.01-1.03), diabetes (OR 2.19, 95% CI: 1.14-4.18) and waist/hip ratio (OR 14.53, 95% CI : 1.21-174.90) were predictive of the disease. Both Lp(a) levers and percen tage of hyperLp(a) increased linearly with the number of significantly dise ased vessels. When the analyses were conducted in men and women separately, hyperLp(a), TC/HDL-C, lifetime smoking dose and age remained as significan t predictors in both groups but the waist/hip ratio was only predictive in women. Conclusions: As Lp(a) is an independent predictor of the occurrence and ext ent of coronary stenosis and relevant to treatment options, we suggest that it should be measured routinely in the coronary risk profile assessment of high-risk patients.