Annals of Vascular Surgery

, Volume 7, Issue 5, pp 446–451 | Cite as

Lipoprotein (a): A risk factor for peripheral vascular disease

  • Mark D. Widmann
  • Bauer E. Sumpio
Original Articles
  • 3 Downloads

Abstract

Lipoprotein (a) [Lp(a)] is a serum protein that has been reported to be predictive of complications from coronary and cerebrovascular atherosclerotic disease. This study was designed to compare plasma levels of Lp(a) in 100 white male patients with and without peripheral vascular disease (PVD) and to determine the role of Lp(a) as a risk factor for PVD independent of known risk factors such as cigarette smoking (CIG), diabetes mellitus (DM), and coronary artery disease (CAD). Patients with PVD (mean age =67.6 years, n=50) had a statistically significant (p=0.04) elevation of Lp(a) (29.8±3.9 mg/dl) as compared to patients without PVD (20.0±2.9 mg/dl (mean age =68.3 years, n=50). Further analysis revealed that patients with PVD had a significantly higher incidence of CIG (86% vs. 68%,p=0.03), DM (34% vs. 14%,p=0.02), and CAD (52% vs. 30%,p=0.02) than those without PVD. However, there was no statistically significant difference in Lp(a) levels in patients with CIG or CAD compared to those without. Patients with DM had significantly (p=0.04) lower levels of Lp(a) (17.8±3.5 mg/dl) than those without DM (27.1±3.0 mg/dl). Stepwise regression analysis of these various risk factors for PVD revealed that Lp(a) was the strongest significant individual predictor for the presence of PVD (R2=0.07) as compared to DM (R2=0.05) and CIG (R2=0.04). We conclude that there is a significant correlation of Lp(a) levels and the incidence of PVD, which is independent of other major risk factors for PVD.

Keywords

Public Health Diabetes Mellitus Coronary Artery Disease Regression Analysis Plasma Level 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Berg K. A new serum type system in man — the Lp system. Acta Pathol Microbiol Scand 1963;59:369–382.PubMedGoogle Scholar
  2. 2.
    Scanu AM. Lipoprotein (a): A potential-bridge between the fields of atherosclerosis and thrombosis. Arch Pathol Lab Med 1988;112:1045–1047.PubMedGoogle Scholar
  3. 3.
    Albers JJ, Cabana VG, Warnick GR, et al. Lp(a) lipoprotein: Relationship to sinking pre-β1-lipoprotein, hyperlipoproteinemia and apo-lipoprotein B. Metabolism 1975;24:1047–1054.PubMedGoogle Scholar
  4. 4.
    Dahlen GH. Lipoprotein (a) in relation to atherosclerotic diseases. In Naito HK, Widhalm K, eds. Recent Aspects of Diagnosis and Treatment of Lipoprotein Disorders: Impact on Prevention of Atherosclerotic Diseases. New York: Alan R. Liss, 1988, pp 27–36.Google Scholar
  5. 5.
    Utermann G, Menzel HJ, Kraft HG, et al. Lp(a) glycoprotein phenotypes: Inheritance and relation to Lp(a)-lipoprotein concentrations in plasma. J Clin Invest 1987;80:458–465.PubMedGoogle Scholar
  6. 6.
    Carlson LA, Hamsten A, Asplund A. Pronounced lowering of serum levels of lipoprotein Lp(a) in hyperlipidemic subjects treated with nicotinic acid. J Intern Med 1989;226:271–276.PubMedGoogle Scholar
  7. 7.
    Thompson PD, Cullinane EM, Sady SP, et al. Contrasting effects of testosterone and stanozolol on serum lipoprotein levels. JAMA 1989;261:1165–1168.PubMedGoogle Scholar
  8. 8.
    Maede S, Abe A, Seishima M, et al. Transient changes of serum lipoprotein(a) as an acute phase protein. Atherosclerosis 1989;78:145–150.PubMedGoogle Scholar
  9. 9.
    Dahlen G, Ericson C. A new lipoprotein pattern in patients with angina pectoris. Scand J Clin Lab Invest 1971;118(Suppl):54.Google Scholar
  10. 10.
    Armstrong VW, Cremer P, Eberle E, et al. The association between serum Lp(a) concentrations and angiographically assessed coronary atherosclerosis. Atherosclerosis 1986;62:249–257.PubMedGoogle Scholar
  11. 11.
    Dahlen GH, Guyton JR, Attar M, et al. Association of levels of lipoprotein Lp(a), plasma lipids, and other lipoproteins with coronary artery disease documented by angiography. Circulation 1986;74:758–765.PubMedGoogle Scholar
  12. 12.
    Kostner GM, Avogaro P, Cassolato G, et al. Lipoprotein Lp(a) and the risk for myocardial infarction. Atherosclerosis 1981;38:51–61.PubMedGoogle Scholar
  13. 13.
    Koltringer P, Jurgens B. A dominant role of lipoprotein(a) in the investigation and evaluation of parameters indicating the development of cervical atherosclerosis. Atherosclerosis 1985;58:187–198.PubMedGoogle Scholar
  14. 14.
    Murai A, Miyahara T, Fujimoto N, et al. Lp(a) lipoprotein as a risk factor for coronary heart disease and cerebral infarction. Atherosclerosis 1986;59:199–204.PubMedGoogle Scholar
  15. 15.
    Guyton JR, Dahlen GH, Patsch W, et al. Relationship of plasma Lp(a) levels to race and to apolipoprotein B. Arteriosclerosis 1985;5:265–272.PubMedGoogle Scholar
  16. 16.
    Dahlen G, Frick MH, Berg K, et al. Further studies of Lp(a) lipoprotein/pre-β1-lipoprotein in patients with coronary heart disease. Clin Genet 1975;8:183–189.PubMedGoogle Scholar
  17. 17.
    Dahlen G, Garsten P, Erikson H, et al. Insulin response to an oral glucose load in relation to Lp(a)/pre-β1-lipoprotein levels in non-diabetic patients with peripheral vascular disease and in controls. Acta Chir Scand 1979;145:447–454.PubMedGoogle Scholar
  18. 18.
    Rhoads GG, Dahlen G, Berg K, et al. Lp(a) lipoprotein as a risk factor for myocardial infarction. JAMA 1986;256:2540–2544.PubMedGoogle Scholar
  19. 19.
    Fuchs JCA. Atherogenesis and the medical management of atherosclerosis. In Rutherford RB, ed. Vascular Surgery, 3rd ed. Philadelphia: WB Saunders, 1989, pp 194–206.Google Scholar
  20. 20.
    Molgaard J, Klausen C, Lassvik C, et al. Significant association between low-molecular-weight apolipoprotein (a) isoforms and intermittent claudication. Arteriosclerosis Thromb 1992;12:895–901.Google Scholar
  21. 21.
    Mertz DP, Burvenich K. Unterschiedliche werte von lipoprotein Lp(a) bei erwachsenen diabetikern in abhangigkeit von der therapieform. Klin Wochenschr 1985;63:648–650.PubMedGoogle Scholar
  22. 22.
    Bruckert E, Davidoff P, Grimaldi A, et al. Increased serum levels of lipoprotein(a) in diabetes mellitus and their reduction with glycemic control. JAMA 1990;263:35–36.Google Scholar
  23. 23.
    Joven J, Vilella E. Serum levels of lipoprotein(a) in patients with well-controlled non-insulin-dependent diabetes mellitus. JAMA 1991;265:1113–1114.PubMedGoogle Scholar
  24. 24.
    Rath M, Niendorf A, Reblin T, et al. Detection and quantification of lipoprotein(a) in the arterial wall of 107 coronary bypass patients. Arteriosclerosis 1989;9:579–592.PubMedGoogle Scholar
  25. 25.
    Walton KW, Hitchens J, Magnani HN, et al. A study of methods of identification and estimation of Lp(a) lipoprotein and of its significance in health, hyperlipidemia and atherosclerosis. Atherosclerosis 1974;20:323–346.PubMedGoogle Scholar
  26. 26.
    Cushing GL, Gaubatz JW, Nava ML, et al. Quantitation and localization of apolipoproteins [a] and B in coronary artery bypass grafts resected at reoperation. Arteriosclerosis 1989;9:593–603.PubMedGoogle Scholar
  27. 27.
    Houlson R, Friedl W. Biochemistry and clinical significance of lipoprotein(a). Ann Clin Biochem 1988;25:499–503.PubMedGoogle Scholar
  28. 28.
    Utermann G. The mysteries of lipoprotein(a). Science 1989;246:904–910.PubMedGoogle Scholar
  29. 29.
    Karadi I, Kostner GM, Gries A, et al. Lipoprotein (a) and plasminogen are immunochemically related. Biochem Biophys Acta 1988;960:91–97.PubMedGoogle Scholar
  30. 30.
    Edelberg JM, Gonzalez-Gronow M, Pizzo SV. Lipoprotein(a) inhibition of plasminogen activation by tissue-type plasminogen activator. Thromb Res 1990;57:155–162.PubMedGoogle Scholar
  31. 31.
    Hajjar KA, Gavish D, Breslow JL, et al. Lipoprotein(a) modulation of endothelial cell surface fibrinolysis and its potential role in atherosclerosis. Nature 1989;339:303–305.PubMedGoogle Scholar
  32. 32.
    Miles LA, Fless GM, Levin EG, et al. A potential basis for the thrombotic risks associated with lipoprotein(a). Nature 1989;339:301–303.PubMedGoogle Scholar

Copyright information

© Annals of Vascular Surgery Inc. 1993

Authors and Affiliations

  • Mark D. Widmann
    • 1
  • Bauer E. Sumpio
    • 1
  1. 1.Division of Vascular Surgery, Department of SurgeryYale University School of MedicineNew Haven

Personalised recommendations