Elevated Plasm Lipoprotein(a) Is Associated With Coronary Artery Disease in Patients With Chronic Stable Angin Pectoris

Objectives. We sought to assess the relation between plasm lipoprotein(a) [Lp(a)] levels, clinical variables and angiographic coronary artery disease (CAD) in patients with chronic stable angina. Background. The relation between plasm Lp(a) levels and the severity and extent of angiographic CAD has not been studied in well characterized patients with stable angin pectoris. Methods. We investigated clinical variables, lipid variables and angiographic scores in 129 consecutive white patients (43 women) undergoing coronary angiography for chronic stable angina. Results. Plasm Lp(a) levels were significantly higher in patients with than in those without significant angiographic stenoses (≥70%) (372 mg/liter [interquartile range 87 to 884] vs. 105 mg/liter [interquartile range 56 to 366], respectively, p = 0.002). This difference remained significant when patients with mild or severe angiographic disease were compared with those with completely normal coronary arteries (312 mg/liter [interquartile range 64 to 864] vs. 116 mg/liter [interquartile range 63 to 366], respectively, p = 0.02). However, subset analysis indicated that this difference achieved statistical significance only in women. Multiple logistic regression analysis indicated that Lp(a) concentration was independently predictive of significant angiographic stenoses (adjusted odds ratio [OR] 9.1, 95% confidence interval [CI] 2.0 to 42.1, p = 0.006) and remained true even after exclusion of patients receiving lipid-lowering treatment (n = 27) (OR 10.4, 95% CI 1.1 to 102.9, p = 0.05). Lp(a) also had independent predictive value in similar analysis using mild or severe angiographic disease as the outcome variable (OR 11.8, 95% CI 1.5 to 90.8, p = 0.02). Conclusions. Our results indicate that elevated plasm Lp(a) is an independent risk factor for angiographic CAD in chronic stable angin and may have particular significance in women.