LIPOPROTEIN (A) AND ITS RELATIONSHIP TO RISK-FACTORS AND SEVERITY OF ATHEROSCLEROTIC PERIPHERAL VASCULAR-DISEASE

Objectives: To determine the significance of Lipoprotein (a) (Lp(a)) a s a risk factor for atherosclerotic lower limb peripheral vascular dis ease (PVD), and its relationship to other demographic and biochemical variables and disease pattern and severity. Design: Prospective case-c ontrol study. Material and methods: Demographic and biochemical risk f actors, lipoprotein fractions and Lp(a) were measured in 200 patients and PVD and 200 age- and sex-matched control subjects. Lp(a) levels we re correlated with traditional risk factors and clinical and vascular laboratory disease parameters. Results: Patients with PVD have a highe r incidence of smoking, hypertension, and diabetes mellitus; and had s ignificantly higher levels of serum cholesterol, triglycerides, LDL, V LDL, apolipoprotein B, fasting glucose, fibrinogen, plasminogen, haema tocrit, white cell and platelet counts; but lower levels of HDL and ap olipoprotein A1. Fasting Lp(a) concentration is an independent risk fa ctor for PVD and is significantly higher in the patients (median=26.1 mg/dl [4.8-195], mean=36.5+/-32.6 mg/dl) than in controls (median=18.2 mg/dl [5.4-216], mean=27.2+/-28.1 mg/dl; p<0.0001). In patients with PVD, Lp(a) correlated positively with plasma LDL, cholesterol, fibrino gen, renal disease, and apolipoprotein B. Fasting levels of >24 mg/dl incurred a two-fold increase in risk of PVD. Patients with a higher Lp (a) have a significantly higher incidence of resting pain and ulcerati ons, and regression analysis confirmed smoking and Lp(a) level to be a ssociated with the SVS category of disease severity. Conclusions: Lipo protein (a) is a significant independent risk factor for PVD. Lp(a) le vels correlated with LDL, cholesterol, fibrinogen, apolipoprotein B an d disease severity. An elevated Lp(a) level may be associated with mor e severe forms of PVD.